Saturday, November 19, 2011
Extremity Soft Tissue Sarcoma Resections: How Wide Do You Need to Be?
Sarcomas require a wide margin of resection including a cuff of normal tissue to minimize the risk of local recurrence. The amount of tissue that constitutes a wide margin is unclear in the literature. David M. King, Donald A. Hackbarth and Andrew Kirkpatrick. Clinical Orthopaedics and Related Research; Nov 2011 PDF
The Natural History of Idiopathic Frozen Shoulder: A 2- to 27-year Followup Study
The natural history of spontaneous idiopathic frozen shoulder is controversial. Many studies claim that complete resolution is not inevitable. Based on the 40-year clinical experience of the senior author, we believed most patients with idiopathic frozen shoulder might have a higher rate of resolution than earlier thought. Heidi Vastamäki, Jyrki Kettunen and Martti Vastamäki. Clinical Orthopaedics and Related Research; Nov 2011 PDF
Friday, November 18, 2011
New 'smart' material could help tap medical potential of tissue-penetrating light
Scientists are reporting development and successful initial testing of the first practical "smart" material that may supply the missing link in efforts to use in medicine a form of light that can penetrate four inches into the human body. Their report on the new polymer or plastic-like material, which has potential for use in diagnosing diseases and engineer new human tissues in the lab, appears in ACS' journal Macromolecules. Eurekalert!
Docs Get Animated About Underused Trauma Tx (with video)
The video was prompted by a report earlier this year indicating that British hospitals were using tranexamic acid in only 3% of trauma patients eligible to receive it.
Ian Roberts, MD, head of the CRASH-2 team, told MedPage Today in an email that military leaders were quick to put the results into practice, with the British armed forces adopting them immediately and the Pentagon following suit a short time later.
"However, changing civilian medical care is another story even though the use of this cheap drug could save 140,000 lives per year," Roberts said. MedPage Today
Ian Roberts, MD, head of the CRASH-2 team, told MedPage Today in an email that military leaders were quick to put the results into practice, with the British armed forces adopting them immediately and the Pentagon following suit a short time later.
"However, changing civilian medical care is another story even though the use of this cheap drug could save 140,000 lives per year," Roberts said. MedPage Today
Rewiring the Brain to Ease Pain
How you think about pain can have a major impact on how it feels. That's the intriguing conclusion neuroscientists are reaching as scanning technologies let them see how the brain processes pain.
That's also the principle behind many mind-body approaches to chronic pain that are proving surprisingly effective in clinical trials. Some are as old as meditation, hypnosis and tai chi, while others are far more high tech. In studies at Stanford University's Neuroscience and Pain Lab, subjects can watch their own brains react to pain in real-time and learn to control their response—much like building up a muscle. When subjects focused on something distracting instead of the pain, they had more activity in the higher-thinking parts of their brains. When they "re-evaluated" their pain emotionally—"Yes, my back hurts, but I won't let that stop me"—they had more activity in the deep brain structures that process emotion. Either way, they were able to ease their own pain significantly, according to a study in the journal Anesthesiology last month. Wall Street Journal PDF
That's also the principle behind many mind-body approaches to chronic pain that are proving surprisingly effective in clinical trials. Some are as old as meditation, hypnosis and tai chi, while others are far more high tech. In studies at Stanford University's Neuroscience and Pain Lab, subjects can watch their own brains react to pain in real-time and learn to control their response—much like building up a muscle. When subjects focused on something distracting instead of the pain, they had more activity in the higher-thinking parts of their brains. When they "re-evaluated" their pain emotionally—"Yes, my back hurts, but I won't let that stop me"—they had more activity in the deep brain structures that process emotion. Either way, they were able to ease their own pain significantly, according to a study in the journal Anesthesiology last month. Wall Street Journal PDF
Malpractice suits cause psychological distress and career burnout among US surgeons
According to the results of a new study published in the November 2011 Journal of the American College of Surgeons, malpractice lawsuits against U.S. surgeons occur often and can take a profound personal toll on the surgeon, resulting in emotional exhaustion, stress, and professional dissatisfaction.
The researchers examined personal and professional characteristics and found malpractice lawsuits were strongly and independently linked to surgeon depression and career burnout. The stress caused by malpractice litigation was rated as equivalent to that of financial worries, pressure to succeed in research, work/home conflicts, and coping with patients' suffering and death. Finally, surgeons who experienced a recent malpractice lawsuit reported less career satisfaction and were less likely to recommend a surgical or medical career to their children or others. Eurekalert! PDF
The researchers examined personal and professional characteristics and found malpractice lawsuits were strongly and independently linked to surgeon depression and career burnout. The stress caused by malpractice litigation was rated as equivalent to that of financial worries, pressure to succeed in research, work/home conflicts, and coping with patients' suffering and death. Finally, surgeons who experienced a recent malpractice lawsuit reported less career satisfaction and were less likely to recommend a surgical or medical career to their children or others. Eurekalert! PDF
Thursday, November 17, 2011
Predictors of healing and functional outcome following transmetatarsal amputations.
Transmetatarsal amputations have low healing rates, and patient demographic characteristics and preoperative assessment do not help predict healing. Transmetatarsal amputation healing, however, significantly predicts subsequent ambulatory status and should be pursued in patients with good rehabilitation potential. Landry GJ, Silverman DA, Liem TK, Mitchell EL, Moneta GL. Arch Surg. 2011 Sep;146 9):1005-9. PMID: 21930995 PDF
Ultrasound-Guided Interventional Release of Rotator Interval and Posteroinferior Capsule for Adhesive Capsulitis of the Shoulder Using a Specially Designed Needle.
Adhesive capsulitis is a common but poorly understood disorder of the shoulder. Various treatments have been developed to manage this condition, but the efficacy of these treatments is controversial. We developed an ultrasound-guided, minimally invasive interventional technique to manage adhesive capsulitis of the shoulder using a specially designed needle. Ahn K, Jhun HJ, Choi KM, Lee YS. Pain Physician. 2011 Nov;14(6):531-537. PMID: 22086094 PDF
Journal of Hand Surgery (European) [Epub ahead of print]
1. The effect of the involvement of the dominant or non-dominant hand on grip/pinch strengths and the Levine score in patients with carpal tunnel syndrome. Zyluk A, Walaszek I. J Hand Surg Eur Vol. 2011 Nov 15. [Epub ahead of print] PMID: 22086788 PDF
2. Early CT for suspected occult scaphoid fractures. Stevenson JD, Morley D, Srivastava S, Willard C, Bhoora IG. J Hand Surg Eur Vol. 2011 Nov 15. [Epub ahead of print] PMID: 22086787 PDF
Tawfik J, Powell-Smith E, Bremner-Smith A. J Hand Surg Eur Vol. 2011 Nov 15. [Epub ahead of print] No abstract available. PMID: 22086786 PDF
4. In de Quervain’s with a separate EPB compartment, ultrasound-guided steroid injection is more effective than a clinical injection technique: a prospective open-label study. , , , , , J Hand Surg Eur; first published on November 17, 2011. PDF
5. Entrapment of the extensor pollicis longus tendon after a radial fracture in a child. , , J Hand Surg Eur; first published on November 16, 2011. PDF
, , , Re: Ozcelik B, Egemen O, Sacak B. 2011, 36: 518–9 J Hand Surg Eur, first published on November 16, 2011. PDF
Wednesday, November 16, 2011
Determination of pelvic orientation from sparse ultrasound data for THA operated in the lateral position.
B-mode ultrasound imaging has the potential to replace conventional percutaneous digitization of bony landmarks in navigated total hip arthroplasties (THAs). For THAs operated in the lateral position, only one side of the pelvis is freely accessible. This paper presents a new ultrasound to statistical shape model (SSM) registration method for operating the pelvis in the lateral position, based on sparse ultrasound images, which does not interfere with the clinical routine in terms of redraping and repositioning the patient. Schumann S, Nolte LP, Zheng G. Int J Med Robot. 2011 Nov 14. doi: 10.1002/rcs.443. [Epub ahead of print] PMID: 22081512
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
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
Recent Military Ortho Articles in PubMed
1. Median nerve repair with autologous sciatic nerve graft: a case report. Ragel BT, Park GC, Brevard S.
ISRN Surg. 2011;2011:120367. Epub 2011 Apr 26. PMID: 22084742
2. Predisposing risk factors for non-contact ACL injuries in military subjects. Evans KN, Kilcoyne KG, Dickens JF, Rue JP, Giuliani J, Gwinn D, Wilckens JH. Knee Surg Sports Traumatol Arthrosc. 2011 Nov 12. [Epub ahead of print] PMID: 22080351
3. Anemia, Iron Deficiency, and Stress Fractures in Female Combatants During 16 Months. Yanovich R, Merkel D, Israeli E, Evans RK, Erlich T, Moran DS. J Strength Cond Res. 2011 Nov 10. [Epub ahead of print] PMID: 22080308
4. Management of head trauma due to landmine explosions: From battle field to operation room. Atabey C, Asir A, Ersoy T. Br J Neurosurg. 2011 Nov 11. [Epub ahead of print] PMID: 22077586
5. The epidemiology of cross country skiing injuries. Howes J, Droog SJ, Evans J, Wood IM, Wood AM. Br J Sports Med. 2011 Dec;45(15):A20. PMID: 22077033
6. Military sports medicine clinics should continue to organise MRI prior to listing for "fast track" meniscectomy. Howes J, Wood AM, Bell DJ, Wrigley S, Angus C. Br J Sports Med. 2011 Dec;45(15):A17. PMID: 22077019
Howes J, Wood AM, Bell DJ, Wrigley S, Angus C. Br J Sports Med. 2011 Dec;45(15):A15. PMID: 22077012
The epidemiology of fractures of the proximal ulna.
Fractures of the proximal ulna are fragility fractures that predominantly occur in elderly patients. Given the number of elderly patients sustaining these injuries, research is needed to determine the role of non-operative treatment for these fractures, particularly in patients with multiple co-morbidities and low functional demands.
Duckworth AD, Clement ND, Aitken SA, Court-Brown CM, McQueen MM. Injury. 2011 Nov 9. [Epub ahead of print] PMID: 22077988 PDF
The Athlete's Pain: Hip Impingement or Bone Shaving Surgery Grows Popular
It is one of the most popular operations in sports medicine. It comes in various forms, all with the same name: Hip impingement or bone shaving surgery. World-renowned athletes have had the operation — the Yankees’ third baseman Alex Rodriguez had it about two years ago and the sprinter Tyson Gay had it last summer.
But some sports medicine researchers are asking: where is the evidence that shaving bone helps? Might the bumps or irregular shapes they call impingement be just normal variations? Does the shaved bone grow back? NYT
But some sports medicine researchers are asking: where is the evidence that shaving bone helps? Might the bumps or irregular shapes they call impingement be just normal variations? Does the shaved bone grow back? NYT
Tuesday, November 15, 2011
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.
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
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
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.
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.
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
Monday, November 14, 2011
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
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
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
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
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
Sunday, November 13, 2011
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
Saturday, November 12, 2011
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.
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
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
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
Friday, November 11, 2011
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
Thursday, November 10, 2011
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
Wednesday, November 9, 2011
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
“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
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?”
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
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
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
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
Monday, November 7, 2011
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
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
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
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
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