Resveratrol inhibits interleukin 1β-mediated inducible nitric oxide synthase expression in articular chondrocytes by activating SIRT1 and thereby suppressing nuclear factor-κB activity.

In chondrocytes, resveratrol, a natural SIRT1 activator, exerts an anti-inflammatory response via inhibition of nuclear factor kappaB (NF-κB). Given that SIRT1 inhibits the transactivation potential of NF-κB by deacetylating acetylated lysines in p65, the NF-κB subunit, we investigated the effects of resveratrol-activated SIRT1 on articular chondrocytes. We found that when chondrocytes were stimulated with interleukin 1β (IL-1β), the time- and dose-dependent expression of inducible nitric oxide synthase (iNOS) expression and nitric oxide (NO) production was suppressed by resveratrol. Resveratrol-activated SIRT1 mediated this suppression. SIRT1 suppressed not only the nuclear translocation of NF-κB but also the acetylation of p65. Furthermore, acetylated Lys310 in p65, which must be present for transactivation activity, was the immediate downstream target of SIRT1. Therefore, SIRT1 protects against the inflammatory response induced by IL-1β in articular chondrocytes. Resveratrol, as an activator of SIRT1, merits consideration as a therapeutic agent in the treatment and prevention of osteoarthritis. Lei M, Wang JG, Xiao DM, Fan M, Wang DP, Xiong JY, Chen Y, Ding Y, Liu SL. Eur J Pharmacol. 2011 Oct 25. [Epub ahead of print] PMID: 22044919

Safety and efficacy of radiation therapy as secondary prophylaxis for heterotopic ossification of non-hip joints.

Prophylactic radiation therapy (RT) is an established adjuvant therapy for heterotopic ossification (HO) of the hip when delivered in the immediate pre- or postoperative setting. Its role in prevention of recurrence after excision of HO is supported by randomised trials for HO of the hip, but there is scant evidence to demonstrate the safety and efficacy of a similar approach in non-hip joints. In the current study, we evaluate radiological and functional outcomes after prophylactic RT for prevention of HO of the knee and upper extremity. Mishra MV, Austin L, Parvizi J, Ramsey M, Showalter TN. J Med Imaging Radiat Oncol. 2011 Jun;55(3):333-6. PMID: 21696569

Smart materials that get bone to heal

Bone tissue is very good at self-healing, but in many situations the natural healing process is not sufficient. In a dissertation at Uppsala University, Sonya Piskounova shows how functional materials that she and her colleagues have developed can form bone tissue in places in the body where there originally was no bone. MedicalXpress

A New Definition for Periprosthetic Joint Infection

A rise in periprosthetic joint infection (PJI) rates has the orthopedic community moving to develop it’s first-ever agreed upon definition and diagnostic criteria to help better treat patients.

The proposed criteria, published in the November issue of Clinical Orthopaedics and Related Research (PDF) was developed by a Musculoskeletal Infection Society working group led by Javad Parvizi, M.D., director of Research at the Rothman Institute at Jefferson. The group analyzed available research, much of which was conducted at Jefferson, to develop the new definition and criteria. Clinical Orthopaedics and Related Research

Any Ortho Uses? Autodesk bringing 3D modeling to the masses.

On Monday, the design software giant will unveil 123D Catch and 123D Make, new tools that are intended to give almost any user the ability to create digital 3D models and schematics. c/net

Lumbar paraspinal compartment syndrome.

The purpose of this study was to systematically review the available evidence on lumbar paraspinal compartment syndrome with specific reference to patient demographics, aetiology, types, diagnosis, clinical features, and treatment. This was an Institutional Review Board-exempt study performed at a Level 1 trauma center. A PubMed search was conducted with the title query: lumbar paraspinal compartment syndrome. Nathan ST, Roberts CS, Deliberato D. Int Orthop. 2011 Oct 26. [Epub ahead of print] PMID: 22038444

Monster Anatomy Upper Limb iPad app is a decent radiographic introduction to the upper limb

Monster Anatomy was prominently featured in older Apple commercials for the original iPad with their Lower Limb Anatomy app. iMedicalApps did a full text and video review of the app last year.

This impressive app was well received by us, although one of its major limitations was the fact that it only covered the lower limb. This has now changed with Monster Anatomy releasing a similar app covering the Upper Limb. iMedicalApps

New on Audio Digest

PATELLA PROBLEMS
Orthopaedics
Volume 34, Issue 22
November 21, 2011The natural history and treatment of patellar dislocation – Robert E. Hunter, MD
Biologic resurfacing of the patella: current options – Brian J. Cole, MD, MBA

Low vitamin D common in spine surgery patients

A new study indicates that many patients undergoing spine surgery have low levels of vitamin D, which may delay their recovery.

In a study of 313 patients undergoing spinal fusion surgery, orthopaedic surgeons at Washington University School of Medicine in St. Louis found that more than half had inadequate levels of vitamin D, including one-fourth who were more severely deficient.

The researchers report their findings today at the 26th Annual Meeting of the North American Spine Society. The study was chosen as one of the meeting's best papers. Eurekalert!

Reimplantation of an Extruded Osteoarticular Segment of the Distal Tibia in a 14-Year-Old Girl. Case Report and Review of the Literature

This case report describes the reimplantation of a 15-cm osteoarticular segment of the distal tibia in a 14-year-old girl who was hit by a truck. The bone fragment was debrided and reimplanted on the day of injury. A free flap was performed within 1 week. Bony union was achieved without complication. At 5-year follow-up, the patient is able to ambulate for several hours at a time without an assistive device, although arthritis of the ankle joint is present. She scores 43.8 on the physical component of the 36-Item Short Form Health Survey and 49.0 on the mental component. The patient states that she is very pleased with her outcome. This seems to be the first description of an osteoarticular segment reimplantation of a long bone in the orthopaedic literature. Farrelly, Erin MD; Ferrari, Louis BA; Roland, Donald MD; DiFelice, Gregory S MD. Journal of Orthopaedic Trauma: POST AUTHOR CORRECTIONS, 22 October 2011.

Use for Ortho? Exenatide (Byetta) has rapid, powerful anti-inflammatory effect, UB study shows

Exenatide, a drug commonly prescribed to help patients with type 2 diabetes improve blood sugar control, also has a powerful and rapid anti-inflammatory effect, a University at Buffalo study has shown. The study of the drug, marketed under the trade name Byetta, was published recently in the Journal of Clinical Endocrinology and Metabolism. 

Apart from corticosteroids, which are known anti-inflammatory drugs, and insulin, no other drug demonstrates such a powerful and rapid anti-inflammatory effect," adds Dandona. Eurekalert!

New Ortho Related Descriptors (MeSH) - 2012

Hyperlinked MeSH Descriptors

Accessory Nerve Injuries

Anatomic Landmarks

Anterior Cruciate Ligament Reconstruction

Bone Anteversion

Bone Retroversion

Brachydactyly

Breakthrough Pain

Cellular Microenvironment

Cementoplasty

Chronic Pain

Coinfection

Coxa Valga

Coxa Vara

Foraminotomy

Glenoid Cavity

Herniorrhaphy

Multidetector Computed Tomography

Musculoskeletal Pain

Nociception

Nociceptive Pain

Numbers Needed To Treat

Occupational Injuries

Osteology

Pain Management

Pelvic Girdle Pain

Peripheral Nerve Injuries

Physical Therapists

Plyometric Exercise

Positron-Emission Tomography/Computed Tomography

Pudendal Nerve

Pudendal Neuralgia

Pulsed Radiofrequency Treatment

Slipped Capital Femoral Epiphyses

Total Disc Replacement

Trigger Points

Ultrasonic Surgical Procedures

Changed Descriptors - 2012

Investigation of factors affecting loosening of Ilizarov ring-wire external fixator systems at the bone-wire interface

The potential for peri-implant bone yielding and subsequent loosening of Ilizarov ring-wire external fixation systems was investigated using non-linear finite element (FE) analyses. A strain-based plasticity model was employed to simulate bone yielding. FE models also incorporated contact behavior at the wire-bone interface, orthotropic elasticity, and periosteal-endosteal variation of bone properties. These simulations were used to determine the extent and location of yielding with change in age-related bone structure and properties for the bone-Ilizarov construct at the tibial midshaft. Finn E. Donaldson, Pankaj Pankaj, A. Hamish R.W. Simpson. Journal of Orthopaedic Research; Article first published online: 31 OCT 2011 PDF

Clinical features of partial anterior bursal-sided supraspinatus tendon (PABST) lesions.

We characterized PABST lesions that may be overlooked because of their peculiar location in the far anterolateral insertional section of the supraspinatus tendon at the bursal side. PABST lesions usually occur in younger patients, and trauma is frequently associated with acute symptom onset. Surgical treatment was effective for pain reduction and functional improvement. Oh JH, Oh CH, Kim SH, Kim JH, Yoon JP, Jung JH. J Shoulder Elbow Surg. 2011 Oct 29. [Epub ahead of print] PMID: 22036541 PDF

The diagnostic accuracy of magnetic resonance imaging and ultrasonography in gluteal tendon tears - a systematic review.

Gluteal tendon tears are one of the many pathologies causing pain around the greater trochanter that are often labelled as trochanteric bursitis. We systematically reviewed the peer-reviewed literature to establish the accuracy of magnetic resonance imaging and ultrasonography in the diagnosis of gluteal tendon tears in patients with persistent lateral hip pain or Greater Trochanteric Pain Syndrome (GTPS). Westacott DJ, Minns JI, Foguet P. Hip Int. 2011 Oct 28: [Epub ahead of print] PMID: 22038311

Effect of Combined Nicotine and Shrapnel Exposure on Pain Measures and Gait After Nerve Injury

A significant fraction of military soldiers sustain nerve injury and use tobacco or nicotine containing products. Healing of nerve injuries is influenced by many factors, such as degree of original injury, healing potential of the nerve, and general health of patient. However, recently, it has been demonstrated that the presence of retained insoluble metal fragments decreases healing. The effects of systemic nicotine administration, with or without metal fragments at the site of nerve injury, were evaluated. Both the nicotine-administered groups (nicotine, nicotine + shrapnel) showed significant increase in the peroneal function compared with untreated controls, as assessed by paw area (p < 0.05). Furthermore, to test possible role of altered sensory function, we used the hot plate assay. Latency to withdraw paw from a hot plate was significantly shorter in nicotine groups (p < 0.05). These data indicate that nicotine improves sensory and motor aspects of nerve function, in the presence or absence of shrapnel. Rittenhouse, Bradley; Hill-Pryor, Crystal D.; McConathy, Adam; Parker, Peter; Franco, Nelson; Toussaint, Esra; Barker, Darrell; Prasad, Balakrishna; Pizarro, Jose M. Military Medicine, Volume 176, Number 11, November 2011 , pp. 1335-1340(6) PDF

FDA Green Lights Non-Opioid Post-Op Pain Drug

The FDA has approved the non-opioid analgesic bupivacaine liposome injectable suspension (Exparel) for use in postsurgical pain relief.  The 1.3% solution delivers extended pain relief through a liposomal platform, called DepoFoam, that allows the drug to be administered into the surgical site, producing postsurgical analgesia for up to 72 hours, according to Pacira Pharmaceuticals. MedPage Today

3 New Eurekalert! Alerts

MIT: New algorithm could substantially speed up MRI scans. MIT researchers have developed a new algorithm that could substantially speed up MRI scans from 45 to 15 minutes.

Drugs used to tackle hospital-acquired infections can increase post-op complications. The introduction of new antibiotic regimes to tackle hospital-acquired infections, such as C. difficile, must take into account the possibility of increased infections following specific surgical procedures.

Physicians who play Mozart while performing colonoscopy may improve adenoma detection rate. Physicians who listen to Mozart while performing colonoscopy may increase their detection rates of precancerous polyps, according to the results of a new study unveiled today.

Yoga Bests Usual Care for Back Function (CME/CE)

In the second study in as many weeks, yoga has again proven superior to routine care for improving function in patients with chronic low back pain, researchers found.

The stretching-and-mindfulness-based therapy improved back function in adult patients in the U.K. with the condition, more than usual care, Helen Tilbrook, MSc, of the University of York, and colleagues reported in the Annals of Internal Medicine. MedPage Today

Radiologists, primary users of non-cardiac ultrasound

Although non-radiologist physicians have contributed to the widespread use of point-of-care (POC) ultrasound, radiologists remain the primary users, according to a study in the November issue of the Journal of the American College of Radiology. POC ultrasound is defined as an ultrasound performed (and interpreted) by the clinician at the bedside.

A recent paper in the New England Journal of Medicine (PDF and video) by Moore and Copel indicated that miniaturization and a drop in costs have facilitated the growth of non-cardiac POC ultrasound by clinicians and that the concept of an "ultrasound stethoscope" is rapidly moving from the theoretical to a reality. Eurekalert!

Stem Cell Cocktail for Us Old Folks

'Rejuvenated' stem cells coaxed from centenarian. Scientists said Tuesday they had transformed age-worn cells in people over 90 -- including a centenarian -- into rejuvenated stemcells that were "indistinguishable" from those found in embryos.

The technical feat, reported in the peer-reviewed journal Genes & Development, opens a new path toward regenerative medicine, especially for the elderly, the researchers said.

Lemaitre and colleagues decided to alter the standard genetic starter kit used to generate adult stemcells by adding two new ingredients -- known as transcription factors -- called NANOG and LIN28. MedicalXpress

New Ortho Related Books in the Health Sciences Library

Click here for spreadsheet.

Those without call numbers have not yet been cataloged.

Fighting fire with fire: 'Vampire' bacteria has potential as living antibiotic

A vampire-like bacteria that leeches onto specific other bacteria – including certain human pathogens – has the potential to serve as a living antibiotic for a range of infectious diseases, a new study indicates.
The bacterium, Micavibrio aeruginosavorus, was discovered to inhabit wastewater nearly 30 years ago, but has not been extensively studied because it is difficult to culture and investigate using traditional microbiology techniques. However, biologists in the University of Virginia's College of Arts & Sciences, Martin Wu and graduate student Zhang Wang, have decoded its genome and are learning "how it makes its living," Wu said.
The bacterium "makes its living" by seeking out prey – certain other bacteria – and then attaching itself to its victim's cell wall and essentially sucking out nutrients.

Unlike most other bacteria, which draw nutrients from their surroundings, M. aeruginosavorus can survive and propagate only by drawing its nutrition from specific prey bacteria. This kills the prey – making it a potentially powerful agent for destroying pathogens. One bacterium it targets is Pseudomonas aeruginosavorus, which is a chief cause of serious lung infections in cystic fibrosis patients.

His study, detailing the DNA sequence of M. aeruginosavorus, is published online in the journal BMC Genomics [link: http://www.biomedcentral.com/1471-2164/12/453 (PDF)].It provides new insights to the predatory lifestyle of the bacterium and a better understanding of the evolution of bacterial predation in general. Eurekalert!

See also: Postop wound Infections

See also the BBC documentary: Phage - The Virus that Cures

Struggling to Be Self-Directed: Residents' Paradoxical Beliefs About Learning.

Self-directed learning (SDL) skills serve as the basis for physician lifelong learning; however, residency training does not typically emphasize SDL skills. To understand residents' needs regarding SDL curricula, the authors used qualitative methods to examine the residency learning culture and residents' views of SDL. Nothnagle M, Anandarajah G, Goldman RE, Reis S. Acad Med. 2011 Oct 25. [Epub ahead of print] PMID: 22030764

Long-term Results of Surgical Decompression of Chronic Exertional Compartment Syndrome of the Forearm in Motocross Racers.

Chronic exertional compartment syndrome (CECS) is occasionally observed in the forearm flexor muscles of motocross racers. Long-term results of fasciectomy and fasciotomy for this syndrome are scarce. Winkes MB, Luiten EJ, van Zoest WJ, Sala HA, Hoogeveen AR, Scheltinga MR. Am J Sports Med. 2011 Oct 26. [Epub ahead of print] PMID: 22031858 PDF

Hook retraction for scapulothoracic arthroscopy.

Scapulothoracic arthroscopy is an established method for evaluating the articulation between the thoracic cage and the scapula. The "chicken-wing" position is often used to enhance visualization of the scapulothoracic space. There are situations in which the chicken-wing position is not feasible or practical, such as in simultaneous arthroscopy of both joints. In this article, we describe a new technique that aids in arthroscopy of the scapulothoracic joint, particularly when the chicken-wing position is unavailable. William Beaumont Army Medical Center, El Paso, Texas, USA. Thomas DM, Hansen U, Owens BD. Am J Orthop (Belle Mead NJ). 2011 Jul;40(7):372-3. PMID: 22013575

Dual delivery of an antibiotic and a growth factor addresses both the microbiological and biological challenges of contaminated bone fractures.

Introduction: Open fractures are plagued by high complication rates, among which infection and nonunion are the most common, leading to higher morbidity and poor patient outcomes. Despite meticulous surgical care and employment of adjunctive therapies, infection rates remain at 20%, due to the limitations of conventional therapies. Areas covered: Persistent bacteria often survive initial debridement and treatment with antibiotics. Thus, the bone graft subsequently implanted to promote healing can be the nidus for infection. The principles of biofilm theory and the "race to the surface" have been applied to develop dual-purpose bone grafts that are protected by a sustained release of an antibiotic, thereby preventing bacterial colonization. A simultaneous sustained release of a recombinant human growth factor allows the defect to become vascularized and heal. Expert opinion: Current therapies fail to meet the challenges of open fractures. Tissue engineering and drug delivery approaches can address the challenges of healing large bone defects while protecting the implant from infection. When combined as an adjunctive therapy with existing clinical practices for management of open fractures, dual-purpose bone grafts that release both an antibiotic and a growth factor at biologically relevant time scales can potentially reduce infection rates and improve patient outcomes.  United States Army Institute of Surgical Research , Extremity Trauma & Regenerative Medicine Task Area. Wenke JC, Guelcher SA. Expert Opin Drug Deliv. 2011 Oct 22. [Epub ahead of print] PMID: 22017669

Accuracy of blind versus ultrasound-guided suprapatellar bursal injection.

RESULTS.: US-guided HA injection exhibited a significantly greater accuracy (48 of 50 knees, 96.0%) than blind injection (41 of 49 knees, 83.7%). Bum Park Y, Ah Choi W, Kim YK, Chul Lee S, Hae Lee J. J Clin Ultrasound. 2011 Oct 28. [Epub ahead of print] PMID: 22033897

Bone tissue composition varies across anatomic sites in the proximal femur and the iliac crest.

Thus, the average cortical tissue mineral content and the widths of the distributions of cortical crystal size/perfection differ at the subtrochanteric femur relative to the greater trochanter and the iliac crest. In particular, the cortex of the iliac crest has lower mineral content relative to that of the subtrochanteric femur and may have limited utility as a surrogate for subtrochanteric bone. Donnelly E, Meredith DS, Nguyen JT, Boskey AL. J Orthop Res. 2011 Oct 27. doi: 10.1002/jor.21574. [Epub ahead of print] PMID: 22034199

Multi-touch table system for medical visualization: application to orthopedic surgery planning.

Medical imaging plays a central role in a vast range of healthcare practices. The usefulness of 3D visualizations has been demonstrated for many types of treatment planning. Nevertheless, full access to 3D renderings outside of the radiology department is still scarce even for many image-centric specialties. Our work stems from the hypothesis that this under-utilization is partly due to existing visualization systems not taking the prerequisites of this application domain fully into account. We have developed a medical visualization table intended to better fit the clinical reality. The overall design goals were two-fold: similarity to a real physical situation and a very low learning threshold. This paper describes the development of the visualization table with focus on key design decisions. The developed features include two novel interaction components for touch tables. A user study including five orthopedic surgeons demonstrates that the system is appropriate and useful for this application domain. Lundström C, Rydell T, Forsell C, Persson A, Ynnerman A. IEEE Trans Vis Comput Graph. 2011 Dec;17(12):1775-84. PMID: 22034294

Must Read: M.R.I.’s, Often Overused, Often Mislead, Doctors Warn

Dr. James Andrews, a widely known sports medicine orthopedist in Gulf Breeze, Fla., wanted to test his suspicion that M.R.I.’s, the scans given to almost every injured athlete or casual exerciser, might be a bit misleading. So he scanned the shoulders of 31 perfectly healthy professional baseball pitchers.

The pitchers were not injured and had no pain. But the M.R.I.’s found abnormal shoulder cartilage in 90 percent of them and abnormal rotator cuff tendons in 87 percent. “If you want an excuse to operate on a pitcher’s throwing shoulder, just get an M.R.I.,” Dr. Andrews says. Published: October 28, 2011 in The NYT

Journal of Surgical Education: in press, corrected proofs

Operating Room Fatigue: Is Your Twentieth Surgical Knot as Strong as Your First? PDF

Self-Regulated Learning Strategies Used in Surgical Clerkship and the Relationship with Clinical Achievement PDF

Learning Styles of First-Year Orthopedic Surgical Residents at 1 Accredited Institution PDF

Mastery Learning Simulation-Based Curriculum for Laparoscopic TEP Inguinal Hernia Repair PDF

Descriptive Operative Reports: Teaching, Learning, and Milestones to Safe Surgery PDF

Sleep, Supervision, Education, and Servi Views of Junior and Senior Residents PDF

The American Journal of Sports Medicine: PreView articles

Long-term Results of Surgical Decompression of Chronic Exertional Compartment Syndrome of the Forearm in Motocross Racers

The Incidence and Clinical Relevance of Graft Hypertrophy After Matrix-Based Autologous Chondrocyte Implantation

Relationship Between Proximal Femoral and Acetabular Alignment in Normal Hip Joints Using 3-Dimensional Computed Tomography

Man gets smartphone dock built into prosthetic arm

Source: The Telegraph

A British man has become the world's first ever patient to have a smartphone docking system built into his prosthetic arm. Trevor Prideaux, who was born without his left arm, used to have to balance the smartphone on his prosthetic arm or put it on a flat surface to use it.

But now Mr Prideaux, 50, can call and text his loved ones without moving the mobile, which is embedded into his fibreglass and laminate limb. The Telegraph

Extracorporeal shockwave-induced expression of lubricin in tendons and septa.

Lubricin, a lubricating glycoprotein that facilitates tendon gliding, is upregulated by mechanical as well as biochemical stimuli, prompting this study of its induction by extracorporeal shockwave therapy (ESWT). The objective of this study was to characterize and quantify the effect of ESWT on lubricin expression in tendons and septa in a rat model. Hindlimbs of six rats were treated with low-dose ESWT and those of another six with high-dose ESWT, using contralateral limbs as controls. After 4 days, resected samples were processed for immunolocalization of lubricin using a purified monoclonal antibody. ESWT was found to increase lubricin expression in both low-dose and high-dose ESWT-treated tendons and also in septa. Lubricin expression generally increased with increasing dose of ESWT. Increased lubricin expression may contribute to the beneficial effects of ESWT in providing pain and symptom relief in musculoskeletal disorders by decreasing erosive wear. Zhang D, Kearney CJ, Cheriyan T, Schmid TM, Spector M. Cell Tissue Res. 2011 Oct 19. [Epub ahead of print] PMID: 22009294 

Lubricin PubMed RSS Search

An Introduction to Inkling – the future of medical education

If you have been a regular reader of iMedicalApps.com, then you will have heard of Inkling, the interactive electronic textbook company.

If you haven’t, then allow me to introduce you to one aspect of the future of medical education. Inkling has enjoyed a meteoric rise since their humble beginnings in 2010, and we are a massive fan of their body of work. In the first of this series on Inkling, we are going to look at their company profile and the impact they are making in the medical education sector. iMedicalApps

Understanding The Orthopedic Surgeon Salary | Apparent Articles

The area of orthopedic surgery had grown in popularity and has increased the competition in this field. Even with the competition, the Bureau of Labor Statistics is predicting that this area of specialty will continue to grow. The range for orthopedic surgeon salary starts at three hundred and fifty thousand annually, and can go over five hundred thousand annually. The highest salaries are earned by doctors who work in a private practice. Apparent Articles

Epocrates app for iPhone gets major facelift, akin to Facebook app

Epocrates has done a tremendous facelift on their mobile app for the iPhone. Gone are the basic menu trees, and replacing them are moveable icons, similar to an older version of the Facebook app, before it’s recent reincarnation. iMedicalApps

Lower dose of corticosteroids just as effective as higher for shoulder pain

Although corticosteroid injections are one of the most common treatments for shoulder pain, there have been relatively few high-quality investigations of their efficacy and duration of action. In a study scheduled for publication in the December issue of the Archives of Physical Medicine and Rehabilitation, researchers report on the first comparative study of the two most commonly corticosteroid doses administered for shoulder pain. They found that lower doses were just as effective as higher doses in terms of reduction of pain, improved range of motion and duration of efficacy. Eurekalert!  PDF

PubMed Alternative? NLMplus is Featured by the NLM

NLMplus ( http://nlmplus.com) is an innovative semantic search and discovery application, developed by WebLib LLC, a small business in Maryland, in response to a challenge contest by the National Library of Medicine (NLM) to make use of NLM’s vast collection of biomedical data and services for the benefit of the Library’s diverse worldwide user communities. ScienceRoll

Six year outcome excision of the trapezium for trapeziometacarpal joint osteoarthritis: is it improved by ligament reconstruction and temporary Kirschner wire insertion?

This randomized prospective study compared the treatment of trapeziometacarpal joint osteoarthritis with a) trapeziectomy with no ligament reconstruction, no soft tissue interposition and no temporary Kirschner wire stabilization (Group T); b) trapeziectomy with flexor carpi radialis ligament reconstruction and interposition and temporary K-wire stabilization (Group T+LRTI). Salem H, Davis TR. J Hand Surg Eur Vol. 2011 Oct 24. [Epub ahead of print] PMID: 22025011

Hyponatremia and bone: an emerging relationship.

Hyponatremia is the most common electrolyte disorder and is mainly known for its neurological complications. New studies suggest previously unrecognized complications of hyponatremia, including falls, osteoporosis and fractures. Because these novel associations are mainly derived from epidemiological studies, it remains unclear whether hyponatremia has a direct effect on bone or whether it is a surrogate marker of another etiology. Hoorn EJ, Liamis G, Zietse R, Zillikens MC. Nat Rev Endocrinol. 2011 Oct 25. [Epub ahead of print] PMID: 22024973

Fourth and fifth carpometacarpal fracture and dislocation of the hand: new classification and treatment

Cain’s classification of fourth and fifth carpometacarpal (CMC) fracture and dislocation does not include the intraarticular metacarpal (MC) base fracture that may influence the treatment outcome. We reviewed 37 cases of fourth and fifth CMC fracture and dislocation treated with operative method, and we have devised a new classification based on the articular surface of the hamate and the involvement of the MC base. Sang-Uk Lee, Il-Jung Park, Hyoung-Min Kim, Changhoon Jeong and Jin-Rok Oh. European Journal of Orthopaedic Surgery & Traumatology;  DOI: 10.1007/s00590-011-0887-6. Epub ahead of print.

Clinical Use of High-Resolution Ultrasonography for the Diagnosis of Type II Accessory Navicular Bone.

Medial foot pain is a common complaint in rehabilitation clinics. The differential diagnoses include many musculoskeletal disorders like tendonitis and inflammation of ossicles. Posterior tibialis tendonitis is a common cause of foot pain in adults. The accessory navicular (AN) bone is occasionally observed and considered as a secondary ossification center of the navicular bone. Occasionally, posterior tibialis tendonitis and AN bone may cause acute or chronic medial foot pain with varying degrees of dysfunction. Chuang YW, Tsai WS, Chen KH, Hsu HC. Am J Phys Med Rehabil. 2011 Oct 22. [Epub ahead of print] PMID: 22024638

Journal of Orthopaedic Trauma: epub ahead of print

Early Radial Head Excision for Displaced and Comminuted Radial Head Fractures: Considerations and Concerns at Long-Term Follow-Up

An Off-Loading Triceps Suture for Augmentation of Plate Fixation in Comminuted Osteoporotic Fractures of the Olecranon

Infection After Spanning External Fixation for High-Energy Tibial Plateau Fractures: Is Pin Site-Plate Overlap a Problem?

Pelvic Ring Injury Is Associated With Sexual Dysfunction in Women

Mechanical stress can help or hinder wound healing depending on time of application

A new study demonstrates that mechanical forces affect the growth and remodeling of blood vessels during tissue regeneration and wound healing. The forces diminish or enhance the vascularization process and tissue regeneration depending on when they are applied during the healing process.

The study found that applying mechanical forces to an injury site immediately after healing began disrupted vascular growth into the site and prevented bone healing. However, applying mechanical forces later in the healing process enhanced functional bone regeneration. The study's findings could influence treatment of tissue injuries and recommendations for rehabilitation.

The study was published last month in the journal Proceedings of the National Academy of Sciences. The research was supported by the National Institutes of Health, the Armed Forces Institute of Regenerative Medicine and the U.S. Department of Defense. Eurekalert!

Musculoskeletal neoplasms: biopsy and intervention.

Percutaneous core needle biopsy and fine-needle aspiration are safe and cost-effective methods and can be important steps in the workup of a bone or soft tissue lesion. These procedures should be performed in collaboration with the orthopedic oncologist who performs the definitive surgery. In the extremities, attention to compartmental anatomy is paramount. With frozen section evaluation at the time of biopsy, the chances of a nondiagnostic specimen necessitating rebiopsy are minimized. The principles underlying the percutaneous approach to various lesions are valuable and can be applied to minimally invasive percutaneous therapy for bone and soft tissue lesions. Huang AJ, Kattapuram SV. Radiol Clin North Am. 2011 Nov;49(6):1287-305. PMID: 2202429

Military Medicine Works on Managing Pain

Military medicine is seeking additional ways to help patients manage their pain instead of just prescribing powerful drugs, the chief of staff of the Army’s pain management task force said here today. Col. Kevin Galloway told the Defense Writers Group that the military had to start looking at pain comprehensively. DoD

Todd Kuiken (Physiatrist/Engineer): A prosthetic arm that "feels"

Physiatrist and engineer Todd Kuiken is building a prosthetic arm that connects with the human nervous system -- improving motion, control and even feeling. Onstage, patient Amanda Kitts helps demonstrate this next-gen robotic arm. TED Talks

Increasing surgeon productivity: the effect of the addition of musculoskeletal physicians to an orthopedic surgery department.

The orthopedic surgery department at Mayo Clinic, Jacksonville, Florida, sought to improve the productivity of individual surgeons while maintaining quality of patient care as well as patient and physician satisfaction by expanding the department to include dedicated nonoperative musculoskeletal physicians who would evaluate patients and refer those requiring surgical care to surgeons within the department. With the addition of two such physicians, the yield of surgical patients by orthopedic surgeons increased by 20%, and the direct margin of the department increased by 19%. Moreover, referring physicians and patients were very satisfied with the care provided by the musculoskeletal physicians. Vizzini MR, O'Connor MI. J Med Pract Manage. 2011 Jul-Aug;27(1):29-35. PMID: 21936428

Color and Power Doppler US for Diagnosing Carpal Tunnel Syndrome and Determining Its Severity: A Quantitative Image Processing Method.

Color Doppler US can be used to accurately diagnose CTS. By processing the recorded power Doppler images and determining the number of pixels in the intraneural vascular area, the severity of CTS can be assessed. Ghasemi-Esfe AR, Khalilzadeh O, Vaziri-Bozorg SM, Jajroudi M, Shakiba M, Mazloumi M, Rahmani M.

Radiology. 2011 Nov;261(2):499-506. Epub 2011 Sep 7. PMID: 21900619

Diagnostic ultrasound for traumatic radial neuropathy.

The radial nerve is the most commonly injured nerve in cases of long-bone fracture.1 Traditionally, radial neuropathy following trauma is evaluated through a combination of history, examination, electrodiagnostic studies, and, in some cases, surgical exploration.2 Recent studies suggest that high-resolution ultrasound may be valuable in the pre-operative assessment of traumatic neuropathies.3-5 However, the benefit of dynamic ultrasound imaging (with movement of the arm in several positions) for traumatic radial nerve injury has not been described. We present a case in which dynamic high-resolution ultrasonography assisted in the diagnosis and treatment decision-making in an individual with a traumatic radial neuropathy. Cartwright MS, Yoon JS, Lee KH, Deal N, Walker FO. Am J Phys Med Rehabil. 2011 Apr;90(4):342-3. PMID: 20531154 PDF

The Effect of Operative Timing on Functional Outcome After Isolated Spinal Trauma

To evaluate the effect of operative timing on functional outcome in patients suffering spinal trauma, we conducted a retrospective analysis of the National Trauma Data Bank. By treating time to operation as a categorical variable and limiting our analysis to isolated spinal trauma, we hypothesized that time to operation would not be a predictor of functional outcome. Sacks, Greg D. MD, MPH; Panchmatia, Jaykar R. MA, MPH, MB BChir, MRCS (Eng); Marino, Miguel PhD; Hill, Caterina MSc; Rogers, Selwyn O. Jr. MD, MPH. Journal of Trauma-Injury Infection & Critical Care: POST AUTHOR CORRECTIONS, 24 October 2011

Correlation between radiological assessment of acute ankle fractures and syndesmotic injury on MRI

Owing to the shortcomings of clinical examination and radiographs, injury to the syndesmotic ligaments is often misdiagnosed. When there is no indication requiring that the fractured ankle be operated on, the syndesmosis is not tested intra-operatively, and rupture of this ligamentous complex may be missed. Subsequently the patient is not treated properly leading to chronic complaints such as instability, pain, and swelling. We evaluated three fracture classification methods and radiographic measurements with respect to syndesmotic injury. J. J. Hermans, N. Wentink, A. Beumer, W. C. J. Hop, M. P. Heijboer, A. F. C. M. Moonen, A. Z. Ginai. Skeletal Radiology; Online Date Wednesday, October 19, 2011.

Diagnosis of bursal-side partial-thickness rotator cuff tears.

To study the clinical features and diagnosis of bursal-side partial-thickness rotator cuff tears. Methods:  From August 1999 to June 2006, 38 patients with bursal-side partial-thickness rotator cuff tear were evaluated. Twenty-eight men and ten women of average age 45.7 years (range, 18-69 years) with 11 left and 27 right shoulders were studied. According to the Ellman classification, 6 cases were classified as grade I, 7 as II and 25 as III. Physical and X-ray examination, including anteroposterior and supraspinatus outlet views, were performed on both shoulders of all patients. Ultrasonography and MR examination were performed in 27 and 35 patients, respectively. Xiao J, Cui GQ, Wang JQ. Orthop Surg. 2010 Nov;2(4):260-5. PMID: 22009960

Groin pain beyond the hip: how anatomy predisposes to injury as visualized by musculoskeletal ultrasound and MRI.

The purpose of this article is to show ultrasound and MRI examples of the normal anatomic structures and their resulting modifications from trauma and disease. CONCLUSION: Although groin pain from hip pathology is well recognized, lower anterior abdominal wall and anterior pelvis structures can be interrelated sources of pain. Brandon CJ, Jacobson JA, Fessell D, Dong Q, Morag Y, Girish G, Jamadar D. AJR Am J Roentgenol. 2011 Nov;197(5):1190-7. PMID: 22021514

Surgical Treatment within Six Months of Lumbar Disc Herniation Symptoms Associated with Improved Outcomes

A new study in the Journal of Bone and Joint Surgery (JBJS) found that patients with herniated lumbar disc symptoms were significantly worse if the patients had symptoms for more than six months prior to treatment, compared to those who had symptoms for six months or less. Symptoms included pain, function, general health, work status and patient satisfaction. AAOS

BMP-2 Researchers Minimized Cancer Finding

In 2009, when researchers were preparing to publish findings from a pivotal trial of a novel spinal fusion product, they discovered that the number of cancer cases among patients treated with bone morphogenetic protein-2 (BMP-2) had crossed the threshold for statistical significance -- but they chose to omit this information from the manuscript.

Medtronic, the company that paid for the study, was also aware that cancer had gone from a non-significant adverse event affecting eight patients, to a small, but significant side effect seen in nine patients. But it, too, said nothing.

That silence constitutes an ethical breach, according to independent researchers, but it is only the latest controversy revealed during an ongoing investigation by the Journal Sentinel/MedPage Today into the relationship between a group of prominent spine surgeons who have been paid millions by Medtronic. MedPage Today

Tensile properties, collagen content, and crosslinks in connective tissues of the immature knee joint.

The major connective tissues of the knee joint act in concert during locomotion to provide joint stability, smooth articulation, shock absorption, and distribution of mechanical stresses. These functions are largely conferred by the intrinsic material properties of the tissues, which are in turn determined by biochemical composition. A thorough understanding of the structure-function relationships of the connective tissues of the knee joint is needed to provide design parameters for efforts in tissue engineering. Eleswarapu SV, Responte DJ, Athanasiou KA. PLoS One. 2011;6(10):e26178. Epub 2011 Oct 13. PMID: 22022553 PDF

Skin-like sensor flexible enough for prosthetic limbs

Researchers at Stanford are developing new sensors so flexible and pressure-sensitive that they could be used to make touch-sensitive prosthetic limbs, pressure-sensitive badges, and more. CNET

University of Delaware to lead DoD orthopaedic rehabilitation consortium

The Department of Defense (DoD) Congressionally Directed Medical Research Programs (CDMRP) Peer Reviewed Orthopaedic Research Program (PRORP) has awarded a $19.7 million grant to the University of Delaware to create and manage a consortium that will improve the quality of life for warfighters who suffer significant limb injuries in combat.

The Bridging Advanced Developments for Exceptional Rehabilitation (BADER) Consortium will conduct clinical trial research at several hospitals, both military and civilian, across the country. Congressionally Directed Medical Research Programs (CDMRP)

My list of 25 free essential Android apps

I just wiped out my smartphone and I was going through the process of installing apps all over again. I decided that I would share my list of 25 free apps that I'm running on my smartphone.

I'm not including apps that are built-in like Maps, Facebook, Gmail, etc. I'm only listing apps that you have to download and install through the Android market. Medical SmartPhones

Early effect of hyaluronic acid intra-articular injections on serum and urine biomarkers in patients with knee osteoarthritis: An open-label observational prospective study

The aim of the study was to investigate the effect of hyaluronic acid (HA) intra articular injections (IA) on osteoarthritis (OA) biomarkers in patients with knee OA. Prospective open label study. Fifty-one patients with unilateral symptomatic K-OA received IA injections of 2mL of HA on days (D) 1, 7, 14 and were followed 3 months. Conrozier, T., Balblanc, J.-C., Richette, P., Mulleman, D., Maillet, B., Henrotin, Y., Rannou, F., Piroth, C., Hilliquin, P., Mathieu, P., Walliser-Lohse, A., Rousselot, I., Plattner, V., Maillefert, J.-F., Vignon, E., Chevalier, X. Journal of Orthopaedic Research; Article first published online: 24 OCT 2011 PDF

Infection After Spanning External Fixation for High-Energy Tibial Plateau Fractures: Is Pin Site-Plate Overlap a Problem?

The purpose of this study was to determine whether overlap between temporary external fixator pins and definitive plate fixation correlates with infection in high-energy tibial plateau fractures. Laible, Catherine MD; Earl-Royal, Emily BA; Davidovitch, Roy MD; Walsh, Mike PhD; Egol, Kenneth A MD. Journal of Orthopaedic Trauma: POST AUTHOR CORRECTIONS, 18 October 2011. PDF

The American Journal of Sports Medicine PreView Articles

Predictors of Radiographic Knee Osteoarthritis After Anterior Cruciate Ligament Reconstruction PDF

Effects of Platelet-Rich Fibrin Matrix on Repair Integrity of At-Risk Rotator Cuff Tears PDF

New Suture Method for Radial Tears of the Meniscus: Biomechanical Analysis of Cross-Suture and Double Horizontal Suture Techniques Using Cyclic Load Testing PDF

Traumatic Patellar Dislocation: Nonoperative Treatment Compared With MPFL Reconstruction Using Patellar Tendon PDF

Volar Plating for Unstable Proximal Interphalangeal Joint Dorsal Fracture-Dislocations

Fixation of unstable PIP joint DFDs via a volar approach is technically feasible with mini plates and screws. This treatment allows early active range of motion and provides good objective and subjective outcomes; however, noteworthy complications occurred in 39% of patients. Andre E.J. Cheah, David M.K. Tan, Alphonsus K.S. Chong, Winston Y.C. Chew. The Journal of Hand Surgery. In Press, Corrected Proof available online 22 October 2011 PDF

Host serum is not indispensable in collagen performance in viable meniscal transplantation at 4-week incubation

Viable meniscal transplantation has been criticized as an expensive and logistically demanding technique. The purpose was to compare the standard culture medium with another culture medium that is more widely available and easier to work with and to assess the collagen net ultrastructure architecture and the capacity of the preserved cells to produce proteins. Pablo Eduardo Gelber, Raúl Torres, Natalia Garcia-Giralt, Juan Erquicia, Ferran Abat and Juan Carlos Monllau. Knee Surgery, Sports Traumatology, Arthroscopy. DOI: 10.1007/s00167-011-1722-7

Treatment of trans-scaphoid perilunate dislocations using a volar approach with scaphoid osteosynthesis and temporary Kirschner wire fixation

Trans-scaphoid perilunate fracture dislocations (TSPLD) are uncommon injuries and constitute about 3% of all carpal injuries. Up to 25% of these high energy trauma cases go undiagnosed. Presented are 43 (3 female, 40 male) consecutive patients treated for dorsal TSPLD, all were closed fractures. Malović M, Pavić R, Milosević M. Mil Med. 2011 Sep;176(9):1077-82. PMID: 21987969 PDF

Magnetic resonance imaging in glenohumeral instability.

The glenohumeral joint is the most commonly dislocated joint of the body and anterior instability is the most common type of shoulder instability. Magnetic resonance (MR) imaging, and more recently, MR arthrography, have become the essential investigation modalities of glenohumeral instability, especially for pre-procedure evaluation before arthroscopic surgery. Injuries associated with glenohumeral instability are variable, and can involve the bones, the labor-ligamentous components, or the rotator cuff. Anterior instability is associated with injuries of the anterior labrum and the anterior band of the inferior glenohumeral ligament, in the form of Bankart lesion and its variants; whereas posterior instability is associated with reverse Bankart and reverse Hill-Sachs lesion. Multidirectional instability often has no labral pathology on imaging but shows specific osseous changes such as increased chondrolabral retroversion. This article reviews the relevant anatomy in brief, the MR imaging technique and the arthrographic technique, and describes the MR findings in each type of instability as well as common imaging pitfalls  Jana M, Gamanagatti S. World J Radiol. 2011 Sep 28;3(9):224-32. PMID: 22007285  PDF

Limb salvage in open tibia fractures: are prehospital time and tourniquet significant?

Letter to Editor

Are spine injuries sustained in battle truly different?

Battle spine injury and NBSI are separate entities that may ultimately have disparate long-term prognoses. Nonbattle spine injury patients, although having similar MOIs compared with civilian spinal trauma, maintain a different patient demographic. Further research must be directed at accurately quantifying the long-term disabilities of all spine injuries sustained in a combat theater, whether they are the result of battle or not. Blair JA, Patzkowski JC, Schoenfeld AJ, Cross Rivera JD, Grenier ES, Lehman RA, Hsu JR; Skeletal Trauma Research Consortium (STReC). Spine J. 2011 Oct 13. [Epub ahead of print] PMID: 22000726

Trabecular microstructure of the human lunate in Kienbock's disease.

The trabecular microstructure of normal lunates and lunates with Kienböck's disease was investigated using micro-computed tomography (micro-CT). Five lunates with advanced Kienböck's disease were obtained during lunate excision and scaphocapitate fusion, and five control lunates were from embalmed cadavers. Microstructural morphometric parameters were measured using micro-CT images. Han KJ, Kim JY, Chung NS, Lee HR, Lee YS. J Hand Surg Eur Vol. 2011 Sep 30. [Epub ahead of print] PMID: 21965181 PDF

See also:
Kienböck's disease

Autologous osteochondral graft for traumatic defects of finger joints.

Finger joint defects in 16 adults were treated with an autologous osteochondral graft from the base of the second metacarpal, the radial styloid, the base of the third metacarpal or the trapezoid and these patients were followed up from between 12 and 62 months. There was no donor site morbidity. One patient had resorption of the graft and developed pain. The joint was subsequently fused. The mean range of movement was 55.8% of the opposite normal joint. At follow up, 15 patients had no discomfort or mild discomfort. Three had mild narrowing of the joint space and two had slight joint subluxation. Only two patients with concomitant severe injury to the same limb had difficulty performing daily activities. Ten were open injuries and these had poorer outcomes. A hemicondylar defect of a finger joint can be treated using an osteochondral graft obtained from the same hand. Wu WC, Fok MW, Fung KY, Tam KH. J Hand Surg Eur Vol. 2011 Oct 14. [Epub ahead of print] PMID: 22002507 PDF

MR imaging of the postoperative knee.

Advances in orthopedic and arthroscopic surgical procedures of the knee such as, knee replacement, ligamentous reconstruction as well as articular cartilage and meniscus repair techniques have resulted in a significant increase in the number of patients undergoing knee arthroscopy or open surgery. As a consequence postoperative MR imaging examinations increase. Comprehensive knowledge of the normal postoperative MR imaging appearances and abnormal findings in the knee associated with failure or complications of common orthopedic and arthroscopic surgical procedures currently undertaken is crucial. This article reviews the various normal and pathological postoperative MR imaging findings following anterior and posterior cruciate ligament, medial collateral ligament and posterolateral corner reconstruction, meniscus and articular cartilage surgery as well as total knee arthroplasty with emphasis on those surgical procedures which general radiologists will likely be faced in their daily clinical routine. Gnannt R, Chhabra A, Theodoropoulos JS, Hodler J, Andreisek G. J Magn Reson Imaging. 2011 Nov;34 5):1007-21. PMID: 22002752

Virtual Issues from the Journal of Orthopaedic Research

Cutting Edge Issues in Hip and Knee Arthroplasty, October 2011

Advances in Distraction Osteogenesis, July 2011

Musculoskeletal Regenerative Medicine and Tissue Engineering, May 2011

Can We Improve Fracture Treatment?, April 2011

Computer-Assisted Orthopaedic Surgery, March 2011

Advances in Understanding of Joint Function, January 2011

See also:
Early Vew Articles

The Journal of Trauma: [Epub ahead of print]

1. Low Complication Rate Associated With Raising Mature Flap for Tibial Nonunion Reconstruction. Will RE, Fleming ME, Lafferty PM, Fletcher JW, Cole PA. J Trauma. 2011 Oct 13. [Epub ahead of print] PMID: 22002619 PDF

2. Scaphoid Fracture Epidemiology. Duckworth AD, Jenkins PJ, Aitken SA, Clement ND, Court-Brown CM, McQueen MM. J Trauma. 2011 Oct 13. [Epub ahead of print] PMID: 22002617 PDF

3. A Comparison of Absorbable Screws and Metallic Plates in Treating Calcaneal Fractures: A Prospective Randomized Trial. Zhang J, Ebraheim N, Lausé GE, Xiao B, Xu R. J Trauma. 2011 Oct 13. [Epub ahead of print] PMID: 22002615 PDF

Ossification process involving the human thoracic ligamentum flavum: role of transcription factors

Ossification of the ligamentum flavum (OLF) of the spine is associated with serious neurologic compromise, but the pathomechanism of this process remains unclear. The objective of this study was to investigate the pathomechanism of the ossification process, including the roles of various transcriptional factors in the ossification of human thoracic ligamentum flavum. Kenzo Uchida, Takafumi Yayama, Hong-Xin Cai, Hideaki Nakajima, Daisuke Sugita, Alexander Rodríguez Guerrero, Shigeru Kobayashi, Ai Yoshida, Ke-Bing Chen and Hisatoshi Baba. Arthritis Research & Therapy.2011-10-01. PDF

Computer-assisted patellar resection system: Development and insights

Incorrect resection of the patella during total knee arthroplasty (TKA) can lead to anterior knee pain (AKP), patellar maltracking, patellofemoral impingement, patellar fracture, component loosening, and reduced range of motion. Computer-assisted surgery (CAS) systems for the tibia and femur improve cut accuracy, but no CAS system is available for patellar resection. We developed a system that included an optoelectronic localizer, marker arrays on the patella and instruments, and navigation software. Chun Kit Fu1,Jeff Wai, Estee Lee, Carol Hutchison, Curtis Myden, Eldridge Batuyong, Carolyn Anglin. Journal of Orthopaedic Research. Article first published online: 17 OCT 2011 PDF

Google Body Browser Victim of Google Labs Shutdown, Lives on as Zygote Body

As announced by Google last July, it has shut down Labs, the playground where you could test unfinished prototypes built by Google engineers. One of the victims is Google Body Browser, the impressive Google Earth-like explorer for the human body, which was only launched last December.

However, no time for crying, as it will live on as Zygote Body, which will be a free application available online and as an Android app (Zygote is also the company which originally created the 3D models used in the body browser). The code for the 3D viewer behind Google Body will be open-sourced. Here is the announcement that was previously displayed on the Body Browser page:

As Google Labs winds down, we will be retiring Google Body. However, you will soon be able to find its functionality elsewhere. We are working on open-sourcing the code that powers Google Body so that anyone will be able to create and run a searchable 3D viewer. We are also working with our partner, Zygote Media Group, on an application called Zygote Body. This application will be free, available on the web and on Android, and will enable students, teachers, and others using Google Body to continue to have access to a human anatomy browser. MedGadget

Omega-3 fatty acids shown to prevent or slow progression of osteoarthritis

New research has shown for the first time that omega-3 in fish oil could "substantially and significantly" reduce the signs and symptoms of osteoarthritis.

According to the University of Bristol study, funded by Arthritis Research UK and published in the journal Osteoarthritis and Cartilage, omega-3-rich diets fed to guinea pigs, which naturally develop osteoarthritis, reduced disease by 50 per cent compared to a standard diet. Eurekalert!

UGA study suggests key to avoiding ankle re-injury may be in the hips and knees

Nearly all active people suffer ankle sprains at some point in their lives, and a new University of Georgia study suggests that the different ways people move their hip and knee joints may influence the risk of re-injury.

In the past, sports medicine therapists prescribed strengthening and stretching exercises that targeted only ankle joints after a sprain. The study by UGA kinesiology researchers, published in the early online edition of the journal Clinical Biomechanics, suggests that movements at the knee and hip joints may play a role in ankle sprains as well. University of Georgia

New on Audio Digest. Must sign in first. User name and password on library intranet.

ARTHROSCOPIC SHOULDER REPAIR
Orthopaedics
Volume 34, Issue 21
November 7, 2011
Acute anterior dislocation of the shoulder: has the standard changed? – Robert A. Arciero, MD
Maximizing results with arthroscopic 270º labral repair – Dr. Arciero
Revision of failed instability surgery – Dr. Arciero
Bone defects – Dr. Arciero

ALL ABOUT BONE
Orthopaedics
Volume 34, Issue 20
October 21, 2011
Beyond BMD: bone quality and bone strength – Mary L. Bouxsein, PhD
Bone imaging: what's on the horizon – Dr. Bouxsein

For knee and hip surgeries, robots show promise for a better fit

Orthopedic surgeons are doctors, but they are also artisans, sculpting bone so that it fits snugly with artificial hips and knees.

But even the best artists make mistakes, says Dr. William Bargar, an orthopedic surgeon at Sutter General Hospital in Sacramento, and the imperfections that are charming in handicrafts have no place in modern medicine. That's why he invented the bone-drilling Robodoc.

The robot, which excavates bones to make room for hip and knee replacements, is made by Curexo Technology Corp. in Fremont, Calif. It and another surgical tool, Robotic Arm Interactive Orthopedic (RIO) System made by Mako Surgical Corp. of Fort Lauderdale, Fla., are designed to minimize human error and turn surgical art into operating-room engineering. latimes.com

Older adults' experiences regarding discharge from hospital following orthopaedic intervention: A metasynthesis.

Older adults' experiences around hospital discharge, collected through qualitative research, provide health authorities with valuable information that could be used in care pathway planning. Health professionals involved in in-patient and community care should be aware that a perceived loss of independence, function and activity limitations, and the ability to cope with pain can influence mental outlook and consequently rehabilitation. Perry MA, Hudson HS, Meys S, Norrie O, Ralph T, Warner S. Disabil Rehabil. 2011 Oct 8. [Epub ahead of print] PMID: 21981113

Multiple stress fractures of the lower extremity in healthy young men

Stress fractures result from abnormal stresses imposed on normal bones by the continued and repeated actions of muscles or from normal stresses imposed on abnormal bones. The risk factors that can cause such stress fractures include excessive use, such as, in soldiers or athletes, nutritional deficiencies, and endocrine disorders. In addition, disease may arise from long-standing rheumatoid arthritis, osteoporosis, corticosteroid therapy, joint stiffness or contracture, or the correction of angular deformity. In these cases, stress fractures may occur in one area or multiple areas. However, no case of multiple stress fractures in a young man who was not a professional athlete and who had no stress fracture risk factor, such as, an endocrine disease, has been previously reported. Hyun-Ju Choi and Hong-Man Cho. Journal of Orthopaedics and Traumatology; First Published Online 14 October 2011. PDF

Improving Awareness of Best Practices to Reduce Surgical Site Infection: A Multistakeholder Approach

Surgical site infection (SSI) is recognized as a focus area by the Centers for Medicare and Medicaid Services, the Joint Commission, the Institute for Healthcare Improvement, and the Institute of Medicine. An estimated 47% to 84% of SSIs present after discharge from the hospital or ambulatory care facility and, as a result, go undetected by standard SSI surveillance programs. Evidence-based processes and practices that are known to reduce the incidence of SSIs tend to be underused in routine practice. This article describes a multistakeholder process used to develop an educational initiative to raise awareness of best practices to reduce SSIs. The goal was to create a patient-centric educational initiative that involved an active partnership among all stakeholders-medical professional organizations, hospitals/health systems, health insurers, employers and other purchasers, and consumers/patients-to provide the climate necessary to create and sustain a culture of safety. Skoufalos A, Clarke JL, Napp M, Abrams KJ, Berman B, Armellino D, Schilling ME, Pracilio V. Am J Med Qual. 2011 Sep 29. [Epub ahead of print] PMID: 21960647 PDF

Optimization of intramedullary nailing by numerical simulation of fracture healing

Due to the annular gap between intramedullary (IM) nails and the endosteal surface, high interfragmentary movement can occur under loading. This could prolong the healing time, particularly for thin IM nails that are often used for unreamed IM nailing. The aims of our study were to determine the influence of the nail diameter on the healing time of human tibial shaft fractures and to investigate whether the healing time could be shortened by increasing the stiffness of the implant material. Therefore, a corroborated numerical model for simulating the fracture healing process in humans was used to simulate the healing process of human tibial fractures treated with IM nails. Tim Wehner1, Lutz Claes, Anita Ignatius, Ulrich Simon. Journal of Orthopaedic Research. Article first published online: 14 OCT 2011 PDF

Antibiotics Manual iPad app is a detailed reference resource for Providers

Antibiotics find their way into nearly every area of medicine. Accordingly, there is no shortage of resources that healthcare providers consult when it comes to understanding and prescribing antibiotics.

Add to this large body of tools a new app for the iPad called Antibiotics Manual by Spearhead Global Inc. This app is a collection of 188 flashcards, with each card detailing a particular antimicrobial. It is sold for $24.99 with a 50% educational discount available. The content comes from two infectious disease physicians from Temple University School of Medicine. iMedicalapps

Skeletal Radiology: 3 new articles

Double-bundle depiction of the anterior cruciate ligament at 3 Tesla PDF

Ultrasound-guided injection for MR arthrography of the hip: comparison of two different techniques PDF

Dynamic ultrasound of the subacromial–subdeltoid bursa in patients with shoulder impingement: a comparison with normal volunteers PDF

How to read a postoperative knee replacement radiograph  PDF

Down the Road in Ortho Research: the Automated Biology Explorer (ABE)

An interdisciplinary team of scientists at Vanderbilt University, Cornell University and CFD Research Corporation, Inc., has taken a major step toward this goal by demonstrating that a computer can analyze raw experimental data from a biological system and derive the basic mathematical equations that describe the way the system operates. According to the researchers, it is one of the most complex scientific modeling problems that a computer has solved completely from scratch.

The paper that describes this accomplishment is published in the October issue of the journal Physical Biology and is currently available online. The work was a collaboration between John P. Wikswo, the Gordon A. Cain University Professor at Vanderbilt, Michael Schmidt and Hod Lipson at the Creative Machines Lab at Cornell University and Jerry Jenkins and Ravishankar Vallabhajosyula at CFDRC in Huntsville, Ala.

The “brains” of the system, which Wikswo has christened the Automated Biology Explorer (ABE), is a unique piece of software called Eureqa developed at Cornell and released in 2009. Schmidt and Lipson originally created Eureqa to design robots without going through the normal trial and error stage that is both slow and expensive. After it succeeded, they realized it could also be applied to solving science problems.
One of Eureqa’s initial achievements was identifying the basic laws of motion by analyzing the motion of a double pendulum. What took Sir Isaac Newton years to discover, Eureqa did in a few hours when running on a personal computer. Vanderbilt University

Knee injuries on the rise in child and adolescent athletes

Sports-related knee injuries in children and adolescents seem to be increasing at an alarming rate. Researchers at the Children's Hospital of Philadelphia noted a more than 400 percent increase in these injuries at their institution over the last decade, according to new research presented on Sunday, Oct. 16, at the American Academy of Pediatrics (AAP) National Conference and Exhibition in Boston.

In "Knee Injuries In Children and Adolescents: Has There Been An Increase In ACL and Meniscus Tears In Recent Years?" researchers reviewed billing records of patients under age 18 treated for tibial spine fractures, ACL and meniscal tears, at a large academic children's hospital from 1999 through 2011. Over that time period, ACL tears increased by 11.35 injuries per year and meniscus tears increased by 13.95 injuries per year. However, tibial spine fractures, which are though to be caused by a similar mechanism as ACL tears, only jumped by 1.07 injuries per year. Eurekalert!