Ortho News

Sunday, February 26, 2012

Rib fractures linked to circulatory disorder often seen in athletes

Surgeons at Washington University School of Medicine in St. Louis have identified tiny fractures and other rib abnormalities in patients treated for a circulatory condition called venous thoracic outlet syndrome.

The findings come from a study of 37 patients who underwent surgery for the syndrome at Barnes-Jewish Hospital.

Also known as subclavian vein effort thrombosis or Paget-Schroetter syndrome, the disorder is often seen in elite athletes who rely on their upper extremities. The hallmark of the syndrome is blockage of the vein that carries blood from the arm to the heart. The vein passes over the first rib and under the collarbone, making it vulnerable to compression, especially under repetitive stress with the arm in an elevated position. MedicalXpress

Novel Bioactive Peptides Promote Wound Healing In Vivo

Researchers have combined bioactive peptides to successfully stimulate wound healing. The in vitro and in vivo study, published today in PLoS ONE, demonstrates that the combination of two peptides stimulates the growth of blood vessels and promotes re-growth of tissue. Further development of these peptides could lead to a new treatment for chronic and acute wounds. Newswise

Skeletal System Pro III app develops anatomical understanding through strong visuals

The popular NOVA series by 3D4Medical cover a range of systems and anatomical areas and have all recently been upgraded to version III.

This significant update has brought better quality visuals, integrated animations, and audio features among a range of other features.

Skeleton System Pro III has been updated in collaboration with Stanford University School of Medicine and features an in depth look at the skeletal system. This app will appeal to a range of medical professionals ranging from student to educator. iMedicalApps

iPads show the way forward for medical imaging

Results of the University of Sydney study, presented this month at the International Society for Optical Engineering (SPIE) Medical Imaging conference in San Diego, show tablet computers such as the iPad are as good as standard LCD computer screens when used as secondary display devices for viewing medical imaging. Secondary display devices can be used by doctors who move from patient to patient in hospital wards. MedicalXpress

Allergy Tests Needed Before New Knee or Hip (CME/CE)

Preoperative skin patch testing for metal allergy influenced treatment planning in two-thirds of a small cohort of patients scheduled to receive metal-containing prosthetic devices, a retrospective chart review showed.
All 21 patients with positive tests received allergen-free prostheses and had no complications associated with hypersensitivity.

Post-implantation patch testing led to prosthesis removal in 10 additional patients, and six had resolution of hypersensitivity-associated symptoms.

"The findings of this study support a role for patch testing in patients with a clinical history of metal hypersensitivity before prosthetic device implantation," Natasha Atanaskova Mesinkovska, MD, PhD, of the Cleveland Clinic, and co-authors wrote in an article published online in Archives of Dermatology. MedPage Today

Guideline: Monitoring Spinal Cord During Surgery May Help Prevent Paralysis

The American Academy of Neurology is issuing an updated guideline that recommends monitoring the spinal cord during spinal surgery and certain chest surgeries to help prevent paralysis, or loss of muscle function, related to the surgeries. The guideline, which was developed with the American Clinical Neurophysiology Society, is published in the February 21, 2012, print issue of Neurology®, the medical journal of the American Academy of Neurology and also in the Journal of Clinical Neurophysiology. Newswise

A step forward in effort to regenerate damaged nerves

The carnage evident in disasters like car wrecks or wartime battles is oftentimes mirrored within the bodies of the people involved. A severe wound can leave blood vessels and nerves severed, bones broken, and cellular wreckage strewn throughout the body – a debris field within the body itself.

It's scenes like this that neurosurgeon Jason Huang, M.D., confronts every day. Severe damage to nerves is one of the most challenging wounds to treat for Huang and colleagues. It's a type of wound suffered by people who are the victims of gunshots or stabbings, by those who have been involved in car accidents – or by soldiers injured on the battlefield, like those whom Huang treated in Iraq.

Now, back in his university laboratory, Huang and his team have taken a step forward toward the goal of repairing nerves in such patients more effectively. In a paper published in the journal PLoS One, Huang and colleagues at the University of Rochester Medical Center report that a surprising set of cells may hold potential for nerve transplants. Eurekalert!

'Mirror therapy' reduces chronic phantom pain

A team of researchers led by Stefan Seidel from the University Department of Neurology at the MedUni Vienna has demonstrated that – and how – mirror therapy, as it is known, can help patients reduce the symptoms of phantom pain following limb amputations. This is achieved by stimulating a "motor network” in the brain that "substitutes for" the original motor centre. MedicalXpress

Improved assessment of cartilage repair tissue using fluid-suppressed (23)Na inversion recovery MRI at 7 Tesla: preliminary results.

OBJECTIVES: To evaluate cartilage repair and native tissue using a three-dimensional (3D), radial, ultra-short echo time (UTE) (23)Na MR sequence without and with an inversion recovery (IR) preparation pulse for fluid suppression at 7 Tesla (T). Chang G, Madelin G, Sherman OH, Strauss EJ, Xia D, Recht MP, Jerschow A, Regatte RR. Eur Radiol. 2012 Feb 18. [Epub ahead of print] PMID: 22350437

Superior Labral Anterior-to-Posterior Lesions: Comparison of External Rotation and Active Supination CT Arthrography with Neutral CT Arthrography

Purpose: To compare the diagnostic performance of computed tomographic (CT) arthrography performed with external rotation and active supination (ERAS) with that of CT angiography performed in the neutral position for superior labral anterior-to-posterior (SLAP) lesions. Choi JY, Kim SH, Yoo HJ, Shin SH, Oh JH, Baek GH, Hong SH. Radiology. 2012 Feb 17. [Epub ahead of print] PMID: 22344405

Lumbar MR Imaging and Reporting Epidemiology: Do Epidemiologic Data in Reports Affect Clinical Management?

Purpose: To retrospectively examine the association between the inclusion of epidemiologic information in lumbar spine magnetic resonance (MR) imaging reports regarding findings in asymptomatic individuals and the rates of subsequent cross-sectional imaging and treatments in patients with low back pain or radiculopathy referred for imaging by primary care providers. McCullough BJ, Johnson GR, Martin BI, Jarvik JG. Radiology. 2012 Mar;262(3):941-6. PMID: 22357893

Two new Ortho lectures from Audio Digest

NEUROLOGY OF THE SPINE
Orthopaedics
Volume 35, Issue 05
March 7, 2012
Optimizing anesthesia to reduce postoperative pain – Jeremy A. Lieberman, MD
Intracranial hypotension and headache with cerebrospinal fluid leaks – John W. Engstrom, MD
Minimally invasive approaches for spinal tumors – Valli P. Mummaneni, MD
Neurologic cases with difficult differential diagnoses – Dr. Engstrom
________________________________________
SPORTS INJURIES
Orthopaedics
Volume 35, Issue 04
February 21, 2012
Update on osteochondritis dissecans – Robert E. Hunter, MD
Anterior cruciate ligament reconstruction – Robert A. Arciero, MD
Pearls and pitfalls of multiple–ligament knee surgery – Dr. Arciero

Wednesday, February 15, 2012

First interactive medical iPad iBook arrives in Apple’s bookstore, free to download

When Apple announced iBooks 2 and iBooks author, there was much excitement amongst the medical tech community about the possibility of physicians creating their own interactive textbooks. Last Friday saw the release of the first interactive medical textbook, created by Dr. Ed Wallitt, Founder of Podmedics.com.

We recently reviewed PodMedics, a UK based site which offers a range of medical podcasts for medical students and junior doctors alike. The iBook entitled, The Podmedics Do Surgery, is a free medical textbook designed for medical students. It combines text, interactive images, video lectures and questions in one place and is a first for medical education. iMedicalApps

DePuy Announces The Launch of Several New Products at this Year’s AAOS Meeting

DePuy had some ... announcements for new additions to many of their product lines at last week’s annual meeting of the American Academy of Orthopaedic Surgery (AAOS). The new launches includes the new AOX Polyethylene, an anti-oxidant polyethylene liner for knee replacements, RECLAIM and GRIPTION TF, new systems for revision hip replacements, TRUMATCH, and a personalized knee replacement system and GLOBAL UNITE and GLOBAL STEPTECH, new solutions for shoulder replacement and fractures. MedGadget

Orthopaedic smart device provides personalized medicine

Imagine a smart sensor customized to provide vital, real-time information about a patient's recent orthopaedic surgery. Instead of relying on X-rays or invasive procedures, surgeons will be able to collect diagnostic data from an implantable sensor. A study presented at the Orthopaedic Research Society 2012 Annual Meeting in San Francisco outlined this remarkable technology that promises to make post-surgical diagnosis and follow up more precise, efficient, and cost-effective.

"The sensor provides opportunities to make specific and detailed diagnostics for a particular patient and to tailor care based on very objective and quantitative measures," said Eric H. Ledet, PhD, Assistant Professor, Rensselaer Polytechnic Institute. Eurekalert!

Conventional thought on ACL injury mechanism challenged

Landing from a jump can cause a non-contact anterior cruciate ligament (ACL) injury. But evidence presented at the Orthopaedic Research Society 2012 Annual Meeting demonstrates that the injury mechanism that causes that ACL injury involves a combination of factors rather than a single factor as some have claimed. Many hold the view that an athlete ruptures the ACL via a single plane motion -- the tibia moving forward due to a large quadriceps contraction.

According to Timothy E. Hewett, PhD, FACSM, Director of Research, Ohio State University Sports Health and Performance Institute and Cincinnati Children's Sports Medicine Biodynamics Center, that injury occurs due to a tri-planar multi-dimensional combination of factors. "Sometimes in science we have a lot of clinical expertise and a lot of engineering expertise but we don't have much—what I call--'common sense-pertise'." Eurekalert!

Building bone from cartilage

A person has a tumor removed from her femur. A soldier is struck by an improvised explosive device and loses a portion of his tibia. A child undergoes chemotherapy for osteosarcoma but part of the bone dies as a result.

Every year, millions of Americans sustain fractures that don't heal or lose bone that isn't successfully grafted. But a study presented at the Orthopaedic Research Society (ORS) 2012 Annual Meeting in San Francisco offers new hope for those who sustain these traumas. Eurekalert!

Supraspinatus tendon tears at 3.0 T shoulder MR arthrography: diagnosis with 3D isotropic turbo spin-echo SPACE sequence versus 2D conventional sequences

Compared with 2D conventional sequences, MR arthrography using 3D TSE-SPACE was comparable for diagnosing supraspinatus tendon tears despite limitations in detecting small partial-thickness tears and in discriminating between full-thickness and deep partial-thickness tears. Jung JY, Jee WH, Park MY, Lee SY, Kim YS. Skeletal Radiol. 2012 Feb 10. [Epub ahead of print] PMID: 22322904

Magnetic resonance imaging of acute patellar dislocation in children: patterns of injury and risk factors for recurrence.

Acute patellar dislocations remain a common injury in pediatric patients. The pattern of injury to the MPFL and VMO on MRI has not been described in a pediatric population. The triad of injury to the MPFL, VMO, and chondral surfaces should be recognized and understood, particularly when surgical reconstruction is necessary. Seeley M, Bowman KF, Walsh C, Sabb BJ, Vanderhave KL. J Pediatr Orthop. 2012 Mar;32(2):145-55. PMID: 22327448

Neuron memory key to taming chronic pain

“Perhaps the best example of a pain memory trace is found with phantom limb pain,” suggests Coderre. “Patients may have a limb amputated because of gangrene, and because the limb was painful before it was amputated, even though the limb is gone, the patients continue to feel they are suffering from pain in the absent limb. That’s because the brain remembers the pain. In fact, there’s evidence that any pain that lasts more than a few minutes will leave a trace in the nervous system.” It’s this memory of pain, which exists at the neuronal level, that is critical to the development of chronic pain. But until now, it was not known how these pain memories were stored at the level of the neurons.

Recent work has shown that the protein kinase PKMzeta plays a crucial role in building and maintaining memory by strengthening the connections between neurons. Now Coderre and his colleagues have discovered that PKMzeta is also the key to understanding how the memory of pain is stored in the neurons. They were able to show that after painful stimulation, the level of PKMzeta increases persistently in the central nervous system (CNS).

Even more importantly, the researchers found that by blocking the activity of PKMzeta at the neuronal level, they could reverse the hypersensitivity to pain that neurons developed after irritating the skin by applying capsaicin – the active ingredient in hot peppers. Moreover, erasing this pain memory trace was found to reduce both persistent pain and heightened sensitivity to touch. McGill

Saturday, February 11, 2012

2 new apps for Ortho Patient education

DrawMD is a great tool to help surgeons visually explain procedures iMedicalApps

Zimmer announces release of Arthritis 411 app for iPad iMedicalApps

Confusion Reigns in MoM Hip Implant Debacle (with video)

Although there is wide agreement that metal-on-metal hip implants have not performed as well as they should overall, consensus on managing patients who already have them remains elusive.

That was the essential take-away message from a series of research studies presented here at the American Academy of Orthopedic Surgeons' annual meeting this week. Seemingly, every talk contradicted the one preceding it. Medpage Today

Authors with financial conflicts reporting negative outcomes in major orthopaedic journals

In a new study presented today at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), researchers completed a systematic review of three major orthopaedic journals – the Journal of Bone and Joint Surgery (American and British editions) and the Journal of Arthroplasty (JOA) – for all articles related to metal-on-metal total hip replacement between October 1999 and May 2011. As a conflict of interest can increase the potential for research bias and study outcomes, the AAOS and major orthopaedic journals require all presenters and authors to disclose potential professional conflicts. Eurekalert!

Delaying ACL reconstruction in kids may lead to higher rates of associated knee injuries

Kids treated more than 150 days after an Anterior Cruciate Ligament (ACL) injury have higher rates of other knee injuries, including medial meniscal tears, say researchers presenting at the American Orthopaedic Society for Sports Medicine's (AOSSM) Specialty Day in San Francisco, CA. Eurekalert!

PRP treatment aids healing of elbow injuries say researchers

As elbow injuries continue to rise, especially in pitchers, procedures to help treat and get players back in the game quickly have been difficult to come by. However, a newer treatment called platelet rich plasma (PRP) may pose hope, according to researchers presenting their findings at the American Orthopaedic Society for Sports Medicine's Specialty Day meeting in San Francisco. Eurekalert!

Treatment for hip conditions should not rest solely on MRI scans

When it comes to treating people with hip pain, physicians should not replace clinical observation with the use of magnetic resonance images (MRI), according to research being presented today at the American Orthopaedic Society for Sports Medicine's (AOSSM) Specialty Day in San Francisco, CA.

"We performed MRI scans on a sample of volunteers without any hip pain, and discovered about 73% had abnormal findings," commented the study's lead author Bradley C. Register, MD, of the Steadman-Philippon Research Institute. Eurekalert!

New data provides direction for ACL injured knee treatments

Primary Anterior Cruciate Ligament (ACL) reconstruction improves quality of life and sports functionality for athletes, according to research presented today at the American Orthopaedic Society for Sports Medicine's Specialty Day in San Francisco, CA.

"ACL knee injuries have long been a source of problems for athletes, and we are excited to have such a large body of data to evaluate different treatments," said Jüri T Kartus, MD, Department of Orthopaedics, NU-Hospital Organization, Sweden. "To see patients improving in the years following surgery is a great indicator of what we are doing right." Eurekalert!

Steroid injections prove effective in treatment of lumbar disc herniations

The use of epidural steroid injections may be a more efficient treatment option for lumbar disc herniations, according to research presented today at the American Orthopaedic Society for Sports Medicine's Specialty Day in San Francisco.

"Our study showed an 89% success rate in athletes returning to play after suffering an injury during practice or a game," commented lead author Aaron J. Krych, MD, from the Mayo Clinic's Department of Orthopaedic Surgery. "These injections are a safe initial therapy in athletes that do not have neurological deficits, allows them to participate effectively in physical therapy sooner, and can significantly reduce the time a player misses." Eurekalert!

Orthopaedic surgery report provides transparency on patient safety, quality initiatives

At NYU Langone Medical Center the focus on quality, patient safety and patient experience are not just broad stroke initiatives – but measureable, quantifiable and concrete. Patients and health care professionals can learn about this commitment to world-class care and operational transparency in the Department of Orthopaedic Surgery's recently published "2012 Quality and Outcomes Report," which is now available online as well as in hard copy at the American Academy of Orthopaedic Surgeons (AAOS) meeting taking place this week in San Francisco. MedicalXPress

Arthritic knees, but not hips, have robust repair response

Researchers at Duke University Medical Center used new tools they developed to analyze knees and hips and discovered that osteoarthritic knee joints are in a constant state of repair, while hip joints are not.

"This suggests the knee has capacity for repair we didn't know about and the main treatment strategy probably would need to focus on turning off the breakdown of knee tissue," said Virginia Kraus, M.D., Ph.D., professor of Rheumatology and Immunology at Duke.

The findings, published in the Journal of Biological Chemistry on Friday, Feb. 10, suggest that for hips, however, turning off the degenerative process might not be enough. The hips would need a treatment to both turn off of the degenerative process as well as stimulate factors that could help to begin repair. Eurekalert!

Army studies: High recurrence of shoulder instability, better arthroscopic repair outcomes

Two studies on shoulder instability in a military population were presented today by U.S. Army sports medicine surgeons at the American Academy of Orthopaedic Surgeons' annual meeting. Findings in one study suggest patients with a self-reported history of shoulder instability are far more likely to experience future instability, while the second study outlined key factors associated with surgical failure and concluded that arthroscopic surgical intervention has better outcomes than an open shoulder repair. Eurekalert!

Shorter hospital stay for knee replacement linked with greater revision, mortality risks

No previous research has quantified and compared the costs and outcomes between total knee replacement (TKR) patients who have differing lengths of hospital stay following surgery.

In new research presented today at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), investigators identified Medicare patients who had undergone TKR between 1997 and 2009. The patients were separated into the following groups: outpatient, 1-day inpatient, 2-day inpatient, 3- or 4-day inpatient (standard of care), and 5 plus day inpatient. Investigators reviewed outcomes for the patient groups including annual payments, mortality, readmission, revision and common complications. Eurekalert!

New method makes culture of complex tissue possible in any lab

Scientists at the University of California, San Diego have developed a new method for making scaffolds for culturing tissue in three-dimensional arrangements that mimic those in the body. This advance, published online in the journal Advanced Materials, allows the production of tissue culture scaffolds containing multiple structurally and chemically distinct layers using common laboratory reagents and materials. Eurekalert!

AAOS focuses on disaster responders, both yesterday's and tomorrow's

When mass-casualty events occur, orthopaedic surgeons travel throughout the world to treat wounded patients in countries devastated by war, natural disaster and poverty. In 2010, 500 U.S. orthopaedic surgeons traveled to Haiti to help treat hundreds of thousands of victims following a catastrophic earthquake on that Caribbean island. And while the effort was generally successful in treating the broken bones, fractures and other orthopaedic injuries associated with earthquakes, not all of the volunteers were adequately prepared to work in a devastated country.

"Individual physicians arrived without food, equipment, transportation and personal security, or an assignment," said Christopher T. Born, MD, who co-chaired the American Academy of Orthopaedic Surgeons (AAOS)/Orthopaedic Trauma Association (OTA) Disaster Preparedness Project Team. Eurekalert!

4.5 million Americans living with total knee replacement

New research presented at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) found that more than 4.5 million Americans are living with a total knee replacement (TKR), as the number of TKR surgeries has more than doubled over the past decade, with the sharpest rise among younger patients. Osteoarthritis continues to be the primary reason for TKR. Eurekalert!

Rothman at Jefferson researchers show benefits of local anesthesia after knee replacement surgery

Researchers at the Rothman Institute at Jefferson have shown that local anesthesia delivered through a catheter in the joint, intraarticularly, may be more beneficial than traditional opioids such as morphine and Oxycontin for pain management following total knee replacement surgery. Their research will be recognized with the Knee Society Award for the best work on a surgical technique at the American Academy of Orthopedic Surgeons annual meeting, February 7-11 in San Francisco. Eurekalert!

Thursday, February 9, 2012

Video-based home exercise can minimize osteoarthritis pain, improve mobility

The benefits of exercise in minimizing pain and improving mobility for individuals living with osteoarthritis has been well documented.

In a new study presented today at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), 107 individuals with diagnosed osteoarthritis in the knee were randomized to either a DVD-based exercise group, or a control group. The "DVD" group received a DVD-based exercise program, as well as verbal and hands-on exercise instructions, for the first four to eight weeks. The individuals in both groups were evaluated at three, six and 12 months. Eurekalert!

Anxiety trait linked to post-operative pain in men following total knee replacement

Increased pain following surgery has long been linked to anxiety and "catastrophizing," an extreme response to stress.

In a new study presented today at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), 97 patients – men and women – who were about to undergo minimally invasive total knee replacement (TKR) surgery, completed a brief survey to quantify their level of anxiety, as well as their typical level of anxiety and potential for catastrophizing. Pain data was then collected for seven days following surgery. Eurekalert!

BattleView Infrared Vascular Trans-illuminator Shows Off Veins When The Lights Are Out

Let’s just say that you’re a medic out there “in the field” in the middle of the night, with bad guys all over the surrounding hill tops, and they just shot one of your buddies. You managed to move the injured soldier to a safer location, and are attempting to setup an IV, but you certainly don’t want to turn on the flashlight with enemy snipers scanning every inch of the landscape.

That’s where the BattleView Infrared Vascular Trans-illuminator may be of help, as it shines infrared light through the body part where you’re trying to set the IV, illuminating the internal anatomy for your night vision goggles to see as bright as day. MedGadget

Post surgical phone support improves outcome following knee replacement

Poor emotional health and morbid obesity are associated with less functional gain following total knee replacement (TKR) surgery. In the new study, "Can Telephone Support During Post-TKR Rehabilitation Improve Post-op Function: A Randomized Controlled Trial," presented today at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), approximately 180 patients were categorized by gender, body mass index (BMI) and emotional health. Each patient randomly received either emotional telephone support by a trained behavioral specialist, or standard patient care. Telephone support included three phone calls before surgery, one in-person hospital visit, and eight weekly post-operative calls. Eurekalert!

Rothman at Jefferson researchers find epidural steroid injections do not benefit spine patients

Researchers at the Rothman Institute at Jefferson examined data on patients being treated for lumbar stenosis and the degenerative spine condition spondylolisthesis and found that patients who received epidural steroid injections (ESI) had a higher rate of crossover to surgery and fared worse in physical health and bodily pain versus those who did not receive ESI, dispelling their pre-study hypothesis. Eurekalert!

Aspirin may prevent DVT and PE in joint replacement patients

Following a total joint replacement, anticoagulation (blood thinning) drugs can prevent Deep Vein Thrombosis (DVT), a blood clot deep within the extremities, or a pulmonary embolism (PE), a complication that causes a blood clot to move to the lungs. However, prolonged use of these therapies may increase the risk of hemorrhage and infection.

In the study, "Aspirin was Effective to Prevent Proximal DVT and PE in TKA and THA - Analysis of 1,500 Cases," presented today at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), investigators performed a venography, a test for DVT, before and after knee or hip surgery on 1,500 patients. All patients used a foot pump and wore an elastic stocking immediately after surgery. In addition, each patient took a regular dose of aspirin beginning two days post-surgery. Eurekalert!

Risk of pulmonary embolism greatest during first week following total joint replacement

The elevated risk of pulmonary embolism (PE) – a blood clot that travels from the leg to the lungs – following total joint replacement (TJR) surgery has been well established, yet little is known about the natural course and timing of this potentially fatal condition.

In the study, "Pulmonary Embolism Following Total Joint Arthroplasty: When Do They Occur?", presented at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), researchers reviewed the records of 25,660 patients who received TJR between 2000 and 2010. All patients received the anticoagulation (blood thinning) drug Coumadin immediately following surgery and each was monitored, but not screened, for PE. Pulmonary embolism occurring within 90 days of the joint replacement was documented. Eurekalert!

Economic factors impact orthopaedic trauma volume

Previous studies have found that human behavior during a recession is remarkably different than that during a bullish economy. For example, people tend to spend more time focused on working and less time engaging in leisure and recreation activities, resulting in fewer motor vehicle and other accidents.

According to a 10-year study at a Level 1 regional trauma center, presented today at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), economic trends do impact orthopedic trauma volume. Eurekalert!

Rothman at Jefferson research suggests abandon convention in diagnosing periprosthetic joint infection

In their search for new, better ways to diagnose periprosthetic joint infection, Rothman Institute at Jefferson researchers have discovered that measurement of C-reactive protein in the synovial fluid is extremely accurate, while measuring a patients’ serum white blood cell count (WBC) and the percentage of neutrophils (PMN%), the conventional method for diagnosis, has a minimal role in the determination of PJI.

Eurekalert!

Rothman at Jefferson research suggests abandon convention in diagnosing periprosthetic joint infection

Archive of failed joint replacements provides tips to building a better hip replacement

A study by Hospital for Special Surgery researchers has provided the first comprehensive look at just how metal-on-metal total hip replacements are failing in patients around the country. Made possible by what is thought to be the largest archive of failed joint replacements, the research should help doctors develop a better hip replacement for future patients. The study will be reported at the upcoming annual meeting of the American Academy of Orthopaedic Surgeons, Feb. 7-11. Eurekalert!

New procedure bests standard of care for fixing damaged cartilage

A new study has demonstrated that a procedure wherein healthy cartilage is transplanted to fix an area of damaged cartilage (osteoarticular cartilage transplantation or OATS procedure) is superior to the standard of care for repairing cartilage defects. It is thought that fixing such lesions may ultimately help to prevent the onset of osteoarthritis, and get athletic individuals back to sporting activities reliably. The study by Hospital for Special Surgery researchers was reported at the annual meeting of the American Academy of Orthopaedic Surgeons, Feb. 7-11. Eurekalert!

Halting bone-building osteoporosis drug use cuts risk for additional atypical femur fracture in half

There is growing evidence that supports an association between atypical fractures of the femur– a rare break of the thigh bone, typically without trauma – and the use of bisphosphonates, drugs proven to enhance bone density and reduce fracture incidence caused by osteoporosis. While the risk for suffering an atypical femur fracture while taking bisphosphonates is still very small – just 1 in 1,000 patients after six years of treatment – research presented today at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) found that discontinuing bisphosphonate use following an atypical femur fracture can significantly lower the risk for a subsequent atypical fracture. Eurekalert!

Obese children more likely to suffer growth plate fractures

Obese children are 74 percent more likely to sustain a fracture of the growth plate, the softer end of the bone where growth occurs. A new study presented today at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), involved 224 children visiting a Maryland hospital with a fracture. Information was collected on each patient regarding their sex, age, height, weight, fracture location and pattern. Patients ages 2 to 16 were divided into two groups for comparison: a "normal weight" group and an "obese/overweight" group for children with a body mass index (BMI) greater than the 85 percentile. Eurekalert!

Antidepressant use linked with less patient satisfaction after hip replacement

Patients taking antidepressants up to three years prior to undergoing a total hip replacement (THR) were more likely to report greater pain before and after surgery and less satisfaction with their procedure, according to new research presented today at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). Eurekalert!

Excessive sporting activity may impair long-term success of hip resurfacing

In hip resurfacing the femoral ball in the hip joint is not removed, but instead is trimmed and capped with a smooth metal covering. Young and active patients with arthritis often choose hip resurfacing over total hip replacement to minimize the risk of hip dislocation, and to preserve the bone for a revision surgery should the primary resurfacing fail. However, the long-term effects of sports on a resurfaced hip were unknown.

In new research presented today at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), investigators surveyed 445 patients between one and five years after hip resurfacing. Eurekalert!

Online support following joint replacement surgery is cost and time effective for patients

Patients who have had total joint replacement (TJR) are expected to return to their physician's office or clinic regularly for routine follow-up care. In a new study presented today at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), researchers asked 210 TKR patients (with no known complications) to either complete a Web-based follow-up, which included an online survey and an X-ray taken at the nearest Internet-enabled facility; or, to return to the clinic/office for their regular appointment. Eurekalert!

Annual cost of defensive orthopaedic medicine estimated at $2 billion

In a first-ever national survey of orthopaedic surgeons, 96 percent said they have practiced defensive medicine – the ordering of tests, referrals to specialists and hospital admissions primarily to avoid liability and without significant benefit to patients – according to a new study presented today at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). The study estimates the annual cost of defensive orthopaedic care at $2 billion. Eurekalert!

Ultrasound can reliably diagnose hip dysplasia at age 6 months

Developmental dislocation (dysplasia) of the hip (DDH) is a common congenital condition in which a child's upper thighbone is dislocated from the hip socket. The condition can be present at birth or develop during a child's first year of life. Plain radiography (X-rays) has long been the gold standard screening modality for this condition in 6-month-old children, despite concerns over exposing very young children to ionizing radiation.

In new research presented today at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), 35, 5- to 7-month-old children at high risk for DDH were screened with the standard pelvis X-ray, as well as a bilateral non-stress hip ultrasounds. Blinded orthopaedic surgeons then evaluated the X-rays and ultrasounds for standard measure of hip dysplasia. Of the 35 children involved in the study, only one was diagnosed with dysplasia, and the diagnosis was made on both the ultrasound and X-ray. Eurekalert!

Physician adoption of mobile devices outpacing software development

Mobile devices in healthcare organizations are no longer a rare sight – some reports suggest that as many as 80% of physicians use mobile devices at work. Yet despite this rapid adoption, a survey from SpyGlass Consulting indicates that physicians believe that mobile devices currently fill a limited number of uses and fall short of their potential.

The report, Point of Care Computing for Physicians 2012 indicates that while 98 percent of physicians interviewed are using mobile devices to support both personal and professional workflows, 83 percent of them are still using desktop computers as their primary source for accessing patient data when at the hospital, clinic or home. iMedicalApps

Does Foot Form Explain Running Injuries?

The members of Harvard University’s men’s and women’s distance running squads are young, fast, fit, skinny, bright, disciplined and, without exception, dutiful. Every day during the cross-country and track seasons, they enter their mileage and pace into an online training Web site overseen by the team’s coaches and trainers.

They also, like most serious runners, get hurt with distressing frequency, often missing practice due to aching muscles or over-stressed bones. Each of those injuries, no matter how niggling, also gets duly reported and entered into the computer.

Meaning that these student athletes, in their high-achieving way, fashioned an excellent database through which to examine running-related injuries, as evidenced by a study published online last month in Medicine & Science in Sports & Exercise. NYT

Tuesday, February 7, 2012

World’s First Titanium Mandible Created, 205 More Bones Needed for a Complete Terminator

A multidisciplinary team of engineers and clinicians led by The Functional Morphology Research Group at the University of Hasselt BIOMED Research Institute has created what they believe to be the very first complete 3D-printed lower jaw. The implant was manufactured by Layerwise NV, a company based in Leuven, Belgium that specializes in additive manufacturing. MedGadget

UGA discovery uses 'fracture putty' to repair broken bone in days

Broken bones in humans and animals are painful and often take months to heal. Studies conducted in part by University of Georgia Regenerative Bioscience Center researchers show promise to significantly shorten the healing time and revolutionize the course of fracture treatment. MedicalXpress

Exercise triggers stem cells in muscle

University of Illinois researchers determined that an adult stem cell present in muscle is responsive to exercise, a discovery that may provide a link between exercise and muscle health. The findings could lead to new therapeutic techniques using these cells to rehabilitate injured muscle and prevent or restore muscle loss with age. U of I

Smallest tools could give biggest results in bone repair

When William Murphy works with some of the most powerful tools in biology, he thinks about making tools that can fit together. These constructions sound a bit like socket wrenches, which can be assembled to turn a half-inch nut in tight quarters, or to loosen a rusted-tight one-inch bolt using a very persuasive lever.

The tools used by Murphy, an associate professor of biomedical engineering and orthopedics and rehabilitation at University of Wisconsin-Madison, however, are proteins, which are vastly more flexible than socket wrenches -- and roughly 100 million times smaller. One end of his modular tool may connect to bone, while the other end may stimulate the growth of bone, blood vessels or cartilage. Eurekalert!

New DVT Guidelines

New guidelines suggest DVT prophylaxis not appropriate for all patients Eurekalert!

New DVT guidelines: No evidence to support 'economy class syndrome' Eurekalert!

Rothman Institute at Jefferson research suggests use of LE strips to diagnose PJI

Rothman Institute at Jefferson joint researchers continue to seek better ways to diagnose and subsequently treat periprosthetic joint infection (PJI) in patients following total joint arthroplasty. Their latest research shows leukocyte esterase reagent (LE) strips, common in diagnosing urinary tract infections, can also have a role in rapid diagnosis of PJI. Eurekalert!

Study identifies steep learning curve for surgeons who perform ACL reconstructions

Patients who have their anterior cruciate ligament (ACL) reconstructed by surgeons who have performed less than 60 surgeries are roughly four to five times more likely to undergo a subsequent ACL reconstruction, according to a study by researchers at Hospital for Special Surgery. The study also showed that participating in a subspecialty orthopedic fellowship-training program did not improve the learning curve of young surgeons performing ACL reconstructions. The research was presented at the annual meeting of the American Academy of Orthopedic Surgeons, held Feb 7-11. Eurekalert!

New from iMedicalApps

Which iPhone version works best for medical professionals?

Government personnel to receive secured Android phones may impact medical app development

National Quality Forum endorses 2 American College of Surgeons NSQIP measures

Two outcomes-based measures from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) were recently endorsed by the National Quality Forum (NQF). The two measures, surgical site infection (SSI) and urinary tract infection (UTI), were developed by ACS in partnership with the Centers for Medicare and Medicaid Services (CMS), as possible national outcomes measures that could be adopted by the governmental body as early as 2015. Eurekalert!

Tuesday, January 31, 2012

Trying to keep current with clinical guidelines, Review of Journal Watch Hospital Medicine Blackberry app

The use of the SkyScape platform has been previously reviewed by iMedicalApps for the bolt-on app of Outlines in Clinical Medicine: SkyScape review – Outlines in Clinical Medicine.

The breathtaking speed of modern day research results in physicians being besieged with hundreds of new clinical pearls in their own field alone. iMedicalApps

An en bloc approach to CT perfusion for the evaluation of limb ischemia

We examine volumetric CT perfusion in soft tissues of the entire foot with an en bloc technique to provide a meaningful measure of differentiation between mild and major vascular impairment. With Institutional Review Board approval, 22 healthy male subjects between the ages of 21 and 50 (mean 37) were enrolled. Volumetric computed tomography using an en bloc technique was conducted on 14 subjects for validation while unilateral vascular obstruction was simulated in the calves of the remaining 8 subjects. Perfusion estimates were made using in-house software and differences in perfusion estimates between feet were evaluated with Student's t-test at 95% confidence. Subjects with simulated major vascular obstruction (calf blood pressure cuff inflated to 200 mmHg) showed significantly higher ratios of perfusion estimates between the unobstructed and obstructed foot compared to subjects with simulated mild vascular obstruction (cuff inflated to 120 mmHg), mean 4.6, SD 2.6 vs. mean 1.3, SD 0.2; P = 0.05. CT perfusion using an en bloc technique shows promise for the future evaluation of patients with critical limb ischemia and particularly for re-characterization post medical, surgical or endovascular intervention. Barfett J, Velauthapillai N, Kloeters C, Mikulis DJ, Jaskolka JD. Int J Cardiovasc Imaging. 2012 Jan 28. [Epub ahead of print] PMID: 22286394

New methods enable the early detection of Achilles tendon damage

Two biochemical methods, developed at the Centre of Excellence for High Field Magnetic Resonance at the MedUni Vienna by Vladimir Juras from the University Department of Radiodiagnostics, are enabling Achilles tendon damage to be visualised at an early stage. The processes used are sodium imaging and T2 mapping. MedicalXpress

Emerging MRI Technologies for Imaging Musculoskeletal Disorders Under Loading Stress [Free].

Musculoskeletal conditions are the most common cause of disability in the United States. The differential diagnosis of nonspecific musculoskeletal complaints is challenging and the use of imaging modalities, such as magnetic resonance imaging (MRI), is often required to establish a diagnosis, determine treatment, or monitor disease progression. Although MRI is widely used in medicine today, there remains considerable uncertainty as to the optimal imaging approach for most musculoskeletal conditions. Agency for Healthcare Research and Quality (US); November 2011.

Updates to Surgical Intern Survival Guide improve its utility and functionality

In the initial review of Surgical Intern Survival Guide , we concluded that the app was a simple starting point that could help the fresh surgical interns get their bearings.

In the few months since our review, the authors have given the app a facelift, in both appearance and content. iMedicalApps

Making the most of your CT scan

X-ray photography has been used for decades for medical purposes. Now, scientists have found new ways of obtaining precise and comprehensive data from x-ray computer tomography. In the project BIO-CT-EXPLOIT, an international team of mathematicians, physicists, and engineers figured out new ways to extract valuable information from the data obtained in CT scans. The research project has led to new computer codes for medical applications. In future, they will be used for bone implants, surgery, and tissue engineering. MedicalXpress

Sunday, January 29, 2012

Off Topic but very interesting in the order of "On the Nature of Things (De rerum natura)" by Lucretius

Radical theory explains the origin, evolution, and nature of life.

The earth is alive, asserts a revolutionary scientific theory of life emerging from Case Western Reserve University School of Medicine. The trans-disciplinary theory demonstrates that purportedly inanimate, non-living objects—for example, planets, water, proteins, and DNA—are animate, that is, alive. With its broad explanatory power, applicable to all areas of science and medicine, this novel paradigm aims to catalyze a veritable renaissance.

Erik Andrulis, PhD, assistant professor of molecular biology and microbiology, advanced his controversial framework in his manuscript "Theory of the Origin, Evolution, and Nature of Life," published in the peer-reviewed journal, Life (free PDF). His theory explains not only the evolutionary emergence of life on earth and in the universe but also the structure and function of existing cells and biospheres.

Journal of Surgical Education - Articles in Press

Service versus Education, What Are We Talking About? PDF

Nomogram to Predict Successful Placement in Surgical Subspecialty Fellowships Using Applicant Characteristics PDF

Attitudes and Practices of Surgery Residency Program Directors Toward the Use of Social Networking Profiles to Select Residency Candidates: A Nationwide Survey Analysis PDF

Computer-Aided Feedback of Surgical Knot Tying Using Optical Tracking PDF

Educational Value of Morbidity and Mortality (M&M) Conferences: Are Minor Complications Important? PDF

A Crisis of Faith? A Review of Simulation in Teaching Team-Based, Crisis Management Skills to Surgical Trainees PDF

Union of an intra-articular distal radius fracture after successive failures of three locking plates: a case report

We report a case of a 30-year old male, who presented with a right distal radius intra-articular fracture complicated by compartment syndrome. He was treated with fasciotomies and fracture fixation with a 3.5 mm LCP (Synthes^™), followed 7 days later by skin graft. Repeat radiographs 8 weeks later showed a break across the plate at the level of an unfilled screw hole over the fracture. He underwent exchange plating with a 2.4 mm LCP Distal Radius Plate (Synthes^™). This revision was complicated by an infected wound dehiscence 2 weeks later requiring multiple procedures. Radiographs at 20 weeks showed broken distal screws. A second revision was performed. At 12 months, the fracture had healed clinically and radiologically, but the three distal screws had broken. We discuss the multifactorial failures of the these three attempts at osteosynthesis, and which factors helped achieve osseous union. We also discuss the literature on volar locking plate breakage and conclude with the recommendations to avoid this rare complication.

S. K. Khan and C. Gozzard. Strategies in Trauma and Limb Reconstruction; Jan 2012. PDF

Battlefield applications for handheld ultrasound.

Combat medical care provides unique challenges and opportunities for military medical teams. The austerity of the environment severely limits access to many diagnostic and therapeutic tools. Because of their compact size, handheld ultrasound (US) machines are increasingly being used in these constrained environments. A growing body of literature documents the diagnostic utility of handheld US for trauma encountered in the battlefield. Furthermore, US guidance may assist in the performance of some procedures performed in battlefield medical care. This review will provide an overview of the history, current status, limitations and potential future of US utility for the battlefield. Nations JA, Browning RF. Ultrasound Q. 2011 Sep;27(3):171-6. Review. PMID: 21873854

Medtronic’s Aquamantys SBS 5.0 Sheathed Bipolar Sealer Cleared in U.S. for Spinal Surgeries

The SBS 5.0 Sheathed Bipolar Sealer gives spine surgeons the ability to optimize speed and continuity in surgical cases by providing hemostatic sealing capabilities for both incised soft tissue (e.g., cut muscle) and epidural veins with a single device. Like other devices in the Aquamantys line, the SBS 5.0 uses Transcollation® technology, a combination of radiofrequency energy and saline that has been shown to reduce blood loss and improve visualization when used during spine procedures. Reductions in blood loss during surgery have been linked to reduced blood transfusion rates and decreased surgical time. MedGadget

UT Arlington engineer developing 'Biomask' to aid soldiers recovering from facial burns

UT Arlington engineers working with Army surgeons are developing a pliable, polymer mask embedded with electrical, mechanical and biological components that can speed healing from disfiguring facial burns and help rebuild the faces of injured soldiers. MedicalXpress

Resveratrol engages AMPK to attenuate ERK and mTOR signaling in sensory neurons and inhibits incision-induced acute and chronic pain.

These results highlight the importance of signaling to translation control in peripheral sensitization of nociceptors and provide further evidence for activation of AMPK as a novel treatment avenue for acute and chronic pain states. Tillu DV, Melemedjian OK, Asiedu MN, Qu N, De Felice M, Dussor G, Price TJ. Mol Pain. 2012 Jan 23;8(1):5. [Epub ahead of print] PMID: 22269797 Free Article

TED: Brian Goldman: Doctors make mistakes. Can we talk about that? - Brian Goldman (2011)

Every doctor makes mistakes. But, says physician Brian Goldman, medicine's culture of denial (and shame) keeps doctors from ever talking about those mistakes, or using them to learn and improve. Telling stories from his own long practice, he calls on doctors to start talking about being wrong. TED Talks