Locked intramedullary femoral nailing without fracture table or image intensifier

The present retrospective study aims to evaluate the outcome in 41 patients of femoral shaft fractures, who had closed intramedullary nailing in lateral decubitus position without fracture table or image intensifier. Mean age was 33.2 (range, 18–70) years. The cannulated reamer in proximal fragment (as intramedullary joystick) and Schanz screw in the distal fragment (as percutaneous joystick) were simultaneously used to assist closed reduction of the fracture without the use of image intensifier. Closed reduction was successful in 38 patients. Open reduction was required in 3 patients. Schanz screw was used for closed reduction in 12 patients. Average number of intra-operative radiographic exposures was 4.4. Two patients had exchange nailing using large diameter nails. One patient had nonunion. Angular and rotatory malalignments were observed in seven patients. We are of the opinion that the present technique is a safe and reliable alternative to achieve closed locked intramedullary nailing and is best suited to stable, less comminuted (Winquist–Hansen types I and II) diaphyseal fractures of the femur. Rajesh Rohilla, Roop Singh, Seema Rohilla, Narender K. Magu, Ashish Devgan and Ramchander Siwach. Strategies in Trauma and Limb Reconstruction Nov 2011 [Epub ahead of print] PDF

Recent Navy Ortho Publications

1. Identification of the Radial Nerve During the Posterior Approach to the Humerus: A Cadaveric Study. Seigerman DA, Choung EW, Yoon RS, Lu M, Frank MA, Gaines RJ, Liporace FA. J Orthop Trauma. 2011 Sep 10. [Epub ahead of print] PMID:  21918485
2. Joint chondrolysis. Provencher MT, Navaie M, Solomon DJ, Smith JC, Romeo AA, Cole BJ.

J Bone Joint Surg Am. 2011 Nov 2;93(21):2033-44. PMID:  22048100

3. 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

4. Low lumbar burst fractures: a unique fracture mechanism sustained in our current overseas conflicts. Lehman RA Jr, Paik H, Eckel TT, Helgeson MD, Cooper PB, Bellabarba C. Spine J. 2011 Oct 7. [Epub ahead of print] PMID:  21982760

5. Two-Year Outcomes of Open Shoulder Anterior Capsular Reconstruction for Instability From Severe Capsular Deficiency. Dewing CB, Horan MP, Millett PJ. Arthroscopy. 2011 Oct 5. [Epub ahead of print] PMID:  21978433

6. Technique: bone-patellar tendon-bone autograft ACL reconstruction in the young, active patient. Provencher MT, Ryu JH, Gaston T, Dewing CB. J Knee Surg. 2011 Jun;24(2):83-92. Review. PMID:  21874943

7. Hand infections. McDonald LS, Bavaro MF, Hofmeister EP, Kroonen LT. J Hand Surg Am. 2011 Aug;36(8):1403-12. PMID: 21816297

8. Total knee arthroplasty in a patient with pseudopseudohypoparathyroidism. Fraser MR Jr, Sechriest VF 2nd. Orthopedics. 2011 Aug 8;34(8):e413-7.  PMID: 2815586
9. Combat-related pelvis fractures in nonsurvivors. Bailey JR, Stinner DJ, Blackbourne LH, Hsu JR, Mazurek MT. J Trauma. 2011 Jul;71(1 Suppl):S58-61. PMID: 21795891

10. Use of an "Antibiotic Plate" for Infected Periprosthetic Fracture in Total Hip Arthroplasty. Liporace FA, Yoon RS, Frank MA, Gaines RJ, Maurer JP, Polishchuk DL, Choung EW. J Orthop Trauma. 2011 Jul 28. [Epub ahead of print] PMID: 21804411
11. Heterotopic ossification in complex orthopaedic combat wounds: quantification and characterization of osteogenic precursor cell activity in traumatized muscle. Davis TA, O'Brien FP, Anam K, Grijalva S, Potter BK, Elster EA. J Bone Joint Surg Am. 2011 Jun 15;93(12):1122-31. PMID: 21776549

12. Blast-induced lower extremity fractures with arterial injury: prevalence and risk factors for amputation after initial limb-preserving treatment. Gwinn DE, Tintle SM, Kumar AR, Andersen RC, Keeling JJ.

J Orthop Trauma. 2011 Sep;25(9):543-8.PMID:  21654527
13. Glenohumeral arthritis in the young adult. Provencher MT, Barker JU, Strauss EJ, Frank RM, Romeo AA, Matsen Iii FA, Cole BJ. Instr Course Lect. 2011;60:137-53. PMID: 21553769
14. Evolution of rotator cuff repair techniques: are our patients really benefiting? Provencher MT, Kercher JS, Galatz LM, Elattrache NS, Frank RM, Cole BJ. Instr Course Lect. 2011;60:123-36. PMID: 21553768 15. Humanitarian assistance and disaster relief aboard the USNS Mercy (TAH-19). Provencher MT, Douglas TD. J Surg Orthop Adv. 2011 Spring;20(1):38-43. PMID:  21477532
16. Extrinsic compression of the external iliac artery following internal fixation of an acetabular fracture.

Koelling E, Mukherjee D. J Vasc Surg. 2011 Jul;54(1):219-21. Epub 2011 Feb 11. PMID: 21315543
17. Analysis and comparison of the biomechanical properties of univalved and bivalved cast models.

Crickard CV, Riccio AI, Carney JR, Anderson TD. J Pediatr Orthop. 2011 Jan-Feb;31(1):39-43. PMID: 21150730

Spinal Surgery Becomes More Cost-Effective Over Time

For specific causes of back pain, spinal surgery provides a good value over long-term follow-up, compared to nonsurgical treatment, concludes a report in the November 15th issue of Spine.

In patients meeting well-defined diagnostic criteria for spinal disorders, estimates of cost-effectiveness at four years' follow-up are more favorable than at two years. "Following effectiveness and cost patterns over time resulted in improved estimates of surgery's value," according to the new research led by Anna N.A. Tosteson, ScD, of The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Lebanon, N.H. NewsWise

Meniscal Repair: World's first stem cell bandage in human clinical trials

Azellon's Cell Bandage has been designed as an alternative to the current treatment of surgical removal of the meniscus (meniscectomy), a procedure that more than 1.7 million people around the world per year are estimated to undergo. This common orthopaedic procedure often results in the early onset of osteoarthritis, leading to further joint surgery including total knee replacement.

The Cell Bandage, which in vitro (tissue culture) has shown great promise for the healing of meniscal tears, is grown from the patient's own stem cells and will be transplanted in the patient's knee joint within two weeks of extracting the stem cells from bone marrow. MedicalXpress

Skyscape’s version of Netter’s Atlas of Anatomy is an average Anatomy Atlas for iPad

Price:

• $79.99

Likes:

• Complete collection of anatomical illustrations covering the whole human body
• Numerous images cover anatomical areas from a number of views helping to understand the complex interplay between various anatomical structures.

Dislikes:

• Opening a new page when selecting a label
• Resolution of images when magnified can be poor making the anatomy unclear

Overall Rating:

• Whilst Netter’s Atlas of Human Anatomy is expensive, it is a complete anatomy text with decent anatomical illustrations.
• The labeling system needs updating before it can be fully recommended as the app is difficult to use when a new page opens once a label has been selected.
• Similarly there are potentially a number of issues relating to the low resolution of images during magnification.
• Overall Skyscape’s version of Netter’s Atlas of Anatomy is a good anatomy atlas, although it is not a stand out contender. iMedicalApps

Exclusive: Mobisante bringing their smartphone ultrasound probe to Android phones

With the release of their Ice Cream Sandwich OS, also called Android 4.0, Google will robustly support USB host mode — enabling phones to use USB devices similar to a traditional computer.

This type of robust connectivity prompted me to contact Mobisante, makers of the much heralded smartphone ultrasound device, MobiUS. One of their biggest limitations has been the inability to have proper USB 2.0 host support to connect to smartphones, forcing them to use an outdated Windows Mobile 6.5 OS on a Toshiba smartphone. iMedicalApps

New Paper in Drugs of the Future Describes Novel Anti-Infective Agent Against Both Gram Positive and Negative Pathogens

The current public health war against bacterial infections is rapidly approaching a critical stage, in which bacterial resistance to antibiotics becomes widespread and our reservoirs of available antibiotics and viable therapeutics are depleted. During the past 60 years, the rise in the frequency of resistance, particularly to multiple drugs, has thwarted the treatment of patients in the hospital and the community. According to Rabih Darouiche, MD of Baylor College of Medicine, microbial resistance is emerging faster than we are replacing our armamentarium of antimicrobial agents.

Dr. Darouiche, in collaboration with the product development team from NovaBay Pharmaceuticals, recently published a monograph on NovaBay’s lead Aganocide® NVC-422 in the journal Drugs of the Future. Newswise

Diagnostic accuracy of MRI in adults with suspect brachial plexus lesions: A multicentre retrospective study with surgical findings and clinical follow-up as reference standard.

The overall diagnostic accuracy of brachial plexus MRI calculated on a per-patient base is relatively high. The specificity of brachial plexus MRI in patients suspected of having a space-occupying mass is very high. The sensitivity is also high, but there are false-positive interpretations as well. Tagliafico A, Succio G, Serafini G, Martinoli C. Eur J Radiol. 2011 Nov 7. [Epub ahead of print] PMID: 22071340

The Journal of Trauma: epub ahead of print

Accidental and Intentional Perpetration of Serious Injury or Death: Correlates and Relationship to Trauma Exposure

The Floating Shoulder-Clinical and Radiological Results After Intramedullary Stabilization of the Clavicle in Cases With Minor Displacement of the Scapular Neck Fracture

AAOS News

New pediatric supracondylar humerus fractures CPG At their meeting on Sept. 24, 2011, the AAOS Board of Directors approved a new clinical practice guideline (CPG) on the treatment of pediatric supracondylar humerus fractures. This is the third CPG to focus on a primarily pediatric condition.

Supracondylar fractures of the humerus are widely considered to be the most common fracture of the elbow in children (Fig. 1). Approximately 3 percent of all fractures in children are supracondylar fractures. They often result from trauma to the elbow, most often due to a fall from a height or related to sports or leisure activities.  AAOS

Hand Surgery: 2 new ultrasound articles

1. High definition ultrasound as diagnostic adjunct for incomplete carpal tunnel release. Tan TC, Yeo CJ, Smith EW. Hand Surg. 2011;16(3):289-94. PMID: 22072462

2. Ultrasonographic findings in cubital tunnel syndrome caused by a cubitus varus deformity. Shimizu H, Beppu M, Arai T, Kihara H, Izumiyama K. Hand Surg. 2011;16(3):233-8. PMID: 22072453

The American Journal of Sports Medicine: PreView articles

Femoral Tunnel Widening After Hamstring Anterior Cruciate Ligament Reconstruction With Bioabsorbable Transfix

Repair Integrity and Functional Outcome After Arthroscopic Rotator Cuff Repair: Double-Row Versus Suture-Bridge Technique

Minimum 10-Year Follow-up of Arthroscopic Intra-articular Bankart Repair Using Bioabsorbable Tacks

Retention of Movement Pattern Changes After a Lower Extremity Injury Prevention Program Is Affected by Program Durations

Clinical Outcome of Autologous Chondrocyte Implantation for Failed Microfracture Treatment of Full-Thickness Cartilage Defects of the Knee Joint

Meniscal Allograft Transplantation Without Bone Plugs: A 3-Year Minimum Follow-up Study

Knee Surgery, Sports Traumatology, Arthroscopy: Online 7 Nov 2011

Short-term outcome of the second generation characterized chondrocyte implantation for the treatment of cartilage lesions in the knee

The effect of tranexamic acid on blood loss and use of blood products in total knee arthroplasty: a meta-analysis

Patients with focal full-thickness cartilage lesions benefit less from ACL reconstruction at 2–5 years follow-up

Multiple associated injuries are common with spine fractures during war.

Spine fractures sustained in OEF and OIF have high rates of AIs. Musculoskeletal AIs are the most common, but visceral injuries adjacent to the spine fracture frequently occur. Multiple spine injuries are more prevalent after military trauma. Patzkowski JC, Blair JA, Schoenfeld AJ, Lehman RA, Hsu JR; Skeletal Trauma Research Consortium (STReC). Spine J. 2011 Nov 2. [Epub ahead of print] PMID: 22054909

Simplified Model to Predict Stress Fracture in Young Elite Combat Recruits.

The purpose of the study was to develop a simple prediction model for stress fractures (SF) in young male recruits in order to identify risk factors for SF. Data were collected from 57 young (18.5±0.5yrs) males prior to elite combat basic training (BT). Measurements included anthropometric variables, blood samples, fitness tests, bone quality (pQCT), psychological assessment, nutritional habits, and history of physical activity. A medical evaluation was done periodically. Moran DS, Finestone A, Arbel Y, Shabshin N, Laor A. J Strength Cond Res. 2011 Nov 4. [Epub ahead of print] PMID: 22067250

Surgical interventions for diaphyseal fractures of the radius and ulna in children.

There is a lack of evidence from randomised controlled trials to inform on when surgery is required and what type of surgery is best for treating children with fractures of the shafts of the radius, ulna or both bones. Abraham A, Kumar S, Chaudhry S, Ibrahim T. Cochrane Database Syst Rev. 2011 Nov 9;11:CD007907. PMID: 22071838

Surgical versus non-surgical interventions for treating patellar dislocation.

There is insufficient high quality evidence to confirm any significant difference in outcome between surgical or non-surgical initial management of people following primary patellar dislocation, and none examining this comparison in people with recurrent patellar dislocation. Adequately powered randomised, multi-centre controlled trials, conducted and reported to contemporary standards are recommended. Hing CB, Smith TO, Donell S, Song F. Cochrane Database Syst Rev. 2011 Nov 9;11:CD008106. PMID: 22071844

Effect of partial meniscectomy at the medial posterior horn on tibiofemoral contact mechanics and meniscal hoop strains in human knees.

From a biomechanical point of view, our in vitro study suggests that the medial joint compartment is not in danger of accelerated cartilage degeneration up to a resection limit of 20% meniscal depth and 10 mm width. Contact mechanics are likely to be more sensitive to partial meniscectomy at higher flexion angles, which has to be further investigated. Seitz AM, Lubomierski A, Friemert B, Ignatius A, Dürselen L. J Orthop Res. 2011 Nov 9. [Epub ahead of print] PMID: 22072570

Lubricin is expressed in chondrocytes derived from osteoarthritic cartilage encapsulated in poly (ethylene glycol) diacrylate scaffold.

The results showed an increased expression of lubricin in explanted tissue and in monolayer cells from normal cartilage, and a decreased expression of lubricin in OA cartilage. The chondrocytes from OA cartilage after 5 weeks of culture in hydrogels (PEGDA) showed an increased expression of lubricin compared with the control cartilage. The present study demonstrated that OA chondrocytes encapsulated in PEGDA, grown in the scaffold and were able to restore lubricin biosynthesis. Thus our results suggest the possibility of applying autologous cell transplantation in conjunction with scaffold materials for repairing cartilage lesions in patients with OA to reduce at least the progression of the disease. Musumeci G, Loreto C, Carnazza ML, Coppolino F, Cardile V, Leonardi R. Eur J Histochem. 2011 Sep 21;55(3):e31. Epub 2011 Aug 27. PMID: 22073377

Cone-beam computed tomography arthrography: an innovative modality for the evaluation of wrist ligament and cartilage injuries

Cone-beam computed tomography (CBCT) has become an important modality in dento-facial imaging but remains poorly used in the exploration of the musculoskeletal system. The purpose of this study was to prospectively evaluate the performance and radiation exposure of CBCT arthrography in the evaluation of ligament and cartilage injuries in cadaveric wrists, with gross pathology findings as the standard of reference.   Reeta Ramdhian-Wihlm, Jean-Marie Le Minor, Matthieu Schmittbuh, Jeremy Jeantroux, Peter Mac Mahon, Francis Veillon, Jean-Claude Dosch, Jean-Louis Dietemann, Guillaume Bierry. Skeletal Radiology; Online Date Monday, November 07, 2011 PDF

Evaluation of ultrasound-guided diagnostic local anaesthetic hip joint injection for osteoarthritis.

The diagnosis of hip osteoarthritis is often complicated by co-existing pathology in the knee and spine, and mismatch between clinical and radiological signs. Temporary pain relief from a local anaesthetic injection into the hip joint has been reported to help localise symptoms, reducing the risk of unnecessary surgery being performed. We hypothesize that good surgical outcome is predicted by good analgesia following diagnostic injection, and that alternative pathology is present when there is no response to injection. Yoong P, Guirguis R, Darrah R, Wijeratna M, Porteous MJ. Skeletal Radiol. 2011 Nov 10. [Epub ahead of print] PMID: 22069031

Scientists identify proteins that direct bone demolition

Scientists at Washington University School of Medicine in St. Louis have identified four proteins that supervise bone demolition, directing the destructive work of cells known as osteoclasts. The finding will help efforts to prevent bone loss and weakening caused by osteoporosis, cancer and other conditions.

“We currently treat these disorders with drugs that inhibit osteoclasts,” says lead author Carl DeSelm, an MD/PhD student. “The ideal drug would slow down osteoclasts when they get out of control but still allow some breakdown so that renewed bone can be built in its place.” The findings appear in Developmental Cell. MedicalXpress

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

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

Hand Clinics [PubMed - in process]

1. Arthroscopic dorsal capsuloligamentous repair in chronic scapholunate ligament tears. Mathoulin CL, Dauphin N, Wahegaonkar AL. Hand Clin. 2011 Nov;27(4):563-72. PMID: 22051397

2. Development of an upper extremity transplant program. Ravindra KV, Gorantla VS. Hand Clin. 2011 Nov;27(4):531-8. Epub 2011 Oct 6. PMID: 22051393

3. Surgical and Technical Aspects of Hand Transplantation: Is it Just Another Replant? Hartzell TL, Benhaim P, Imbriglia JE, Shores JT, Goitz RJ, Balk M, Mitchell S, Rubinstein R, Gorantla VS, Schneeberger S, Brandacher G, Andrew Lee WP, Azari KK. Hand Clin. 2011 Nov;27(4):521-30. Epub 2011 Sep 21 PMID: 22051392

4. Favoring the risk-benefit balance for upper extremity transplantation-the pittsburgh protocol. Gorantla VS, Brandacher G, Schneeberger S, Zheng XX, Donnenberg AD, Losee JE, Lee WP. Hand Clin. 2011 Nov;27(4):511-20. PMID: 22051391

5. Acute and chronic rejection in upper extremity transplantation: what have we learned? Gorantla VS, Demetris AJ. Hand Clin. 2011 Nov;27(4):481-93. PMID: 22051389

6. Functional outcome after hand and forearm transplantation: what can be achieved? Ninkovic M, Weissenbacher A, Gabl M, Pierer G, Pratschke J, Margreiter R, Brandacher G, Schneeberger S. Hand Clin. 2011 Nov;27(4):455-65. PMID: 22051387

7. The spanish experience with hand, forearm, and arm transplantation. Cavadas PC, Landin L, Thione A, Rodríguez-Pérez JC, Garcia-Bello MA, Ibañez J, Vera-Sempere F, Garcia-Cosmes P, Alfaro L, Rodrigo JD, Castro F. Hand Clin. 2011 Nov;27(4):443-53. Epub 2011 Oct 6. PMID: 22051386

8. World experience after more than a decade of clinical hand transplantation: update on the innsbruck program. Hautz T, Engelhardt TO, Weissenbacher A, Kumnig M, Zelger B, Rieger M, Rumpold G, Pierer G, Ninkovic M, Gabl M, Piza-Katzer H, Pratschke J, Margreiter R, Brandacher G, Schneeberger S. Hand Clin. 2011 Nov;27(4):423-31. Epub 2011 Oct 2. PMID: 22051384

9. The history and evolution of hand transplantation. Foroohar A, Elliott RM, Benjamin Kim TW, Breidenbach W, Shaked A, Levin LS. Hand Clin. 2011 Nov;27(4):405-9. Epub 2011 Sep 21. PMID: 22051381

The Journal of the American Academy of Orthopaedic Surgeons [PubMed - in process]

1. Arthroscopic releases for arthrofibrosis of the knee. Chen MR, Dragoo JL. J Am Acad Orthop Surg. 2011 Nov;19(11):709-16. PMID: 22052647

2. Intramedullary Nailing of Extra-articular Proximal Tibia Fractures. Hiesterman TG, Shafiq BX, Cole PA. J Am Acad Orthop Surg. 2011 Nov;19(11):690-700. PMID: 22052645

3. Surgical management of healed slipped capital femoral epiphysis. Kuzyk PR, Kim YJ, Millis MB. J Am Acad Orthop Surg. 2011 Nov;19(11):667-77. PMID: 22052643

4. Arthroscopic revision rotator cuff repair. Denard PJ, Burkhart SS. J Am Acad Orthop Surg. 2011 Nov;19(11):657-66. PMID: 22052642

5. Pediatric disk herniation. Lavelle WF, Bianco A, Mason R, Betz RR, Albanese SA. J Am Acad Orthop Surg. 2011 Nov;19(11):649-56. PMID: 22052641

3D Printed Bone Models Cut Cost of Surgery Operations

A trainee surgeon, Mark Frame, has figured out how to save U.K.'s NHS thousands of pounds by taking advantage of 3D-printer technology. Success in orthopedic operations relies on surgeons having an accurate 3D model of the area where the operation will take place. Such models take time to produce and cost up to £1200 ($1915). Mark, a self-confessed 'technology geek,' used open source OsiriX software to convert CT scans into files which are readable by the 3D printers at Shapeways, a company in the Netherlands. Within a week they produced and delivered the first plastic 3D model of a child's forearm at a cost of £77 ($123). Mark has written a free guide so that other surgeons can make their own bones, which is being considered for publication by the World Journal of Science and Technology." slashdot

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

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