Free vascularized metacarpal bone graft combined with extended dorsal metacarpal artery flap for phalangeal bone and soft tissue loss: case report.

A 45-year-old man suffered from a complex bone and soft tissue defect of the middle phalanx of his left middle finger after an electric saw injury. Here, we present the patient's clinical and radiological outcomes after reconstruction with a free vascularized metacarpal II bone graft and an extended distally based second dorsal metacarpal artery skin flap (DMCA). To our knowledge, this is the first description of a free vascularized metacarpal bone graft combined with DMCA for distal finger reconstruction.

Saalabian AA, Unglaub F, Horch RE, Kneser U. Arch Orthop Trauma Surg. 2011 Aug 21. [Epub ahead of print] PMID: 21858662

Hip Implant Complaints Surge, Even as the Dangers Are Studied

The federal government has received a surge in complaints in recent months about failed hip replacements, suggesting that serious problems persist with some types of artificial hips even as researchers scramble to evaluate the health dangers.  An analysis of federal data by The New York Times indicates that the Food and Drug Administration has received more than 5,000 reports since January about several widely used devices known as metal-on-metal hips, more than the agency had received about those devices in the previous four years combined. NYT

Suture anchor versus screw fixation for greater tuberosity fractures of the humerus—a biomechanical study

Suture anchors and screws are commonly used for fixation of humeral greater tuberosity (GT) fractures in either arthroscopic or open surgeries, but no biomechanical studies have been performed to compare the strength of fixation constructs using these two implants. This cadaveric study aimed to compare the biomechanical strength of three different fixation constructs in the management of GT fractures: Double-Row Suture Anchor Fixation (DR); Suture-Bridge Technique using suture anchors and knotless suture anchors (SB); and Two-Screw Fixation (TS). Lin CL, Hong CK, Jou IM, Lin CJ, Su FC, Su WR.

J Orthop Res. 2011 Aug 19. doi: 10.1002/jor.21530. [Epub ahead of print] PMID: 21858857 PDF

Emergent Management of Trauma is a decent but expensive trauma handbook for the iPhone and iPad

Price

• $59.99

Likes

• Detailed yet concise summaries of a wide range of trauma injuries
• Clinical algorithms to assist in decision making
• Biography

Dislikes

• Expensive for a relatively niche area of medicine

Overall Rating

• Emergent Management of Trauma is a fine introduction to the trauma environment and this app ensures that this is accessible to all levels of healthcare professional; from student to nurse to attending. iMedicalApps

A 40-month multicentre, randomised placebo-controlled study to assess the efficacy and carry-over effect of repeated intra-articular injections of hyaluronic acid in knee osteoarthritis: the AMELIA project.

The results of AMELIA offer pioneer evidence that repeated cycles of intra-articular injections of HA not only improve knee osteoarthritis symptoms during the in-between cycle period but also exert a marked carry-over effect for at least 1 year after the last cycle. In this respect, it is not possible to establish if this carry-over effect reflects true osteoarthritis remission or just a modification of the disease's natural course. ClinicalTrials.gov number, NCT00669032. Navarro-Sarabia F, Coronel P, Collantes E, Navarro FJ, Rodriguez de la Serna A, Naranjo A, Gimeno M, Herrero-Beaumont G; on behalf of the AMELIA study group. Ann Rheum Dis. 2011 Aug 17. [Epub ahead of print] PMID: 21852252   PDF

Wounded Warriors Move Into New Barracks at Bethesda

BETHESDA, Md. (NNS) -- Wounded warriors began moving into new specialized barracks on board Naval Support Activity, Bethesda (NSAB) Aug. 20 following the official opening of the Tranquility Hall barracks.

The barracks will service outpatient military members from both the Walter Reed Army Medical Center and National Naval Medical Center (NNMC).

The new 306-bed facility features 153 two-bedroom, two-bath suites equipped with common kitchens and seating areas, washer and dryer units, flat screen televisions  Navy.mil

Arthroscopy: The Journal of Arthroscopic & Related Surgery [articles in press]

Evaluation of Intra-Articular Mesenchymal Stem Cells to Augment Healing of Microfractured Chondral Defects

The Effect of Platelet Concentrates on Graft Maturation and Graft-Bone Interface Healing in Anterior Cruciate Ligament Reconstruction in Human Patients: A Systematic Review of Controlled Trials

The much anticipated UpToDate iPhone app is finally here

Likes:

• Nothing matches UpToDate when it comes to updated medical references
• Comprehensive, peer-reviewed, reference-oriented, illustrated, and pharm-free
• Smooth user interface with easy dynamic searching and impressive navigation

Dislikes:

• Pricing: UpToDate will cost you, as noted above, for its considerable resources
• While eagerly awaited by many residents and medical students, institutional subscribers do NOT yet have access to the iPhone App version
• While the offline version of the UpToDate App is set to debut later this year, this current version can sometimes take several moments to load topics

Gamification

Gamification of healthcare gets its due recognition from academic elite Proponents of the gamification of healthcare have had a summer filled with accomplishments to support the their cause, particularly in recent weeks as a couple leading academic institutions have made it abundantly clear they believe the gamification trend is more than just a passing fad. iMedicalApps

New Journal for Review of Science of Gaming in Healthcare  A new peer-reviewed journal, Games for Health from Mary Ann Leibert publishers, has just been unveiled. The journal will focus on the topic of games and how they can impact healthcare.

More from the publishers: Games are rapidly becoming an important tool for improving health behaviors ranging from healthy lifestyle habits and behavior modification to self-management of illness and chronic conditions to motivating and supporting physical activity. Games are also increasingly used to train health care professionals in methods for diagnosis, medical procedures, patient monitoring, as well as for responding to epidemics and natural disasters. G4H is a must for anyone interested in the research and design of health games that integrate well-tested, evidence-based behavioral health strategies to help improve health behaviors and to support the delivery of care. MedGadget

Posterior Tibial Tendon Tear After 4-Cortex Syndesmotic Screw Fixation: A Case Report and Literature Review

We describe a previously unreported problem of a patient who underwent errant 4-cortex syndesmotic screw fixation with resultant posterior tibial tendon tear necessitating removal of hardware and repair of a tendon tear. Kwon JY, Campbell JT, Myerson MS. J Orthop Trauma. 2011 Aug 12. [Epub ahead of print] PMID: 21849910

A Comparison of 2 Methods for Scaphoid Central Screw Placement From a Volar Approach

Our data suggest that a volar transtrapezial approach can be an alternative for optimum central placement in volar percutaneous fixation of scaphoid fractures. Meermans G, Verstreken F. J Hand Surg Am. 2011 Aug 15. [Epub ahead of print] PMID: 21849237

US and Vietnamese medics join forces to heal old wounds

Vietnam and the United States have signed their first military-to-military co-operation agreement since the end of the Vietnam War and the normalisation of diplomatic relations.

The statement of intent (SOI) between the US Department of Defense (DoD) and the Vietnamese Ministry of National Defence outlines how the countries will interact in matters of military medicine, according to the US Navy (USN) Bureau of Medicine and Surgery. Janes

Treatment for distal tibial fractures with intramedullary nails and blocking screws

Blocking screws helped to achieve better reduction and alignment with intramedullary nailing of distal tibial fractures by decreasing the effective diameter of the medullary canal. The use of blocking screws enabled to use the intramedullary nailing as an alternative while treating distal tibial fractures.  Seyhan M, Kocaoglu B, Gereli AU  A, Nalbantoglu U, Turkmen M. [Epub Ahead of Print] Springer

One resident's experience designing and running a randomized control trial in orthopedic surgery.

All ACGME-accredited orthopedic residency programs require residents to participate in research during their training. The levels of evidence adopted for clinical research validate the randomized clinical trial (RCT) as the gold (Level 1) standard. While many residents aspire to conduct or be involved in an RCT during their orthopedic training, I would like to describe my experience as an orthopedic surgery resident designing and running an RCT. O'Donnell PW. J Surg Educ. 2011 May-Jun;68(3):250-3. Epub 2011 Jan 15. PMID: 21481812   PDF

Military Malpractice System Needs Overhaul

Reform of the existing administrative approach to malpractice offers the best hope to improve the military's response to medical injury compensation for veterans, health policy specialists suggested.
For more than 60 years, prevailing doctrine has maintained a "seemingly indefensible inequity between civilians and active-duty service members injured as a result of malpractice." However, eliminating the doctrine would simply "replace one injustice with another," according to an article in the August 18 issue of the New England Journal of Medicine. (PDF) via Medpage Today

Closed Reduction and Early Mobilization in Fractures of the Humeral Capitellum.

Seven consecutive patients with an isolated fracture of the humeral capitellum were treated by a single surgeon at a Level II care facility according to a simple treatment algorithm. Closed reduction was attempted in all cases using a standard technique. After reduction, the arm was splinted at 90° of flexion and mobilized at 14 days. All patients completed a clinical and radiographic follow-up consisting of a radiographic evaluation of reduction, elbow range of motion, Disabilities of the Arm, Shoulder and Hand Questionnaire, and a subjective rating of patient satisfaction. None of the patients required conversion to open reduction internal fixation or excision. Disabilities of the Arm, Shoulder and Hand Questionnaire scores ranged from 6 to 13 points (out of 100; mean, 9). The mean flexion/extension arc of motion obtained was 126° with minimal loss of rotation. Patient satisfaction was rated as excellent in five patients and good in two. All fractures appeared united at the most recent clinical and radiographic review. Closed reduction and early mobilization appears to be a safe and effective method of treating displaced fractures of the humeral capitellum with clinical results comparable to that of open reduction internal fixation. Puloski S, Kemp K, Sheps D, Hildebrand K, Donaghy J. J Orthop Trauma. 2011 Jul 28. [Epub ahead of print] PMID: 21804417  PDF

Towards an assessment of bone fracture healing using pulsed mode ultrasound.

Healing rate of fractured bone differs from one patient to another which may lead to incorrect consequent medical procedures. Thus, quantitative assessment of bone healing after fracture becomes important. In this paper, we present a mathematical model which describes the interaction of a pulsed mode ultrasound waves with a multilayered biological structure. The model is applied to estimate the bone callus thickness and degree of hardness. Different frequencies are utilized to obtain highest measurement sensitivity and accuracy of callus thickness and degree of hardness. It is found that a transducer operating at 1 MHz has the highest sensitivity to the different phases of callus hardening. On the other hand, a 3 MHz transducer yields the highest sensitivity to the thickness of the callus layer. Thus, using both frequencies might prove to be useful for full quantitative assessment of the bone healing process. Qaddoumi N, Al-Nashash H, Sediq AB, Al-Shamsi H, Al-Mehrizi M, Khalaf K. Technol Health Care. 2011 Jan 1;19(4):261-9. PMID: 21849736

Posterior Tibial Tendon Tear After 4-Cortex Syndesmotic Screw Fixation: A Case Report and Literature Review.

We describe a previously unreported problem of a patient who underwent errant 4-cortex syndesmotic screw fixation with resultant posterior tibial tendon tear necessitating removal of hardware and repair of a tendon tear. Kwon JY, Campbell JT, Myerson MS. J Orthop Trauma. 2011 Aug 12. [Epub ahead of print] PMID: 21849910

High-resolution magic angle spinning NMR spectroscopy of human osteoarthritic cartilage.

This indicates that N-acetyl can serve as an important bio-marker of OA disease progression. A decrease in the alanine concentration in OA may be attributed to the degradation of the collagen framework with disease progression and eventual loss of the degradation products that are transported from cartilage into the synovial cavity.  Shet K, Siddiqui SM, Yoshihara H, Kurhanewicz J, Ries M, Li X. NMR Biomed. 2011 Aug 18. doi: 10.1002/nbm.1769. [Epub ahead of print] PMID: 21850648

New 'bionic' leg gives amputees a natural gait

A new lower-limb prosthetic developed at Vanderbilt University allows amputees to walk without the leg-dragging gait characteristic of conventional artificial legs.

The device uses the latest advances in computer, sensor, electric motor and battery technology to give it bionic capabilities: It is the first prosthetic with powered knee and ankle joints that operate in unison. It comes equipped with sensors that monitor its user's motion. It has microprocessors programmed to use this data to predict what the person is trying to do and operate the device in ways that facilitate these movements. Eurekalert!

Fujifilm releases radiology viewing app, allows physicians and radiologists to view medical images on the go

Fujifilm Synapase Mobility is now available in the U.S., and not just on the iPhone, but for the Android and iPad as well.  Fujifilm makes a variety of medical images devices, from ultrasound devices to computed radiology devices (x-rays).

If you use their backend server (Synapse PACS and Synapse RIS), you can now view your images on your mobile devices. Whats really interesting about their mobile suite is that it’s browser independent, scalable, and doesn’t just display static images.
Currently the system isn’t FDA approved, but with the amount of business Fujifilm already has in the medical ecosystem, one would think this would happen sooner than later.

It provides advanced viewing capabilities for physicians to view 3D images as well as to be able to zoom, window and level, and use MIP/MPR just as they would do at a clinical workstation. Synapse® Mobility is for non-diagnostic use only. iMedicalApps

The microbiological basis for a revised antibiotic regimen in high-energy tibial fractures: Preventing deep infections by nosocomial organisms

Following high-energy open fracture, a single prophylactic antibiotic regimen directed against environmental wound contaminants does not provide cover for the organisms responsible for deepest SSI's and may have depopulated the niche, promoting nosocomial contamination prior to definitive closure. We advocate a dynamic prophylactic strategy, tailoring a second wave of prophylaxis against nosocomial organisms at the time of definitive wound closure, and at the same time avoiding the potential complications of prolonged antibiotic use. Glass GE, Barrett SP, Sanderson F, Pearse MF, Nanchahal J. J Plast Reconstr Aesthet Surg. 2011 Mar;64(3):375-80. Epub 2010 Jun 29. PMID: 20591757 PDF

Link to articles that have cited above article since publication

Injury: Articles in Press

Pretraining and posttraining assessment of residents' performance in the fourth accreditation council for graduate medical education competency: patient communication skills.

Patient communication skills need to be taught as part of residency training. With limited training, case-specific skills (herein, involving patients with cancer) are likely to improve more than general communication skills. Chandawarkar RY, Ruscher KA, Krajewski A, Garg M, Pfeiffer C, Singh R, Longo WE, Kozol RA, Lesnikoski B, Nadkarni P. Arch Surg. 2011 Aug;146(8):916-21. PMID: 21844435  PDF

Is Dynamic Gadolinium Enhancement Needed in MR Imaging for the Preoperative Assessment of Scaphoidal Viability in Patients with Scaphoid Nonunion? [Musculoskeletal Imaging]

Because the diagnostic performance of dynamic gadolinium-enhanced MR imaging in the evaluation of scaphoid viability was inferior to that of a standard MR imaging protocol, dynamic acquisition may not be needed in patients with nonunion of scaphoid fractures. Donati OF, Zanetti M, Nagy L, Bode B, Schweizer A, Pfirrmann CW. Radiology. 2011 Jun 28. [Epub ahead of print] PMID: 21712471  PDF

[Reality of provision of care in Germany in the fields of orthopedics and casualty surgery.]

Ewerbeck V. Orthopade. 2011 Aug 17. [Epub ahead of print] German. No abstract available. PMID: 21845478 PDF

Note: Article is in Gernman but is open access. However, the article can be saved as PDF then translated at home (this feature of Google Translate is blocked by the DoD) using this link:

Translate document German to English:

Role Playing Boosts Surgical Residents' Bedside Manner

A quick course in communication skills may improve surgical residents' interactions with some patients, researchers said.

Although it didn't significantly improve general communication skills, a two-hour program involving lectures and role playing resulted in significantly better scores on a case-specific content checklist (P=0.005), Rajiv Chandawarkar, MD, of the University of Connecticut Health Center in Farmington, Conn., and colleagues reported in the August issue of the Archives of Surgery.  MedPage Today

DVT Risk Low After General Surgery (CME/CE)

Deep vein thrombosis (DVT) occurs infrequently following general surgery, but when it does, it often involves a central venous catheter, a review of a large clinical series showed.
DVT occurred in fewer than 2% of 2,189 operations, and catheter-associated clotting caused 60% of the episodes. Medpage Today

Treatment for distal tibial fractures with intramedullary nails and blocking screws

Blocking screws helped to achieve better reduction and alignment with intramedullary nailing of distal tibial fractures by decreasing the effective diameter of the medullary canal. The use of blocking screws enabled to use the intramedullary nailing as an alternative while treating distal tibial fractures.  SpringerLink             

Disability system leaves troops in 'vast unknown'

The government determines the pay and benefits given to wounded, sick or injured troops for their military service. Under the old system, a medical board would determine their level of military compensation and the service member would be discharged. Then the veteran essentially would have to go through the process again with the Veterans Affairs Department to determine benefits. While they waited for their VA claim to be processed, many of the war wounded were going broke.

Under the new system, which started in 2007 and will be completely rolled out at military bases nationwide by the end of September, the service member essentially goes through both disability evaluation systems at the same time before leaving the military. AP

New compound may accelerate bone healing, prevent osteoporosis

Hiroki Yokota, professor of biomedical engineering at Indiana University-Purdue University Indianapolis (IUPUI) and adjunct professor of anatomy and cell biology at the IU School of Medicine, will investigate the effect of salubrinal -- a chemical compound originally developed to encourage insulin production in individuals with diabetes -- on human bone strength and growth. Early laboratory research supported by the Indiana Clinical and Translational Sciences Institute (CTSI) suggests weakened bones treated with salubrinal experience a statistically significant increase in strength, as well as accelerated healing in bones that have been fractured. PhysOrg.com

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

15. The virtual isocentric aiming device: a new mechanical targeting concept. Mendel T, Hänni M, Gueorguiev B, Wohlrab D, Hofmann GO. Arch Orthop Trauma Surg. 2011 Aug 13. [Epub ahead of print] PMID: 21842286

16. Interdisciplinary inter-observer agreement and accuracy of MR imaging of the shoulder with arthroscopic correlation. Halma JJ, Eshuis R, Krebbers YM, Weits T, de Gast A. Arch Orthop Trauma Surg. 2011 Aug 13. [Epub ahead of print] PMID: 21842285 PDF

17. Surgical treatment of proximal ruptures of the rectus femoris in professional soccer players.

García VV, Duhrkop DC, Seijas R, Ares O, Cugat R. Arch Orthop Trauma Surg. 2011 Aug 13. [Epub ahead of print] PMID: 21842284

18. Transtendon arthroscopic repair of high grade partial-thickness articular surface tears of the rotator cuff with biceps tendon augmentation: technical note and preliminary results. Ji JH, Shafi M, Jeong JJ, Lee YS, McFarland EG, Kim TK, Chung JY. Arch Orthop Trauma Surg. 2011 Aug 13. [Epub ahead of print] PMID: 21842283

Ultrasound-Guided Injection Techniques for the Low Back and Hip Joint.

This article will review the selected ultrasound-guided injection techniques that are performed in the low-back and hip-joint areas. Sonographic images and schematic illustrations of these ultrasound-guided injection techniques will be shown. Chen CP, Lew HL, Tsai WC, Hung YT, Hsu CC. Am J Phys Med Rehabil. 2011 Aug 12. [Epub ahead of print] PMID: 21844793

Diagnosing ulnar neuropathy at the elbow using magnetic resonance neurography.

Ulnar nerve size and signal intensity were greater in patients with ulnar neuropathy. MRN is a useful test in evaluating ulnar neuropathy at the elbow. Keen NN, Chin CT, Engstrom JW, Saloner D, Steinbach LS. Skeletal Radiol. 2011 Aug 16. [Epub ahead of print] PMID: 21845447

New Orthopedic Device Helps Wounded Warriors Run

FORT SAM HOUSTON, Texas -- A new energy-storing orthopedic device, along with an extensive rehabilitation program, is allowing wounded warriors who previously had difficulties walking or standing due to lower leg injuries to run again.

The Intrepid Dynamic Exoskeletal Orthosis, or IDEO, was designed by prosthetist Ryan Blanck at the Center for the Intrepid. It is a custom-fit device made from carbon and fiberglass that supports the foot and ankle and resembles an amputee’s running prosthetic. Military.com

The prevalence and effect of publication bias in orthopaedic meta-analyses.

Meta-analyses of randomized, controlled trials are considered the highest level-of-evidence, thus strongest source of information. However, questions concerning the validity of meta-analyses in orthopaedic surgery emerged recently. Among the most common sources for errors is publication bias. This describes the fact that studies with small or non-significant outcomes are less likely to be published, thus less likely to be identified and included in systematic reviews and meta-analyses. In this study we asked three questions: (1) Whether publication bias is assessed in orthopaedic meta-analyses, (2) What the actual prevalence of publication bias is, and (3) what effect publication bias has on the outcomes of orthopaedic meta-analyses.  Vavken P, Dorotka R. J Orthop Sci. 2011 Mar;16(2):238-44. Epub 2011 Mar 2. PMID: 21360256

Orthopedic surgery in the United States Army: a historical review.

The contribution of American military surgeons to the development of orthopedic surgery has not previously been explored. The experiences of American military surgeons in conflicts from the Civil War to Iraq and Afghanistan have advanced the orthopedic discipline, resulting in important developments within the field, as well as scientific discoveries that have benefited both the civilian and military communities. From advances in wound care, to spinal surgery, intramedullary nailing of long bone fractures, and external fixation, American military surgeons have been pioneers of orthopedic surgery. The goal of this review was to survey the American military orthopedic experience from the American Revolution to the wars in Iraq and Afghanistan.  Schoenfeld AJ. Mil Med. 2011 Jun;176(6):689-95. PMID: 21702390 PDF

Biomechanical Comparison of Arthroscopic Repairs for Acromioclavicular Joint Instability: Suture Button Systems Without Biological Augmentation.

Isolated reconstruction of the CC ligaments using single and double clavicular tunnel techniques results in a high load to failure for superior translation, which is equal to the native stability, and less translation in all 3 directions as well as higher superior stability when compared with the modified Weaver-Dunn procedure. A potential drawback is the risk of coracoid fracture, as the high load to failure of the device may exceed load to failure of cortical bone prior to device breakage. Clinical Relevance: Single clavicular tunnel arthroscopic reconstructions of the coracoacromial ligaments show good biomechanical results. Beitzel K, Obopilwe E, Chowaniec DM, Niver GE, Nowak MD, Hanypsiak BT, Guerra JJ, Arciero RA, Mazzocca AD. Am J Sports Med. 2011 Aug 12. [Epub ahead of print] PMID: 21841067 PDF

Clinical Orthopaedics and Related Research [Epub ahead of print]

1. Antimicrobial Gauze as a Dressing Reduces Pin Site Infection: A Randomized Controlled Trial. Lee CK, Chua YP, Saw A. Clin Orthop Relat Res. 2011 Aug 13. [Epub ahead of print] PMID: 21842299 PDF

2. Surgical Technique: Does Mini-invasive Medial Collateral Ligament and Posterior Oblique Ligament Repair Restore Knee Stability in Combined Chronic Medial and ACL Injuries? Canata GL, Chiey A, Leoni T.

Clin Orthop Relat Res. 2011 Aug 13. [Epub ahead of print] PMID: 21842298 PDF

3. Rectus Femoris Distal Tendon Resection Improves Knee Motion in Patients With Spastic Diplegia. Presedo A, Megrot F, Ilharreborde B, Mazda K, Penneçot GF. Clin Orthop Relat Res. 2011 Aug 13. [Epub ahead of print] PMID: 21842297 PDF

The levels of evidence in pediatric orthopaedic journals: where are we now?

In recent years, it has become common to publish a level of evidence grading for orthopaedic journal publications. Our primary research question is: is there an improvement in levels of evidence of articles published in pediatric orthopaedic journals over time? In addition, what is the current status of levels of evidence in pediatric orthopaedic journals? Cashin MS, Kelley SP, Douziech JR, Varghese RA, Hamilton QP, Mulpuri K. J Pediatr Orthop. 2011 Sep;31(6):721-5. PMID: 21841452

The Role of Preoperative Cardiac Investigation in Emergency Hip Surgery.

Given the well-recognized imperative to treat hip fractures as expeditiously as possible, there can arise uncertainty regarding the balance between preoperative medical optimization and delay of surgery. Echocardiography is often felt to considerably delay surgery with limited change to patient management.

 Heireamhoin SO, Ahmed M, Mulhall KJ. J Trauma. 2011 Aug 11. [Epub ahead of print] PMID: 21841513

Ultrasound in the selective screening of developmental dysplasia of the hip.

Developmental dysplasia of the hip (DDH) can result in chronic pain, gait abnormalities and degenerative arthritis. Infants with a family history, Breech delivery or unstable/"clicking" of the hip on examination are at higher risk. The goal is to detect cases early enough for normal hip development and function by the end of adolescence, but clinical examination alone is ineffective. Afaq AA, Stokes S, Fareed H, Zadeh HG, Watson M. Eur Rev Med Pharmacol Sci. 2011 Apr;15(4):394-8. PMID: 21608433

MR evaluation of femoral neck version and tibial torsion.

Abnormalities of femoral neck version have been associated with a number of hip abnormalities in children, including slipped capital femoral epiphysis, proximal femoral focal deficiency, coxa vara, a deep acetabulum and, rarely, developmental dysplasia of the hip. Orthopedic surgeons also are interested in quantifying the femoral neck anteversion or retroversion in children especially to plan derotational osteotomies. Historically, the angle of femoral version and tibial torsion has been measured with the use of radiography and later by CT. Both methods carry with them the risks associated with ionizing radiation. Techniques that utilize MR are used less often because of the associated lengthy imaging times. This article describes a technique using MRI to determine femoral neck version and tibial torsion with total scan times of approximately 10 min.

Koenig JK, Pring ME, Dwek JR. Pediatr Radiol. 2011 Aug 13. [Epub ahead of print] PMID:

21842328 PDF

A Doctor’s Review of the Android HTC Flyer as a Medical Tablet

The HTC Flyer promises to be the perfect medical tablet: it supports a fine-tip stylus and is small enough at 7 inches to comfortably carry around in a white coat. The recently reviewed BlackBerry PlayBook impressed with its size (also 7 inches), but ultimately suffered from its lack of third party apps. The HTC Flyer offers the potential of the growing Android marketplace and its many medical apps, so I was thrilled to purchase one for review. One of the two tablets earned a permanent spot in my white coat. Read on to find out which one and why. iMedicalApps

Journal of Rehabilitation Research and Development (from the Veterans Administration)

JRRD, the Journal of Rehabilitation Research and Development, has been a leading research journal for more than 45 years. Formerly the Bulletin of Prosthetics Research (BPR), JRRD debuted in 1983 to include cross-disciplinary findings in rehabilitation. JRRD, a scientifically indexed journal, publishes original research papers from U.S. and international researchers on all rehabilitation research disciplines.

Search by Topics:

Amputation

Functional Outcomes

Orthopedics

Ultrasound-Guided Sclerosing Treatment in Patients With Patellar Tendinopathy (Jumper's Knee): 44-Month Follow-up

A randomized controlled study has shown good clinical results after treatment with sclerosing injections into the area with neovessels in patients with patellar tendinopathy, but no study has investigated medium- or long-term outcomes. Hoksrud A, Bahr R. Am J Sports Med August 12, 2011 Published online before print. PDF

NYU Langone experts find MRI techniques can detect early osteoarthritis

Researchers from NYU Langone Medical Center's Departments of Orthopaedic Surgery and Radiology found that advanced MRI techniques can be used to detect subtle changes in joint cartilage microstructure – and provide physicians a diagnostic tool for finding key markers of early osteoarthritis (OA). By using these techniques during patient exams to identify OA earlier, clinicians can shift the management of the disease from eventual joint reconstruction to long-term preservation. The study was published in the July issue of the Journal of the American Academy of Orthopaedic Surgeons. Eurekalert!  PDF

History, clinical findings, magnetic resonance imaging, and arthroscopic correlation in meniscal lesions.

The aim of this prospective study was to compare the accuracy of clinical examination and magnetic resonance imaging (MRI) versus arthroscopic findings and to determine the value of an experienced examiner in clinical decision making. Ercin E, Kaya I, Sungur I, Demirbas E, Ugras AA, Cetinus EM. Knee Surg Sports Traumatol Arthrosc. 2011 Aug 11. [Epub ahead of print] PMID: 21833511

65 Outstanding Shoulder Surgeons and Specialists

The following shoulder surgeons and specialists were selected for this list based on the awards they have received from major organizations in the field, leadership in those organizations, work on professional publications and positions of service held at hospitals and practices. The surgeons are listed in alphabetical order by last name. All physicians placed on this list have undergone substantial review from our editorial staff. Physicians do not pay and cannot pay to be selected as an outstanding leader. This list is not an endorsement of any individual's or organization's clinical abilities. Becker's Orthopedic, spine & Pain Management Review

'Windmill of War' about pain, moving forward

"(It) is called ‘Windmill of War,' because no matter what's going on with the outside world these men are like a windmill, they just keep turning and moving and going to wherever they're needed," Gehrig said of her patient and all war veterans.

Thanks to medical advancements in the field and orthopedic surgeons like Gehrig, orthopedic patients across the country are able to move forward in their lives as normally as possible.

"The role an orthopedic surgeon plays in all this is the fact that we put their limbs together and they can then function after they heal," Gehrig said.

The American Academy of Orthopaedic Surgeons strives to showcase stories like Gehrig's patient's through the "Wounded in Action" art exhibit. Shown across the country, the exhibit has pieces from orthopedic surgeons and veterans who know what it is like to undergo such a life-changing experience.

Though Gehrig says that "Windmill of War" is a personal expression of how she feels toward her patients, it also is a call for all to take another look at those who have put their lives on the line for Americans.

"You can't really appreciate it until you hear some of the stories and see some of the residue of war and miracles happen with some of these injuries," Gehrig said. Bismarck Tribune

To see the entire "Wounded in Action" exhibit, visit woundedinactionart.org

Sailors can wear ‘toe shoes’ despite military medical warnings

The Navy has reversed its policy banning minimalist 'toes shoes', Military Times reported. According to a fleetwide message released Aug. 5, sailors can wear the popular glove-like shoes, even during physical readiness tests, the newspaper reported.

However, the Navy Bureau of Medicine and Surgery has expressed concerns about the bare-bones Vibram Fivefingers shoes and warned against their use, according to Military Times.

While the Army banned soldiers from wearing the shoes during training earlier this summer, according to The Washington Post, the military school system endorsed them in March.
Read more on the toe shoe debate from Military Times.

Interventions for treating chronic ankle instability.

Neuromuscular training alone appears effective in the short term but whether this advantage would persist on longer-term follow-up is not known. While there is insufficient evidence to support any one surgical intervention over another surgical intervention for chronic ankle instability, it is likely that there are limitations to the use of dynamic tenodesis. After surgical reconstruction, early functional rehabilitation appears to be superior to six weeks immobilisation in restoring early function.  de Vries JS, Krips R, Sierevelt IN, Blankevoort L, van Dijk CN. Cochrane Database Syst Rev. 2011 Aug 10;(8):CD004124. PMID: 21833947

Clinical and Ultrasonographic Results of Ultrasonographically Guided Percutaneous Radiofrequency Lesioning in the Treatment of Recalcitrant Lateral Epicondylitis.

The authors present a newly developed minimally invasive procedure, ultrasonographically guided percutaneous radiofrequency thermal lesioning (RTL), and its clinical efficacy in treating recalcitrant lateral epicondylitis. Lin CL, Lee JS, Su WR, Kuo LC, Tai TW, Jou IM. Am J Sports Med. 2011 Aug 11. [Epub ahead of print] PMID: 21836121

Recent PubMed Entries for the European Journal of Trauma and Emergency Surgery (2007 to present). Not currently indexed for MEDLINE.

Open Access Articles Link

1. Outcomes following operative and non-operative management of humeral midshaft fractures: a prospective, observational cohort study of 47 patients. van Middendorp JJ, Kazacsay F, Lichtenhahn P, Renner N, Babst R, Melcher G. Eur J Trauma Emerg Surg. 2011 Jun;37(3):287-296. Epub 2011 Apr 1. PMID: 21837261

2. Bilateral proximal tibia fracture. Andriessen MJ, Mattens EC, Sleeboom C, Heij HA. Eur J Orthop Surg Traumatol. 2011 Apr;21(3):199-201. Epub 2010 Aug 29. PMID: 21837233

3. Results of 131 consecutive operated patients with a displaced proximal humerus fracture: an analysis with more than two years follow-up. Faraj D, Kooistra BW, Vd Stappen WA, Werre AJ. Eur J Orthop Surg Traumatol. 2011 Jan;21(1):7-12. Epub 2010 Jun 15. PMID: 21837232

Impact of AOA Status and Perceived Lifestyle on Career Choices of Medical School Graduates.

Based upon student ratings of such factors as predictable work hours and personal time, medical specialties have been identified as lifestyle friendly, intermediate, or unfriendly. Lifestyle friendly programs may be more desirable, more competitive, and for students elected to the Alpha Omega Alpha (AOA) Honor Medical Society, more attainable.  Grayson MS, Newton DA, Patrick PA, Smith L. J Gen Intern Med. 2011 Aug 12. [Epub ahead of print]PMID: 21837375

European Journal of Orthopaedic Surgery & Traumatology (1991 to present). Not currently indexed in MedLine

Open Access Articles Link

Most Recent:

1.  Technical Note. Technical details of using sural flap in pes equinovarus surgery: a preliminary report on the technique  Daghan Isik, M. Fethi Ceylan, Savas Guner, M. Ata Gokalp and Bekir Atik

Online First™, 10 August 2011 Show Summary 

2. Up-to date Review and Case Report.  Endometriosis in the deltoid muscle: a case report Yukitaka Nagamoto, Nobuyuki Hashimoto, Shigeki Kakunaga, Takafumi Ueda and Yasuhiko Tomita, et al. Online First™, 10 August 2011 Show Summary 

3.  Up-to date Review and Case Report.  Reconstruction of neglected chronic tendoachilles tear healed in continuity: surgical technique A. Raviraj, Ashish Anand and Gautam Kodikal Online First™, 4 August 2011  Show Summary 

4. Up-to date Review and Case Report. Distal fracture clavicle and acromioclavicular dislocation: a case report and review the literature Antonio Zarza Pérez, J. L. González Montane and A. D. Delgado Martínez Online First™, 4 August 2011  Show Summary 

5. Original Article. Pedicle screw diameter selection for safe insertion in the thoracic spine

Toru Fujimoto, Akira Sei, Takuya Taniwaki, Tatsuya Okada and Toshitake Yakushiji, et al.

Online First™, 4 August 2011 Show Summary 

6. Original Article. Tranexamic acid reduces blood loss in simultaneous bilateral total knee arthroplasty: a randomized control trial A. Raviraj, Ashish Anand, Murali Chakravarthy, S. Kumarswamy and Ajith Prabhu, et al. Online First™, 2 August 2011 Show Summary

Mobile Devices and Medical Liability: Some Important Considerations

As mobile devices become more and more integrated into clinical practice, our health system will have to not only figure out how this technology will change the face of medicine, but also how it will change the system of medical liability. Physicians and administrators alike shudder at the thought of malpractice, but considering the fact that 60% of physicians over the age of 55 have been sued at least once during their career, we have to carefully think about how all of our new tools fit into the liability picture. Michelle Mello, a Harvard health law professor, offered some insight at the World Congress Leadership Summit on mHealth. iMedicalApps

Kienböck Disease

Article in Press: Treatment of Kienböck Disease by Lunate Core Decompression  Mehrpour S, Kamrani S, Aghamirsalim M, Sorbi R, Kaya A. The Journal of Hand Surgery , Corrected Proof  PDF

1 - 3 From PubMed: 

1. Arthroscopic core decompression of the lunate in early stage Kienbock disease of the lunate. Bain GI, Smith ML, Watts AC. Tech Hand Up Extrem Surg. 2011 Mar;15(1):66-9. PMID:  21358528

2. Systematic review of the treatment of Kienböck's disease in its early and late stages. Innes L, Strauch RJ. J Hand Surg Am. 2010 May;35(5):713-7, 717.e1-4. Review. PMID: 20438990 PDF

3. Core decompression of the distal radius for the treatment of Kienböck's disease: a biomechanical study. Sherman GM, Spath C, Harley BJ, Weiner MM, Werner FW, Palmer AK. J Hand Surg Am. 2008 Nov;33(9):1478-81. PMID: 18984326 PDF

Surgical treatment of syndesmotic diastasis: emphasis on effect of syndesmotic screw on ankle function.

Fifty-two consecutive adult patients with syndesmotic diastasis (SD) were treated with closed anatomical reduction and stable fixation by a trans-syndesmotic cancellous screw. A short leg splint was prescribed for a six week postoperative period. Treatment outcomes of syndesmotic screw removal at various time points were studied and compared (group 1 at six weeks, group 2 at three months and group 3 at an average of nine months).  Hsu YT, Wu CC, Lee WC, Fan KF, Tseng IC, Lee PC. Int Orthop. 2011 Mar;35(3):359-64. Epub 2010 Nov 11. PMID: 21069524

Associations between repeated deployments to OEF/OIF/OND, October 2001-December 2010, and post-deployment illnesses and injuries, active component, U.S. Armed Forces.

Since 2001, 1,347,731 U.S. military members have deployed to Afghanistan or Iraq; of these, approximately 40% deployed to Afghanistan or Iraq more than once. We assessed relationships between multiple deployments and diagnoses of diseases and injuries (as defined by 3-digit ICD-9-CM codes) among all male and female deployers within one year after returning from first through fifth deployments. For most illnesses and injuries, the proportions of deployers affected within one year post-deployment hardly varied in relation to the number of prior deployments. Back and joint disorders, sleep disorders, hypercholesterolemia, hypertension, chronic sinusitis, and allergic rhinitis were "excessive" among repeat compared to first-time deployers. Some conditions may be caused or exacerbated by repeat wartime deployments. On the other hand, repeat deployments may select for the most inherently resilient service members and/or incrementally increase the resilience of repeat deployers. Armed Forces Health Surveillance Center (AFHSC). MSMR. 2011 Jul;18(7):2-11. PMID: 21815709 PDF

Effectiveness of the Saline Load Test in Diagnosis of Traumatic Elbow Arthrotomies.

The purpose of this study was to investigate the amount of fluid required and the sensitivity of the saline load test to identify an intra-articular arthrotomy of the elbow. Feathers T, Stinner D, Kirk K, Kirby J, Hsu JR; Skeletal Trauma Research Consortium (STReC); Brooke Army Medical Center. J Trauma. 2011 Jul 15. [Epub ahead of print] PMID: 21768902 PDF

The Modern "Deck-Slap" Injury-Calcaneal Blast Fractures From Vehicle Explosions.

Calcaneal injuries following under-vehicle explosions are commonly associated with significant multiple injuries including severe lower limb injury. The frequency of associated spinal injuries mandates radiologic evaluation of the spine in all such patients. The severity of the hindfoot injury is reflected by the high infection rate and amputation rate. Only a small proportion of casualties were able to return to preinjury military duties.

 Ramasamy A, Hill AM, Phillip R, Gibb I, Bull AM, Clasper JC. J Trauma. 2011 Jul 29. [Epub ahead of print] PMID: 21808204 PDF

Impact of Stress on Resident Performance in Simulated Trauma Scenarios.

In trainees, some aspects of performance and immediate recall appear to be impaired in complex clinical scenarios in which they exhibit elevated subjective and physiologic stress responses. The findings of this study highlight a potential threat to patient safety and demand further investigation. Future studies should strive to further elucidate the effects of stress on specific components of performance and investigate ways to reduce its negative impact.  Harvey A, Bandiera G, Nathens AB, Leblanc VR. J Trauma. 2011 Jul 29. [Epub ahead of print] PMID: 21808212  PDF

Died of wounds on the battlefield: causation and implications for improving combat casualty care.

Understanding the epidemiology of death after battlefield injury is vital to combat casualty care performance improvement. The current analysis was undertaken to develop a comprehensive perspective of deaths that occurred after casualties reached a medical treatment facility.  Eastridge BJ, Hardin M, Cantrell J, Oetjen-Gerdes L, Zubko T, Mallak C, Wade CE, Simmons J, Mace J, Mabry R, Bolenbaucher R, Blackbourne LH. J Trauma. 2011 Jul;71(1 Suppl):S4-8. PMID: 21795876

The Role of Platelet-rich Plasma in Rotator Cuff Repair.

Injections of platelet-rich plasma (PRP) have led to reduced pain and improved recovery in other degenerate pathologies areas together with the restoration of function. This study reviews the current literature on PRP and in particular discusses its relevance in the treatment of rotator cuff tears. Mei-Dan O, Carmont MR. Sports Med Arthrosc. 2011 Sep;19(3):244-50. PMID: 21822108

Treatment of femur fractures in school-aged children using elastic stable intramedullary nailing: a systematic review.

Femur fractures are common long-bone injuries in school-aged children (6-12 years). Among the various acceptable treatment options, elastic stable intramedullary nailing (ESIN) has gained popularity over recent years although the level of evidence for ESIN is low. This study was a systematic review of the literature to examine the outcomes and complications of ESIN in school-aged children and to critically evaluate the quality of the available literature.  Baldwin K, Hsu JE, Wenger DR, Hosalkar HS. J Pediatr Orthop B. 2011 Sep;20(5):303-8. PMID: 21829144

Meniscal Repair Versus Partial Meniscectomy: A Systematic Review Comparing Reoperation Rates and Clinical Outcomes

Whereas meniscal repairs have a higher reoperation rate than partial meniscectomies, they are associated with better long-term outcomes. E. Scott Paxton, Michael V. Stock, Robert H. Brophy, Arthroscopy: The Journal of Arthroscopic and Related Surgery - 08 August 2011 (10.1016/j.arthro.2011.03.088)

Platelet-Rich Plasma Intra-Articular Injection Versus Hyaluronic Acid Viscosupplementation as Treatments for Cartilage Pathology: From Early Degeneration to Osteoarthritis

Autologous PRP injections showed more and longer efficacy than HA injections in reducing pain and symptoms and recovering articular function. Better results were achieved in younger and more active patients with a low degree of cartilage degeneration, whereas a worse outcome was obtained in more degenerated joints and in older patients, in whom results similar to those of viscosupplementation have been observed.
Elizaveta Kon, Bert Mandelbaum, Roberto Buda, Giuseppe Filardo, Marco Delcogliano, Antonio Timoncini, Pier Maria Fornasari, Sandro Giannini, Maurilio Marcacci, Arthroscopy: The Journal of Arthroscopic and Related Surgery - 11 August 2011 (10.1016/j.arthro.2011.05.011) PDF

Long-term results of the surgical treatment of type III acromioclavicular dislocations: AN UPDATE OF A PREVIOUS REPORT.

 According to the Imatani and UCLA scores, there was no difference between the operated shoulder and the opposite shoulder (p > 0.05). Given the same situation, 35 (92.1%) patients would opt for the same surgical treatment again. Operative treatment of type III acromioclavicular joint injuries produces satisfactory long-term results.  Lizaur A, Sanz-Reig J, Gonzalez-Parreño S. J Bone Joint Surg Br. 2011 Aug;93(8):1088-92. PMID: 21768634

Clinical Orthopaedics and Related Research: [Epub ahead of print]

1. Risk Factors for Peroneal Nerve Injury and Recovery in Knee Dislocation. Peskun CJ, Chahal J, Steinfeld ZY, Whelan DB. Clin Orthop Relat Res. 2011 Aug 6. [Epub ahead of print] PMID: 21822573 PDF
2. Lateral Unicompartmental Knee Arthroplasty Through a Lateral Parapatellar Approach Has High Early Survivorship. Berend KR, Kolczun MC 2nd, George JW Jr, Lombardi AV Jr. Clin Orthop Relat Res. 2011 Aug 6. [Epub ahead of print] PMID: 21822570 PDF
3. A More Reliable Method to Assess Acetabular Component Position. Tiberi JV, Pulos N, Kertzner M, Schmlazried TP. Clin Orthop Relat Res. 2011 Aug 6. [Epub ahead of print] PMID: 21822569 PDF
4. Can Stress Radiography of the Knee Help Characterize Posterolateral Corner Injury? Gwathmey FW Jr, Tompkins MA, Gaskin CM, Miller MD. Clin Orthop Relat Res. 2011 Aug 6. [Epub ahead of print] PMID: 21822568 PDF
5. Can Surgeons Predict What Makes a Good TKA?: Intraoperative Surgeon Impression of TKA Quality Does Not Correlate With Knee Society Scores. Lee GC, Lotke PA. Clin Orthop Relat Res. 2011 Aug 6. [Epub ahead of print] PMID: 21822567 PDF

Position of shoulder arthroplasty and clinical outcome in proximal humerus fractures.

Four-part proximal humeral fractures are frequently treated with shoulder replacement. Outcome of this procedure has not been standardized, and there are controversy data on range of motion (ROM) and active function of the shoulder. The aim of this study is to compare shoulder prosthesis position (SPP) in terms of version of humeral head and height of stem with clinical subjective and objective outcome. Padua R, Padua L, Galluzzo M, Ceccarelli E, Alviti F, Castagna A. Musculoskelet Surg. 2011 Jul;95 Suppl :55-8. PMID: 21479866

Skeletal Radiology: Osteochondral Lesions

1. Limitations of radiographs in evaluating non-displaced osteochondral lesions of the talus. Dheer S, Khan M, Zoga AC, Morrison WB. Skeletal Radiol. 2011 Aug 9. [Epub ahead of print]  PMID: 21826614
2. High-resolution MR imaging of talar osteochondral lesions with new classification. Griffith JF, Lau DT, Yeung DK, Wong MW. Skeletal Radiol. 2011 Aug 9. [Epub ahead of print] PMID: 21826613

Lawson scientist presents joint pain treatment 2.0

When patients have OA in the knee, the fluid in their joint breaks down, causing pain and preventing natural shock absorption. To treat this condition, gel-like substances called "viscosupplements" are injected into the knee. This acts as a supplement for the fluid loss and provides temporary pain relief. In the COR1.0 study, Dr. Petrella and his colleagues compared Synvisc-One, the leading market viscosupplement for OA in the knee, to Hydros-TA Joint Therapy. Hydros-TA is a unique dual-action treatment combining steroids within a viscosupplement. It is believed to provide faster acting, longer lasting pain relief than either treatment alone. Eurekalert!

Curry spice could offer treatment hope for tendinitis

A derivative of a common culinary spice found in Indian curries could offer a new treatment hope for sufferers of the painful condition tendinitis, an international team of researchers has shown.  In a paper due to be published in the Journal of Biological Chemistry, the researchers at The University of Nottingham and Ludwig Maximilians University in Munich have shown that curcumin, which also gives the spice turmeric its trademark bright yellow colouring, can be used to suppress biological mechanisms that spark inflammation in tendon diseases. Eurekalert!

The Dedicated Orthopedic Trauma Operating Room

The development and implementation of a dedicated orthopedic trauma operating room (OTOR) that is used for the treatment of orthopedic trauma patients has changed and improved the practice of orthopedic trauma surgery. Advantages noted with OTOR implementation include improvements in morbidity and complication rates, enhancements in the professional and personal lifestyles of the on-call surgeon, and increased physician recruitment and retention in orthopedic traumatology. However, the inappropriate use of the OTOR, which can waste valuable resources and delay the treatment of emergent cases, must be monitored and avoided.

Min, William; Wolinsky, Philip R. Journal of Trauma-Injury Infection & Critical Care. 71(2):513-515, August 2011. PDF

Telemedicine to a moving ambulance improves outcome after trauma in simulated patients.

TM to a moving ambulance improved the care of simulated trauma patients. Furthermore, procedurally naïve EMTs were able to perform needle thoracostomy and pericardiocentesis with TM guidance. Charash WE, Caputo MP, Clark H, Callas PW, Rogers FB, Crookes BA, Alborg MS, Ricci MA. J Trauma. 2011 Jul;71(1):49-55. PMID: 21818014  PDF

Wayne State researcher discovers antibiotic useful for localized treatment of bone wear

Total joint replacement surgeries can help relieve joint pain common in people with conditions like osteoarthritis. But sometimes, the debris from prosthetic joints leads to aseptic loosening, or disintegration of surrounding bones. In 2009, a Wayne State University researcher determined that the anti-inflammatory antibiotic erythromycin can prevent and treat such disintegration. There was one caveat, however: there are side effects associated with long-term usage of erythromycin. Eurekalert!

The Plate-Joystick Technique to Reduce Proximal Humeral Fractures and Nonunions With a Varus Deformity Through the Extended Deltoid-Splitting Approach.

Fractures and nonunions in which there is a varus deformity of the humeral head producing posterinferior subluxation of the articular surface are increasingly recognized as an important subgroup of proximal humeral fractures. Operative open reduction and internal fixation of these injuries is often recommended when the varus deformity is severe. We describe a simple technique to assist in the open reduction and locking plate stabilization of this challenging and complex fracture subtype using tools and implants that are readily available in most modern orthopaedic trauma operating rooms. Robinson CM, Inman D, Phillips SA. J Orthop Trauma. 2011 Jul 28. [Epub ahead of print] PMID:  21804419  PDF

Arthroscopic Treatment of Rotator Cuff Disease (article in press)

The goal of this article is to summarize the current concepts on rotator cuff disease with an emphasis on arthroscopic treatment. Most rotator cuff tears are the result of an ongoing attritional process. Once present, a tear is likely to gradually increase in size. Partial thickness and subscapularis tears can both be successfully treated arthroscopically if conservative management fails. Partial tears involving greater than 50% of tendon thickness should be repaired. Articular sided partial tears involving less than 50% of the rotator cuff can reliably be treated with debridement. A more aggressive approach should be considered for low-grade tears (<50%) if they occur on the bursal side. Biomechanical and anatomic studies have shown clear superiority with dual-row fixation compared with single-row techniques. However, current studies have yet to show clear clinical advantage with dual-row over single-row repairs. Biceps tenotomy or tenodesis can reliably provide symptomatic improvement in patients with irreparable massive tears. True pseudoparalysis of the shoulder is a contraindication to this procedure alone and other alternatives should be considered. Jarrett CD, Schmidt CC. J Hand Surg Am. 2011 Aug 6. [Epub ahead of print] PMID: 21821368  PDF

See also:
Arthroscopic treatment of rotator cuff disease GM Gartsman - Journal of Shoulder and Elbow Surgery, 1995 - Elsevier Rotator cuff disease represents a spectrum of tendon lesions including inflammation of an intrinsically normal tendon, tendon fibrosis, partial-thickness tears, complete tears, and cuff tear arthropathy. An in-depth analysis of the entire subject is beyond the scope of this ...
Cited by 59 (drill up) - Related articles - All 3 versions - Import into EndNote

Visible Body is a complete, fully interactive 3D rendering of the human body and may one day replace traditional anatomy texts

Visible Body  3D Human Anatomy Atlas for iPad 2 is a huge breath of fresh air. While we at iMedicalApps have been reviewing anatomy apps that constantly improved on previous ones, Visible Body simply blew me away. After using Visible Body for mere minutes, it felt as if someone had read my previous review and made it a goal to silence my past quibbles. Not only does it take full advantage of the iPad’s touchscreen interface, it does so in such a gorgeous manner that there are not enough superlatives in my vocabulary to adequately describe it. But since a picture is worth a thousand words (especially when it comes to anatomy), I will include plenty of pictures to rectify my speechlessness and for you to judge for yourself. iMedicalApps

Have you tried the Google Translate App with your patients?

he Google Translate app for Android translates speech in real time. It works best if you don't have a heavy accent. Google Translate is a free mobile app (developed by Google) and you can instantly translate text between more than 50 languages. It includes:
Text-to-speech
and
Voice input
Soon, we won't need interpreters because we'll be using our technology, right? Maybe. MedicalSmartphones

New Ortho Books (via Amazon)

Knee Arthroscopy by Brian McKeon, James V. Bono and John C. Richmond (Aug 29, 2011)

New Advances in Wrist and Small Joint Arthroscopy, An Issue of Hand Clinics (The Clinics: Orthopedics) by David J. Slutsky (Aug 28, 2011)

The Poly-Traumatized Patient with Fractures: A Multi-Disciplinary Approach by Hans-Christoph Pape, Roy Sanders and Joseph Borrelli Jr. (Aug 28, 2011)

Tribology in Total Hip Arthroplasty by Karl Knahr (Aug 28, 2011)

Fundamentals of Revision Hip Arthroplasty: Diagnosis, Evaluation, and Treatment by David J. Jacofsky MD and Anthony K. Hedley MD (Aug 15, 2011)

Oxford Textbook of Trauma and Orthopaedics by Christopher Bulstrode, James Wilson-MacDonald,
Jeremy Fairbank and Tim Briggs (Aug 11, 2011)

Manual of INTERNAL FIXATION: Techniques Recommended by the AO-ASIF Group by Maurice E. Müller, Robert Schneider, Hans Willenegger and Martin Allgöwer (Jul 29, 2011)

FOOT AND ANKLE ARTHROSCOPY, An Issue of Clinics in Podiatric Medicine and Surgery (The Clinics: Orthopedics) by Lawrence G. Rubin DPM (Jul 28, 2011)

Concepts and Cases in Nonunion Treatment by Rene Marti and Peter Kloen (Jul 27, 2011)

Armed Conflict Injuries to the Extremities: A Treatment Manual by Alexander Lerner and Michael Soudry (Jul 18, 2011)

Multidrug-resistant chronic osteomyelitis complicating war injury in iraqi civilians.

War-related orthopedic injury is frequently complicated by environmental contamination and delays in management, placing victims at increased risk for long-term infectious complications. We describe, among Iraqi civilians with war-related chronic osteomyelitis, the bacteriology of infection at the time of admission.  Murphy RA, Ronat JB, Fakhri RM, Herard P, Blackwell N, Abgrall S, Anderson DJ.

J Trauma. 2011 Jul;71(1):252-4. PMID: 21818032

Above- or below-elbow casts for distal third forearm fractures in children? A meta-analysis of the literature.

Fractures of the distal third forearm are common fractures in childhood. Most of these fractures can be treated non-operatively by means of closed reduction and immobilization. The purpose of this meta-analysis is to investigate whether above- or below-elbow cast should be considered the first-choice for conservative treatment.  Hendrickx RP, Campo MM, van Lieshout AP, Struijs PA, van den Bekerom MP. Arch Orthop Trauma Surg. 2011 Aug 5. [Epub ahead of print] PMID: 21818587

Hallux valgus angle as a predictor of recurrence following proximal metatarsal osteotomy.

Our radiographic results indicated that a preoperative hallux valgus angle >40° can be a risk factor for hallux valgus recurrence. Decreased risk factors for recurrence included hallux valgus angle ≤15° and an intermetatarsal angle <10° at the early follow-up. These risk factors may be helpful for modifying surgical procedures, improving surgical outcome, and predicting hallux valgus recurrence.  Okuda R, Kinoshita M, Yasuda T, Jotoku T, Shima H, Takamura M. J Orthop Sci. 2011 Aug 5. [Epub ahead of print] PMID: 21818604

Reconstructive osteotomy of fibular malunion: review of the literature.

The treatment of ankle fractures has a primary goal of restoring the full function of the injured extremity. Malunion of the fibula is the most common and most difficult ankle malunion to reconstruct. The most frequent malunions of the fibula are shortening and malrotation resulting in widening of the ankle mortise and talar instability, which may lead to posttraumatic osteoarthritis. The objective of this article is to review the literature concerning the results of osteotomies for correcting fibular malunions and to formulate recommendations for clinical practice. van Wensen RJ, van den Bekerom MP, Marti RK, van Heerwaarden RJ. Strategies Trauma Limb Reconstr. 2011 Aug;6(2):51-7. Epub 2011 Apr 6. PMID: 21818702 PDF

Tornier Announces First Implant in U.S. Trial of Its Simpliciti Stemless Shoulder Joint Replacement System

Tornier N.V. (Amsterdam, The Netherlands), an orthopedic surgical solutions company, has announced the first implant of its Simpliciti stemless shoulder joint replacement system as part of an FDA -approved, investigational device exemption (IDE) study. The Simpliciti system is designed to allow surgeons to carry out total shoulder replacements without the complications, additional bone removal and time associated with conventional stemmed implants.

Functional reconstruction of ischemic contracture in the lower limb.

Ischemic contracture in the lower limb is a devastating complication after lower limb trauma. The prevention of contracture is much more important than the treatment of an established contracture. Split Achilles tendon transfer to flexor hallucis longus tendon and sural-tibial nerve anastomosis, which was initially implemented by us, could improve the functional recovery of ischemic contracture in lower limbs, and thus provides a new alternative for functional reconstruction of ischemic contracture in the lower limb. Tang H, Zhang SC, Tan ZY, Zhu HW, Zhang QL, Li M. Chin J Traumatol. 2011 Apr 1;14(2):96-9. PMID: 21453575

Management of Grade III Open Dislocated Ankle Fractures: Combined Internal Fixation with Bioabsorbable Screws/Rods and External Fixation.

Isolated dislocation of the ankle with grade III open fracture has been scarcely reported. These ankle injuries usually involved mortise fractures, complete dislocation of the tibial astragaloid joint, capsuloligamentous structure disruption, and severe soft-tissue damage. There is no well-recognized regimen that would result in desirable outcomes. Ye T, Chen A, Yuan W, Gou S. J Am Podiatr Med ssoc. 2011 Jul-Aug;101(4):307-15. PMID: 21816999

Mechanical Comparison of Two Types of Fixation for Ludloff Oblique First Metatarsal Osteotomy.

The use of a medially applied supplementary mini locking plate offers a simple and effective method to improve the mechanical stability of the Ludloff oblique osteotomy.  Tsilikas SP, Stamatis ED, Kourkoulis SK, Mitousoudis AS, Chatzistergos PE, Papagelopoulos PJ. J Foot Ankle Surg. 2011 Aug 1. [Epub ahead of print] PMID: 21813302