Journal of Orthopaedic Trauma - Published Ahead-of-Print

Functional and Quality-of-Life Results of Displaced and Nondisplaced Proximal Humeral Fractures Treated Conservatively

Anatomic Relationships After Instrumentation of the Midshaft Clavicle With 3.5-mm Reconstruction Plating: An Anatomic Study

Negative Pressure Therapy on Primarily Closed Wounds Improves Wound Healing Parameters at 3 Days in a Porcine Model

Ideal Tibial Intramedullary Nail Insertion Point Varies With Tibial Rotation

Results of Cephallomedullary Nail Fixation for Displaced Intracapsular Femoral Neck Fractures

The Impact of Smoking on Complications After Operatively Treated Ankle Fractures-A Follow-Up Study of 906 Patients

Knee Pain Correlates With Union After Tibial Nailing

A Comparison of the Gallie Technique and Casting versus the Harms Technique for the Treatment of Odontoid Fractures

Return to Duty After Type III Open Tibia Fracture

Innovative spinal stapling leads to astonishing outcome for little girl

Six weeks ago Diab performed a rare surgical procedure on Grace called vertebral body stapling at UCSF Benioff Children’s Hospital, the only hospital West of the Mississippi to perform the surgery. While vertebral body stapling is a “newer” operative option, it was first developed in the 1950's. In its original iteration, the surgery failed because the staples were too weak to hold the vertebrae and migrated out of the bone and floated around the chest. MedicalXpress

Exercise boosts health by influencing stem cells to become bone, not fat, McMaster researchers find

McMaster researchers have found one more reason to exercise: working out triggers influential stem cells to become bone instead of fat, improving overall health by boosting the body's capacity to make blood.  The body's mesenchymal stem cells are most likely to become fat or bone, depending on which path they follow.

Using treadmill-conditioned mice, a team led by the Department of Kinesiology's Gianni Parise has shown that aerobic exercise triggers those cells to become bone more often than fat.  The exercising mice ran less than an hour, three times a week, enough time to have a significant impact on their blood production, says Parise, an associate professor.  In sedentary mice, the same stem cells were more likely to become fat, impairing blood production in the marrow cavities of bones.

The research appears in a new paper published by the Journal of the Federation of American Societies for Experimental Biology. Eurekalert!

The Borden Institute - publishes the Textbooks of Military Medicine

The Borden Institute, an agency of the US Army Medical Department Center & School, publishes the Textbooks of Military Medicine (free PDF versions). The volumes in the series, now numbering 20, constitute a comprehensive treatise on the art and science of military medicine, covering such diverse topics as military preventive medicine, military medical ethics, harsh environments, and care of combat injuries.

Borden also publishes specialty clinical titles and works on military medical history. Print version of textbook volumes are available for free in PDF.
Currently Available:

Care of the Combat Amputee (2009) Free PDF


Books in Production:

Musculoskeletal Injuries in Military Women
This monograph discusses the most common musculoskeletal injuries in military women. Prevention and management of these injuries are very important to sustain the fighting force and maintain military readiness. Information about the incidence, risk factors, prevention, diagnosis, evaluation, treatment, and rehabilitation of common musculoskeletal overuse and traumatic injuries sustained by women in the military is included. Sections topics  cover an overview of musculoskeletal injuries in military women; common lower extremity overuse injuries; common traumatic injuries; an overview of general injury prevention, treatment, and rehabilitation techniques; and specific injury prevention, treatment, and rehabilitation techniques in the military.

Emergency War Surgery, 4th Ed
As an update to the much-referenced 2004 version, information in this edition reflects lessons learned from American involvement in Iraq and Afghanistan, and represents state-of-the-art principles and practices of forward trauma surgery. This publication expertly addresses the appropriate medical management of blast wounds, burns, multiple penetrating injuries, as well as other battle and nonbattle injuries. Topics include triage, hemorrhage control, airway/breathing, shock and resuscitation, anesthesia, infections, critical care, damage control surgery, face and neck injuries, soft-tissue injuries, ocular injuries, head injuries, extremity fractures, thoracic injuries, amputations, abdominal injuries, pediatric care, and more.

Ligament Contribution to Patterns of Articular Fractures of the Distal Radius

Intra-articular fractures of the distal radius are common injuries, but the correlation between ligament attachments and fracture location is poorly understood. The purpose of this study was to assess the location of intra-articular fractures compared to the known ligament attachments of the distal radius. Daniel G. Mandziak MBBS, Adam C. Watts MBBS and Gregory I. Bain PhD, MBBS. The Journal of Hand Surgery (Article in Press), Available online 31 August 2011  PDF

Journal of Surgical Education (Articles in Press)

Monitoring Universal Protocol Compliance Through Real-Time Clandestine Observation by Medical Students Results in Performance Improvement  (PDF)

Can Moral Reasoning Predict General Surgery Residents' Clinical Competence?  (PDF)

Assessment of Four Tissue Models on Knot Tensile Strength  (PDF)

Surgical Morbidity and Mortality Conference using Teleconferencing Allows for Increased Faculty Participation and Moderation from Satellite Campuses and Saves Costs  (PDF)

Octenidine in combination with polymethylmethacrylate: a new option for preventing infection?

Orthopedic implant infections represent a serious complication for both patient and surgeon. In order to minimize this risk, it has become standard practice in surgery and orthopedics to add antimicrobial substances to the polymethylmethacrylate (PMMA) bone cement. The aim of this study is to find new options for preventing infection by using alternative adjuvants in combination with PMMA. We hypothesized, that Octenidine, after being combined with PMMA, can be released in vitro and an antimicrobial efficacy of discharged Octenidine can be shown. Weckbach S, Möricke A, Braunwarth H, Goroncy-Bermes P, Bischoff M, Gebhard F. Arch Orthop Trauma Surg. 2011 Aug 30. [Epub ahead of print] PMID: 21877126

New chemical reagent turns mouse brain transparent - think animal models and muscle, connective tissues.

Researchers at RIKEN, Japan's flagship research organization, have developed a ground-breaking new aqueous reagent which literally turns biological tissue transparent. Experiments using fluorescence microscopy on samples treated with the reagent, published this week in Nature Neuroscience, have produced vivid 3D images of neurons and blood vessels deep inside the mouse brain. Highly effective and cheap to produce, the reagent offers an ideal means for analyzing the complex organs and networks that sustain living systems. RIKEN

HTA:101 and Comparative Effectiveness Research: a 2-Part Webinar Series (from NLM)

Educational Objectives:

• Part I: (HTA 101: 2011 Update on Introduction to Health Technology Assessment): Gain an understanding of the origins and fundamental concepts of health technology assessment (HTA), the major organizations that produce or use HTA guidance, the primary data and integrative methods, how topics are determined, the sources of evidence, dissemination and evaluation of impact. This webinar is based on and complements HTA:101, an online primer.
• Part II: (CER-HTA-PCOR: Converging on What Works for Patients): Learn about the evolving definitions used in comparative effectiveness research, the emerging focus on patient-centered outcomes research (PCOR), the types of methods used in conducting CER, the challenges of conducting CER, the controversies, and the relationships among CER, HTA, and PCOR.

Educating patients on knee surgery with a medical app - KneeDecide

OrcaMed has developed a series of anatomically precise mobile apps to aid the clinician who treats musculoskeletal conditions teach patients about relevant anatomy and pathology. We have previously reviewed their shoulder app (Shoulder Decide). Overall I think the KneeDecide app matches up equally as well and would work as a very useful aid in communicating basic knee anatomy and pathology to patients. iMedicalApps

Doctors' and nurses' hospital uniforms contain dangerous bacteria majority of the time, study shows

More than 60 percent of hospital nurses' and doctors' uniforms tested positive for potentially dangerous bacteria, according to a study published in the September issue of the American Journal of Infection Control (PDF), the official publication of APIC - the Association for Professionals in Infection Control and Epidemiology. MedicalXpress

Ghostwriting remains a fundamental problem in the medical literature

An editorial this week in PLoS Medicine (PDF) concludes that in the two years since extensive ghostwriting by pharmaceutical giant Wyeth to promote its hormone drug Prempro was exposed through litigation intervention by PLoS Medicine and The New York Times, medical ghostwriting remains a prevalent problem with few concrete solutions in sight. This week also sees the launch of the PLoS Ghostwriting Collection, which documents everything published across the PLoS journals on the topic.  MedicalXpress

Free calls home from Gmail for all U.S. service members

We understand that it’s not always easy or affordable for our troops serving overseas to call friends and family at home, so starting today we’re making it completely free for all uniformed military personnel with valid United States Military (.mil) email addresses to call the United States, right from Gmail.

Repair of Flexor Digitorum Profundus to Distal Phalanx: A Biomechanical Evaluation of Four Techniques.

Many techniques for repair of the flexor digitorum profundus to the distal phalanx show excessive gapping with variable clinical results. The purpose of this study was to test the biomechanical characteristics of an anchor-button (AB) technique, as compared to 3 other techniques.  Lee SK, Fajardo M, Kardashian G, Klein J, Tsai P, Christoforou D. J Hand Surg Am. 2011 Aug 26. [Epub ahead of print] PMID: 21873002

Results of Arthroscopic Decompression and Tuberoplasty for Irreparable Massive Rotator Cuff Tears.

Arthroscopic tuberoplasty with concomitant acromioplasty, as well as treatment of the biceps tendon when indicated, would be an option for diminishing pain and improving active forward elevation for irreparable massive rotator cuff tears. In particular, satisfactory results during the minimum follow-up period of 24 months can be achieved in the cases with good preservation of the preoperative and postoperative acromiohumeral interval and continuity in the inferior scapulohumeral line, regardless of preoperative mobility.  Lee BG, Cho NS, Rhee YG. Arthroscopy. 2011 Aug 26. [Epub ahead of print] PMID: 21873021

Observer variation for radiography, computed tomography, and magnetic resonance imaging of occult hip fractures.

There were almost perfect observer agreements for CT and MRI in diagnosing non-displaced, occult hip fractures. Observer agreements for radiography were moderate to substantial, and observer experience influenced agreement only at radiography Collin D, Dunker D, Göthlin JH, Geijer M. Acta Radiol. 2011 Aug 26. [Epub ahead of print] PMID: 21873504

The surgical treatment of knee stiffness following anterior cruciate ligament reconstruction.

In conclusion, arthroscopic arthrolysis, in conjunction with MUA, is an effective treatment for knee stiffness post-ACL reconstruction but ideally should be carried out within eight months.  Robertson GA, Coleman SG, Keating JF. Scott Med J. 2011 Aug;56(3):156-60. PMID: 21873721

Convergent Radioulnar Translocation With Radial Head Fracture in a Child: A Case Report and Review of the Literature.

Convergent type radioulnar translocation is an extremely rare form of injury occurring in a growing child. We report a case of convergent radioulnar translocation along with a radial head fracture in a young child. Open reduction of the elbow and internal fixation of the radial head fragment helped in achieving concentric reduction and good functional outcome at 2 years of follow-up. This case has been shown to highlight the diagnostic and management issues of this rare condition, which may be easily missed initially.  Agashe MV, Samant A, Aroojis AJ. J Orthop Trauma. 2011 Aug 20. [Epub ahead of print] PMID: 21873890

Greenbrier announces plans for medical institute. (Ortho Related)

Before choosing West Virginia and the Greenbrier for this facility, orthopedic surgeon Dr.  James Andrews, orthopedic practice consultant Michael Immel and healthcare developer Jack Diamond considered sites in London, England, Riyadh, Saudi Arabia, Brasilia, Brazil and Seoul, South Korea.

Dr. Andrews says the cornerstone of the project is the sports medicine component which will include a comprehensive diagnostic and clinical orthopedic sports medicine complex with state of the art operating rooms and teaching suites. West Virginia Public Broadcasting

Defense cuts will require more focus on critical enablers.

A fourth example of an area requiring sustained investment is military medicine, in general, and tele-medicine, in particular. As the size of the force shrinks, the value to the nation of each individual soldier, sailor, marine and airman's life and well-being increases. The survival rates for soldiers in combat is already above 90 percent. The marriage of near-instantaneous long-distance communications with advanced sensing and imaging is creating the potential for medical intervention and support at long range. Tele-medicine can improve critical care both in forward areas and in the transport of wounded personnel to advanced medical facilities. Military & Aerospace Electronics

Surgical management of pilon fractures with large segmental bone defects using fibular strut allografts: a report of two cases.

We present two patients with open pilon fractures with large bone defects treated successfully with fibular strut allografts. The patients were initially treated by massive irrigation, wound debridement, and temporary external fixation. After complete wound healing, the bone defects were managed. Because autologous iliac crest or fibular bone grafts were impossible to be harvested due to multiple fractures, the bone defects were reconstructed with fibular strut allografts. Fixation was performed with a periarticular distal tibia locking plate. At 2 months postoperatively, the patients ambulated with partial weight-bearing; at 6 months, they had full range of motion of the ankle joint and full weight-bearing.  Kim WY, Ji JH, Park SE, Kim YY, Jeong JJ, Kang HT. Eur J Orthop Surg Traumatol. 2011 Aug;21(6):439-444. Epub 2011 Mar 25. PMID: 21874131

Occult hip and pelvic fractures and accompanying muscle injuries around the hip.

Occult hip and pelvic fractures were almost equally seen among 113 cases with suspected hip fracture but were negative on plain radiography. Different patterns of associated muscle injuries in cases of occult hip fracture and pelvic fracture suggest that the mechanism of hip fracture and pelvic fracture is possibly different.  Ohishi T, Ito T, Suzuki D, Banno T, Honda Y. Arch Orthop Trauma Surg. 2011 Aug 28. [Epub ahead of print] PMID: 21874573

Clinical outcome after Chevron-Akin double osteotomy versus isolated Chevron procedure: a prospective matched group analysis.

These findings indicate that Chevron-Akin double osteotomy is a save and practicable procedure for the treatment of mild-to-moderate hallux valgus. Superiority of combined Chevron-Akin procedure over an isolated Chevron osteotomy might be limited to distinct clinical settings, but should not be generally assumed.  Lechler P, Feldmann C, Köck FX, Schaumburger J, Grifka J, Handel M. Arch Orthop Trauma Surg. 2011 Aug 28. [Epub ahead of print] PMID: 21874575

Ischiofemoral impingement: evaluation with new MRI parameters and assessment of their reliability.

Clinicians and radiologists should be aware of IFI in patients with hip or groin pain, and MRI should be obtained for the presence of the QFM edema/fatty replacement, narrowing of the IFS-QFS, and other features that may help in the clinical diagnosis of IFI for the proper diagnosis and treatment of the disease.  Tosun O, Algin O, Yalcin N, Cay N, Ocakoglu G, Karaoglanoglu M. Skeletal Radiol. 2011 Aug 29. [Epub ahead of print] PMID: 21874607

Comparison of the diagnostic utility of Electromyography, Ultrasonography, Computed Tomography, Magnetic Resonance Imaging in idiopathic Carpal Tunnel Syndrome determined by clinical findings.

EMG or US could be used as the first-step test in most cases. If they are both available, EMG should be the first choice. They may be performed together when diagnosis is challenging. CT may especially be preferred for bone-related pathological conditions, while MRI may be preferred for soft tissue-related pathological conditions. Even though imaging studies have been proven to be powerful diagnostic tools for CTS, no conclusive information currently exists to support replacing EMG with imaging studies. Deniz FE, Oksüz E, Sarkaya B, Kurt S, Erkorkmaz U, Ulusoy H, Arslan S. Neurosurgery. 2011 Aug 23. [Epub ahead of print] PMID: 21869718

Drug-Coated Balloon Saves Ischemic Limbs (CME/CE, with audio)

Revascularization using a paclitaxel-eluting balloon dramatically improved outcomes in patients with critical lower-limb ischemia -- a condition with notoriously high rates of restenosis -- a single-center European study found.

In the first trial of angioplasty with drug-eluting balloons for lengthy occluded or stenosed infrapopliteal arteries, the restenosis rate at three months was 27.4%, Andrej Schmidt, MD, of Park Hospital Leipzig in Germany, and colleagues reported in the Sept. 6 Journal of the American College of Cardiology. Medpage Today

Surgical emergency management made easy with Emergencies in Clinical Surgery medical app

There is a rapidly growing market for the conversion of reference handbooks into applications. MedHand Mobile Libraries has exclusive rights to the Oxford University Press Handbooks. These are a common sight out on the wards and in libraries. Based on the Oxford Handbook of the same name, Emergencies in Clinical Surgery is one of the latest to receive the MedHand treatment. iMedicalApps

Posterior remodeling of medial clavicle causing superior vena cava impingement

Injuries involving the sternoclavicular region resulting in posterior displacement of the medial clavicle are rare, and those that occur prior to fusion of the medial epiphyseal growth plate are more often a result of physis fracture, rather than sternoclavicular joint dislocation. Medial clavicular physis fractures initially are treated by closed reduction with the expectation of normal osseous repair and remodeling. We report a case of a previously fractured medial clavicle physis that abnormally remodeled, was reinjured, and resulted in posterior displacement with superior vena cava impingement and brachioplexopathy. Our case report describes the patient's initial injury and repair, the reinjury and discovery of abnormal remodeling, and the outcome of surgical intervention. We also include a review of recent literature on sternoclavicular joint injuries and treatment options. To our knowledge, this is the first reported case of an abnormally remodeled medial clavicle resulting in superior vena cava compression. Carbone P, Rose M, O'Daniel JA, Doukas WC, O'Toole RV, Anderson RC. Am J Orthop (Belle Mead NJ). 2011 Jun;40(6):297-300. PMID: 21869940 Free PDF with registration

Stanford researchers invent sutureless method for joining blood vessels

Reconnecting severed blood vessels is mostly done the same way today — with sutures — as it was 100 years ago, when the French surgeon Alexis Carrel won a Nobel Prize for advancing the technique. Now, a team of researchers at the Stanford University School of Medicine has developed a sutureless method that appears to be a faster, safer and easier alternative.

In animal studies, a team led by Stanford microsurgeon Geoffrey Gurtner, MD, used a poloxamer gel and bioadhesive rather than a needle and thread to join together blood vessels, a procedure called vascular anastomosis. Results of the research will be published online Aug. 28 in Nature Medicine. Lead authors of the study were Stanford postdoctoral scholar Edward Chang, MD, and surgery resident Michael Galvez, MD. Eurekalert!

Military medical officers from the US, Germany and UK to discuss new innovations in the treatment of combat casualties

The latest technologies and techniques being used to treat soldiers on the front line will be explored at Defence IQ’s Battlefield Healthcare Conference, taking place 21st-23rd November in Munich, Germany.

Results of medication studies in top medical journals may be misleading to readers

Studies about medications published in the most influential medical journals are frequently designed in a way that yields misleading or confusing results. The journals are the New England Journal of Medicine, the Journal of the American Medical Association, the Lancet, the Annals of Internal Medicine, the British Medical Journal and the Archives of Internal Medicine.  The findings are published online in the Journal of General Internal Medicine. PDF  Eurekalert!

Consumer reports empowers patients with new Hospital Ratings app for iPhone & iPad

This week, Consumer Reports released an iPhone/iPad app aimed squarely at healthcare consumer — Hospital Ratings. It’s a relatively cheap app, $2.99, and enables patients to compare hospitals around them, and to look up detailed reports on those particular hospitals. iMedicalApps
 

Orthopedic boot camp: examining the effectiveness of an intensive surgical skills course.

The intensive skills course used in this study was highly effective at teaching and developing targeted surgical skills in first-year orthopedic residents. We predict that allowing residents to acquire key technical skills at the start of their training will enhance learning opportunities at later stages of training.

Sonnadara RR, Van Vliet A, Safir O, Alman B, Ferguson P, Kraemer W, Reznick R. Surgery. 2011 Jun;149(6):745-9. Epub 2011 Jan 14. PMID: 21236456

Use of vacuum-assisted closure (VAC™) in high-energy complicated perineal injuries: analysis of nine cases.

Our study reviewed nine patients who were treated with the VAC™ Abdominal Dressing System after suffering pelvic fractures and soft tissue loss after high-energy pelvic trauma. Between March 2008 and August 2009, our clinic treated nine patients with complicated perineal injuries from high-energy pelvic trauma with multiple irrigation and debridement procedures and broad-spectrum antibiotics. Protective ostomies were created for all nine patients. Ozer MT, Coskun AK, Ozerhan IH, Ersoz N, Yildiz R, Sinan H, Demirbas S, Kozak O, Uzar AI, Cetiner S. Int Wound J. 2011 Aug 19. doi: 10.1111/j.1742-481X.2011.00835.x. [Epub ahead of print] PMID: 21854547

Return to running and sports participation after limb salvage.

The ability to return to running and sports participation after lower extremity limb salvage has not been well documented previously. Although the ability to ambulate without pain or assistive devices is generally a criteria for a good limb salvage outcome, many patients at our institution have expressed a desire to return to a more athletic lifestyle to include running and sports participation. The purpose of this study was to investigate the types of athletic endeavors our high-energy lower extremity trauma patients were able to pursue after limb salvage. Owens JG, Blair JA, Patzkowski JC, Blanck RV, Hsu JR; Skeletal Trauma Research Consortium (STReC). J Trauma. 2011 Jul;71(1 Suppl):S120-4. PMID: 21795870

Orthopedic cast, “Bones”, keeps track of physical therapy and muscle healing

Here’s an interesting concept: Imagine an orthopedic cast with sensors that capture muscle activity, wirelessly broadcasting the information to social networks, including your physician and physical therapist — enabling them to see what type of mobility and therapy you are doing. iMedicalApps

Computer assisted surgery for knee ligament reconstruction.

 A favourable effect of computer assisted surgery for cruciate ligament reconstructions of the knee compared with conventional reconstructions could neither be demonstrated nor refuted. There is insufficient evidence to advise for or against the use of CAS. There is a need for improved reporting of future studies of this technology. Meuffels DE, Reijman M, Scholten RJ, Verhaar JA. Cochrane Database Syst Rev. 2011 Jun 15;(6):CD007601. Review. PMID: 1678367

Arthroscopy: The Journal of Arthroscopic & Related Surgery [In Press, Corrected Proof]

A Randomized Study of the Effectiveness of Suprascapular Nerve Block in Patient Satisfaction and Outcome After Arthroscopic Subacromial Decompression  Hans-Christian Jeske, Franz Kralinger, Markus Wambacher, Florian Perwanger, Rebecca Schoepf, Juergen Oberladstaetter, Dietmar Krappinger, Christian Dallapozza, Frank Hoffmann.  Arthroscopy: The Journal of Arthroscopic & Related Surgery, In Press, Corrected Proof, Available online 24 August 2011, ISSN 0749-8063, DOI: 10.1016/j.arthro.2011.05.016.

Arthroscopic-Assisted Repair of Avulsed Triangular Fibrocartilage Complex to the Fovea of the Ulnar Head: A 2- to 4-Year Follow-Up Study  Norimasa Iwasaki, Kinya Nishida, Makoto Motomiya, Tadanao Funakoshi, Akio Minami.  Arthroscopy: The Journal of Arthroscopic & Related Surgery, In Press, Corrected Proof, Available online 24 August 2011, ISSN 0749-8063, DOI: 10.1016/j.arthro.2011.05.020.

Arthroscopic Management of Femoroacetabular Impingement: Minimum 2-Year Follow-Up  J.W. Thomas Byrd, Kay S. Jones. Arthroscopic Management of Femoroacetabular Impingement: Minimum 2-Year Follow-Up, Arthroscopy: The Journal of Arthroscopic & Related Surgery, In Press, Corrected Proof, Available online 20 August 2011, ISSN 0749-8063, DOI: 10.1016/j.arthro.2011.05.018.

Defining the Origins of the Iliofemoral, Ischiofemoral, and Pubofemoral Ligaments of the Hip Capsuloligamentous Complex Utilizing Computer Navigation

This study demonstrates that there is significant variability in the size and location of the iliofemoral ligament origin versus the pubofemoral and ischiofemoral ligaments. Nam D, Osbahr D, Choi D, Ranawat A, Kelly B and Coleman S.  HSS Journal DOI: 10.1007/s11420-011-9214-3 Online First

Army to field tablets to manage medical records on battlefield

Army medics could soon be accessing an injured soldier's medical data using tablet computers.  Currently, medics use bulky Motorola hand-held devices to document administered care, injuries and illnesses to soldiers in combat zones, ranging from battlefield wounds to a stomach virus. But this technology, fielded four years ago, can only support a limited version of the military's electronic outpatient medical record. And medics complain that the device's keypad is a sand magnet.

Mobile technologies like the iPad, iPhone and Android smartphones can run a more robust version of outpatient and inpatient medical records, with features that alert users to potentially harmful impacts of certain drug interactions and a list of patient allergies. Although medics usually do not administer prescription drugs, these additional capabilities would give them greater insight into a soldier's medical history. Federal Times

The Journal of Arthroplasty: Epubs

1. The flexion-extension axis of the knee and its relationship to the rotational orientation of the tibial plateau. Lawrie CM, Noble PC, Ismaily SK, Stal D, Incavo SJ. J Arthroplasty. 2011 Sep;26(6 Suppl):53-58.e1. Epub 2011 Jul 1.PMID: 21723702

2. Readmission and length of stay after total hip arthroplasty in a national medicare sample. Vorhies JS, Wang Y, Herndon J, Maloney WJ, Huddleston JI. J Arthroplasty. 2011 Sep;26(6 Suppl):119-23. Epub 2011 Jul 1. PMID: 21723700

3. Metal-on-Metal vs Metal-on-Improved Polyethylene Bearings in Total Hip Arthroplasty. Molli RG, Lombardi AV Jr, Berend KR, Adams JB, Sneller MA. J Arthroplasty. 2011 Sep;26(6 Suppl):8-13. Epub 2011 Jul 1. PMID: 21723699

4. Prospective randomized comparison of high-flex and standard rotating platform total knee arthroplasty. Hamilton WG, Sritulanondha S, Engh CA Jr. J Arthroplasty. 2011 Sep;26(6 Suppl):28-34. Epub 2011 Jul 1. PMID: 21723697

5. Benefits of prolonged postoperative cyclooxygenase-2 inhibitor administration on total knee arthroplasty recovery a double-blind, placebo-controlled study. Schroer WC, Diesfeld PJ, Lemarr AR, Reedy ME. J Arthroplasty. 2011 Sep;26(6 Suppl):2-7. Epub 2011 Jul 1. PMID: 21723695

6. Early adverse results with bicompartmental knee arthroplasty a prospective cohort comparison to total knee arthroplasty. Morrison TA, Nyce JD, Macaulay WB, Geller JA. J Arthroplasty. 2011 Sep;26(6 Suppl):35-9. Epub 2011 Jun 24. PMID: 21704484

7. Comparison of surgical outcomes and implant wear between ceramic-ceramic and ceramic-polyethylene articulations in total hip arthroplasty. Amanatullah DF, Landa J, Strauss EJ, Garino JP, Kim SH, Di Cesare PE. J Arthroplasty. 2011 Sep;26(6 Suppl):72-7. Epub 2011 Jun 15. PMID: 21680138

8. Prosthetic joint infection caused by gram-negative organisms. Zmistowski B, Fedorka CJ, Sheehan E, Deirmengian G, Austin MS, Parvizi J. J Arthroplasty. 2011 Sep;26(6 Suppl):104-8. Epub 2011 Jun 8. PMID: 21641762

9. Gender is a Significant Factor for Failure of Metal-on-Metal Total Hip Arthroplasty. Latteier MJ, Berend KR, Lombardi AV Jr, Ajluni AF, Seng BE, Adams JB. J Arthroplasty. 2011 Sep;26(6 Suppl):19-23. Epub 2011 Jun 8. PMID: 21641761

10. Optimal Irrigation and Debridement of Infected Joint Implants An In Vitro Methicillin-Resistant Staphylococcus aureus Biofilm Model. Schwechter EM, Folk D, Varshney AK, Fries BC, Kim SJ, Hirsh DM. J Arthroplasty. 2011 Sep;26(6 Suppl):109-13. Epub 2011 Jun 8. PMID: 21641757

11. Distal fixation of proximally coated tapered stems may predispose to a failure of osteointegration. Cooper HJ, Jacob AP, Rodriguez JA. J Arthroplasty. 2011 Sep;26(6 Suppl):78-83. Epub 2011 May 23. PMID: 21602026

12. The reliability and variation of acetabular component anteversion measurements from cross-table lateral radiographs. Nunley RM, Keeney JA, Zhu J, Clohisy JC, Barrack RL. J Arthroplasty. 2011 Sep;26(6 Suppl):84-7. Epub 2011 May 13. PMID: 21570805

13. Molecular markers for diagnosis of periprosthetic joint infection. Jacovides CL, Parvizi J, Adeli B, Jung KA. J Arthroplasty. 2011 Sep;26(6 Suppl):99-103.e1. Epub 2011 May 13. PMID: 21570803 

14. Revision for Recurrent Instability What are the Predictors of Failure? Carter AH, Sheehan EC, Mortazavi SM, Purtill JJ, Sharkey PF, Parvizi J. J Arthroplasty. 2011 Sep;26(6 Suppl):46-52. Epub 2011 May 8. PMID: 21550768

15. Initial experience of the journey-deuce bicompartmental knee prosthesis a review of 36 cases. Palumbo BT, Henderson ER, Edwards PK, Burris RB, Gutiérrez S, Raterman SJ. J Arthroplasty. 2011 Sep;26(6 Suppl):40-5. Epub 2011 May 8. PMID: 21550763

104-year-old lady undergoes orthopaedic surgery

A major orthopaedic surgery was recently carried out in the district on a 104-year-old-lady who suffered a hip fracture. Mariyam Beevi of Dar ul Huda, Navaikulam, the great grandmother of five generations, survived this intricate procedure, which made her able to move about with the help of walker on the very seventh day after surgery. IBN Live

Dried Plums for Bone Loss

In a new study, researchers randomly assigned 160 postmenopausal women not receiving hormone replacement therapy or any other medications known to affect bone mass to one of two treatment groups. The first group received 100 grams of dried plums daily, and the second group received 100 grams of dried apple daily. The dried apple was used as the comparative control.

Participants from both groups also received 500 milligrams of calcium and 400 international units of vitamin D daily. Bone density was measured before and after the study for the spine, forearm, hip and whole body. Blood samples were also taken before and at various points throughout the study to assess bone biomarkers. Natural Standard

Physicians' exposure to radiation prompt cellular changes that may protect the body from harm

Cardiologists who perform heart operations using x-ray guided catheters are exposed to ionising radiation at levels two to three times higher per year than those experienced by radiologists. Now, new research has found the first evidence that these constant, high levels of exposure cause changes at cell level that might represent the body's way of protecting itself against the harmful effects of radiation.

The research, published online today in the European Heart Journal, found that among ten interventional cardiologists who were regularly exposed to x-rays for their work, levels of two chemicals rose: one, glutathione, an anti-oxidant that protects against cell damage from oxygen-containing molecules called 'reactive oxygen species' (ROS), and the other, hydrogen peroxide, which indicates the amount of oxidative stress caused by the ROS. MedicalXpress

Coracoid Fractures: Therapeutic Strategy and Surgical Outcomes.

The majority of type I coracoid fractures set out in Ogawa's classification constitute double disruption of the superior shoulder suspensory complex (SSSC) as proposed by Goss, frequently resulting in healing delay and adverse functional consequences. However, there are few reports alluding to strategies or concrete treatment methods of such injuries. The purpose of this report is to introduce our surgical strategy for treating the type I coracoid fracture with concurrent injuries and to describe our treatment method with their outcomes. Ogawa K, Matsumura N, Ikegami H. J Trauma. 2011 Aug 17. [Epub ahead of print] PMID: 21857259

Arthroscopic acromioclavicular joint reconstruction using a synthetic ligament device

ACJ dislocations can effectively be treated with arthroscopy-assisted procedure. Since this procedure has given uniformly good to excellent results comparable to open reconstructive procedures, it can be a good treatment option for symptomatic ACJ dislocations. Kany J, Amaravathi R, Guinand R, Valenti P. European Journal of Orthopaedic Surgery & Traumatology. [Epub Ahead of Print]

Revision Surgery for Patellofemoral Problems: Should We Always Resurface?

Bicompartmental knee arthroplasties had higher revision rates than TKAs. Femoral component design did not influence the cumulative revision rate. Secondary patella resurfacing in a bicompartmental knee arthroplasty carried an increased revision risk compared to resurfacing at the time of index TKA. To reduce the probability of reoperation for patellofemoral problems, our data suggest the patella should be resurfaced at the time of index surgery. Johnson TC, Tatman PJ, Mehle S, Gioe TJ. Clin Orthop Relat Res . 2011 Aug 20. [Epub ahead of print]PMID: 21858641 PDF

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