Ortho News

Wednesday, November 9, 2011

ORBIT 3D X-ray Scanner Eliminates the C-Arm From the Operating Room

Researchers at the Fraunhofer Institute are working on the ORBIT, a 3D X-ray scanner that overcomes many of the disadvantages of traditional C-arms. When using a C-arm, procedures need to be paused to make room and move the device in, which will circle around the patient capturing the 3D image. The ORBIT is an open system in which the X-ray source follows a circular path above the operating table. medGadget

Journal of Surgical Education: in press, corrected proofs

Video Review Using a Reliable Evaluation Metric Improves Team Function in High-Fidelity Simulated Trauma Resuscitation

The Surgical Skills Laboratory Residency Interview: An Enjoyable Alternative

Surgeon-Performed Ultrasound—A Call for Consensus and Standardization

Using the Hidden Curriculum to Teach Professionalism During the Surgery Clerkship

Invited Commentary for “Trauma Leadership: Does Perception Drive Reality?”

Surgical techniques and therapeutic results of anatomical reconstruction of coracoclavicular ligaments for acromioclavicular joint dislocations

Generally, the surgical treatment for traumatic acromioclavicular joint dislocation is recommended for type 5 according to Rockwood’s classification. We believe that anatomical restoration of coracoclavicular ligament could best restore the function of the acromioclavicular joint. We attempted to correctly reconstruct the anatomy of the coracoclavicular ligament (trapezoid and conoid ligaments) in which the ipsilateral palmaris longus tendon and Endobutton were used as the reconstructing ligament and fixation material, respectively. Katsumi Takase, Tsuyoshi Kumakura, Ryohei Kono and Kotaro Shinmura. European Journal of Orthopaedic Surgery & Traumatology. Online Nov. 2011.

ACR: Steroids Tied to Bone Death (CME/CE)

Even short courses of glucocorticoids in conditions such as lupus, rheumatoid arthritis, and many other diseases can be associated with the development of osteonecrosis, a researcher cautioned here.

For instance, exposure to these drugs for less than 30 days was associated with an odds ratio of 3.8 (95% CI 2.1 to 6.8) for osteonecrosis compared with no exposure, Steven C. Vlad, MD, of Boston University School of Medicine, reported at the annual meeting of the American College of Rheumatology. MedPage Today

Tuesday, November 8, 2011

Atraumatic Osteonecrosis of the Distal Radius and Ulna: Case Series and Review

Atraumatic multifocal osteonecrosis is defined as the occurrence of this entity in 3 or more anatomic locations, and is rare. We identified 6 patients with osteonecrotic lesions in the distal ulna, radius, or both. The purposes of this study were to describe the clinical manifestations of atraumatic multifocal osteonecrosis affecting these bones, to identify risk factors for developing the disease in these locations, and to evaluate the success of treatment by percutaneous drilling. D. Alex Stroh, Dawn M. LaPorte, David A. Marker, Aaron J. Johnson, Michael A. Mont. The Journal of Hand Surgery. Available online 5 November 2011.

AHRQ: Big Jump in Knee Replacement Surgery

Knee replacement surgery among middle-aged men and women increased 2.5-fold from 1997 to 2009, new figures from the Agency for Healthcare Research and Quality (AHRQ) show.

The rate of hospitalizations for knee arthroplasty for women ages 45 to 64 increased 157%, from 16 per 10,000 people in 1997 to 42 for every 10,000 people in the U.S. in 2009.

For men, the rate jumped 144%, from 11 stays to 28 stays per 10,000 people over the same time period, according to a report released last week by AHRQ on statistics in hospital-based care. MedPage Today

Osteoarthritis results from inflammatory processes, not just wear and tear, Stanford study suggests

In a study to be published online Nov. 6 in Nature Medicine, investigators at the Stanford University School of Medicine have shown that the development of osteoarthritis is in great part driven by low-grade inflammatory processes. This is at odds with the prevailing view attributing the condition to a lifetime of wear and tear on long-suffering joints. Eurekalert!

Study describes first proof of principle for treating rare bone disease

FOP, fibrodysplasia ossificans progressiva, is a rare genetic disorder of progressive extra bone formation for which there is presently no cure. It is caused by a mutation in the gene for ACVR1/ALK2, a bone morphogenetic protein (BMP) receptor that occurs in all classically affected individuals. Individuals who have FOP harbor one normal copy and one damaged copy of the ACVR1/ALK2 gene in each cell. The mutation increases the amount of BMP in cells to greater than normal levels, which initiates the transformation of muscles and cartilage into a disabling second skeleton of bone. MedicalXpress

Journal of Orthopaedic Research: 2 new articles

Human platelet-rich plasma stimulates migration and chondrogenic differentiation of human subchondral progenitor cells Article first published online: 4 NOV 2011

Long-term oral administration of glucosamine or chondroitin sulfate reduces destruction of cartilage and up-regulation of MMP-3 mRNA in a model of spontaneous osteoarthritis in Hartley guinea pigs Article first published online: 4 NOV 2011

Displaced fracture of the waist of the scaphoid. [Instructional review: Upper limb]

A displaced fracture of the scaphoid is one in which the fragments have moved from their anatomical position or there is movement between them when stressed by physiological loads. Displacement is seen in about 20% of fractures of the waist of the scaphoid, as shown by translation, a gap, angulation or rotation. A CT scan in the true longitudinal axis of the scaphoid demonstrates the shape of the bone and displacement of the fracture more accurately than do plain radiographs. Displaced fractures can be treated in a plaster cast, accepting the risk of malunion and nonunion. Surgically the displacement can be reduced, checked radiologically, arthroscopically or visually, and stabilised with headless screws or wires. However, rates of union and deformity are unknown. Mild malunion is well tolerated, but the long-term outcome of a displaced fracture that healed in malalignment has not been established. This paper summarises aspects of the assessment, treatment and outcome of displaced fractures of the waist of the scaphoid. Dias JJ, Singh HP. J Bone Joint Surg Br. 2011 Nov;93(11):1433-9. PMID: 22058291

A Salute to Military Medicine, Our Brave Warriors

Our technology moves as fast as the fighting to come up with new ways to save lives on the battlefield; amid the horror and heartbreak, there have been medical advances. To all of our benefit, breakthroughs born of war and its injuries make their way to our emergency rooms, hospitals, athletic fields and doctors' offices -- and this, of course, does not take into account the great medical talent, the many doctors, nurses and other care-givers trained in our armed forces. Huffington Post

Sunday, November 6, 2011

Recent PubMed results for combat or high-energy trauma

1. Intrasubstance ruptures of the biceps brachii: diagnosis and management. Wilson DJ, Parada SA, Slevin JM, Arrington ED. Orthopedics. 2011 Nov;34(11):890-6. PMID: 22050257

2. Unusual case of isolated lunate fracture without ligamentous injury. Hsu AR, Hsu PA. Orthopedics. 2011 Nov 9;34(11):e785-9. PMID: 22049967

3. Open glenohumeral dislocation: skeletonization of the proximal humerus without associated fracture.

Maroney SS, Devinney DS. Orthopedics. 2011 Nov 9;34(11):e776-80. PMID: 22049963

4. Limb salvage of severely injured extremities after military wounds. Brown KV, Henman P, Stapley S, Clasper JC. J R Army Med Corps. 2011 Sep;157(3 Suppl 1):S315-23. PMID: 22049814

5. Damage control orthopaedics in the context of battlefield injuries: The use of temporary external fixation on combat trauma soldiers. Mathieu L, Bazile F, Barthélémy R, Duhamel P, Rigal S. Orthop Traumatol Surg Res. 2011 Oct 29. [Epub ahead of print] PMID: 22041574

6. Management of Dominant Upper Extremity Injuries: A Survey of Practice Patterns. Yancosek KE.

J Hand Ther. 2011 Oct 28. [Epub ahead of print] PMID: 22037284

7. Radiographic follow-up of 84 operatively treated scapula neck and body fractures. Cole PA, Gauger EM, Herrera DA, Anavian J, Tarkin IS. Injury. 2011 Oct 27. [Epub ahead of print] PMID: 22036452

8. Infection After Spanning External Fixation for High-Energy Tibial Plateau Fractures: Is Pin Site-Plate Overlap a Problem? Laible C, Earl-Royal E, Davidovitch R, Walsh M, Egol KA. J Orthop Trauma. 2011 Oct 18. [Epub ahead of print] PMID: 22011631

Successful Knee Extensor Mechanism Reconstruction in a Warfare-Related Open Lower Extremity Injury Complicated by Mucormycosis Infection: A Case Report.

Subcutaneous zygomycosis infection associated with a lower extremity open fracture is a potentially life- and limb-threatening condition. This rare and poorly characterized infection complicating war wounds is unique, complex, and poses a significant reconstructive challenge. The objective of this article is to report the reconstruction of a complex Gustilo IIIC warfare-related distal femur fracture with partial extensor mechanism loss complicated by a subcutaneous zygomycosis infection using a novel combination of local and systemic antifungals with negative pressure wound therapy. Negative pressure wound therapy with silver-impregnated sponges and antibiotic/antifungal beads was used to provide temporary wound coverage, improve revascularization, and deliver local antifungal therapy. The distal open femur fracture was fixed using a lateral approach and the medial distal thigh wound and extensor mechanism were reconstructed using an extended gastrocnemius flap with skin graft. The limb was successfully salvaged and the patient is now ambulatory. Kumar AR, Hunt P, Ritter EM, Howard R. J Orthop Trauma. 2011 Oct 28. [Epub ahead of print] PMID: 22048185

Combined olecranon osteotomy with triceps reflecting approach for complex humerus fractures

Combined humeral shaft and distal intra-articular fracture patterns present a unique surgical challenge. Various surgical approaches have been described for both the humeral shaft and the distal humerus individually but few exposures allow combined intra-articular and humeral shaft exposure simultaneously. The combined olecranon osteotomy and posterior triceps-splitting approach as originally described by Ebraheim et al has recently been reviewed by Archdeacon. We report a combined anconeus sparing olecranon osteotomy with proximal triceps reflection or Gerwin approach for simultaneous access to both the distal and diaphyseal humerus. Jason C. Tanka, Stephen Loweb, Eric T. Miller. Injury Extra; In Press, Corrected Proof.

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.

Results of the femur fractures treated with the new selfdynamisable internal fixator (SIF)

As axial dynamisation is a recognised method, many authors using interlocking femoral nail perform an additional small operation two months after the primary operation in order to remove one screw so as to provide axial dynamisation. According to the literature, dynamisation happens in about 15–25% of cases, but it cannot be predicted which patient or fracture will need dynamisation. The aim of this study is to present a new selfdynamisable implant and a minimally invasive method for the internal fixation of different femoral fractures. Milorad Mitkovic, S. Milenkovic, I. Micic, D. Mladenovic and Milan Mitkovic European Journal of Trauma and Emergency Surgery; Nov 2011, Online First

Physiological assessment of the polytrauma patient: initial and secondary surgeries

The timing of fracture fixation in polytrauma patients has been debated for a long time. The decision between DCO (damage control orthopaedics) and ETC (early total care) is a difficult dilemma. Overzealous ETC in haemodynamically compromised patients with significant chest and head injuries can be detrimental. It has been shown, however, that early fracture fixation has a trend towards better outcome in patients with less severe injuries. Delaying all orthopaedic surgery in critically injured patients can be a safe alternative, but has several disadvantages like longer ICU stay and septic complications. The literature shows equivocal evidence for both settings. This article will summarize the historical background and controversies regarding patient assessment and decision making during the treatment of polytrauma patients. It will also give guidance for choosing DCO versus ETC in the clinical setting. N. Enninghorst, R. Peralta, O. Yoshino, R. Pfeifer, H. C. Pape, B. M. Hardy, D. C. Dewar and Z. J. Balogh. European Journal of Trauma and Emergency Surgery; Nov 2011, Online First

Mission Complete for Navy Medicine at EMF-Kuwait | Navy Medicine

This week I had the honor of presiding at the final Navy Change of Command and Transfer of Authority ceremony at Expeditionary Medical Facility-Kuwait (EMF-K) during which Navy Capt. Dick Turner, NC, was relieved by Army Col. Joe Robinson, MC, USA, commander of the Army’s 325th Combat Support Hospital (CSH). On this momentous occasion Nov 3., the Navy’s seven and a half year long commitment to provide health service support in Kuwait came to an end.

Navy Medicine assumed this mission April 1, 2004 from the Army’s 801st CSH in a Transfer of Authority ceremony at Camp Doha. Shortly thereafter Capt. Marty Snyder and his team from Naval Medical Center Portsmouth constructed the original 44-bed tent hospital near EMF-K’s current location on Camp Arifjan. Navy Medicine

Saturday, November 5, 2011

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

Friday, November 4, 2011

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

Thursday, November 3, 2011

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!

Wednesday, November 2, 2011

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

Cellular Microenvironment

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

Tuesday, November 1, 2011

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!

Monday, October 31, 2011

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

Sunday, October 30, 2011

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

Saturday, October 29, 2011

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

Thursday, October 27, 2011

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

Wednesday, October 26, 2011

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

Tuesday, October 25, 2011

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

Monday, October 24, 2011

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

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