Ortho News

Thursday, April 5, 2012

New from Orthopedic Clinics of North America Volume 43, Issue 2 (April 2012)

TED: Jack Choi: On the virtual dissection table - Jack Choi (2012)

Onstage at TED2012, Jack Choi demonstrates a powerful tool for training medical students: a stretcher-sized multi-touch screen of the human body that lets you explore, dissect and understand the body's parts and systems. TED Talks

Wednesday, April 4, 2012

New from the Journal of Surgical Education

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

A Simulator Model for Sacroiliac Screw Placement

An Analysis of the Orthopaedic In-Training Examination Rehabilitation Section

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

Attracting Students to Surgical Careers: Preclinical Surgical Experience

Computer-Aided Feedback of Surgical Knot Tying Using Optical Tracking

Evolving Care During a Decade at War

On Jan. 18, 2012, military and civilian orthopaedic surgeons, researchers, government representatives, and other medical specialists gathered in Washington, D.C., to evaluate the progress made in the treatment of extremity war injuries (EWI) and to examine the ongoing clinical and rehabilitative challenges facing orthopaedic surgeons and their patients. AAOS

Monday, April 2, 2012

Two military surgical trauma treatment apps for the Kindle

First to Cut: Trauma Lessons Learned in the Combat Zone, Real-World Scenarios of Patient Care and Surgery, Valuable Advice for Surgeons (Emergency War Surgery Series) [Kindle Edition]

An essential guide to important lessons in trauma surgery and critical care, First to Cut serves as a valuable companion to the famed Emergency War Surgery textbook. The introduction states: The first goal of this book is simple; to save lives. As all deployed combat surgeons know combat trauma is not your parent's civilian trauma. There is no equivalent to a patient with 100 fragmentation holes, above the knee amputation and a 10% burn in the civilian world. Being faced with these unique wounding patterns for the first time often results in mistakes that are not repeated due to experiencing it. We will document these experiences in a rapid format -in a conversational tone - so that combat surgeons can hopefully benefit from our mistakes and pearls of wisdom. To paraphrase Winston Churchill, these lessons can only be "forged in the fires of battle". Contents include: Fragmentation Wounds * Damage Control Resuscitation * Extremity and Vascular * Abdominal Injury * Urologic Injuries * Chest Injuries * Neck Injury * Brain and Spinal Injury * Burn Injury * Blast * Soft Tissue Injuries * Anesthesia * Triage * Military Unique * Intensive Care Unit * Post-Operative Complications * End of Life, Consent, Ethics * En Route Care * Field Expedient * Glossary of Terms.

Joint Theater Trauma System Clinical Practice Guidelines - Practical Emergency Information for Critical Trauma Care, Burns, Compartment Syndrome, Wounds, Head and Spine (Emergency War Surgery Series) [Kindle Edition]

An essential compilation of official Army military medical guidelines on over three dozen vital trauma care topics, this ebook serves as a valuable companion to the famed Emergency War Surgery textbook. Contents include:

Acoustic Trauma and Hearing Loss * Amputation * Blunt Abdominal Trauma * Burn Care * Canine Resuscitation * Management of Patients with Catastrophic, Non-Survivable Head Injury * Cervical and Thoracolumbar Spine Injury * Cervical Spine Evaluation * Clinical Management of Military Working Dogs * Compartment Syndrome and Fasciotomy * Damage Control Resuscitation * Emergent Resuscitative Thoracotomy * Fresh Whole Blood Transfusion * Frozen Blood * High Bilateral Amputation * Hypothermia Prevention * Infection Control * Inhalation Injury and Toxic Industrial Chemicals * Initial Care of Ocular and Adnexal Injuries * Intratheater Transfer and Transport * Management of Pain Anxiety and Delirium * Management of War Wounds * Management of Patients with Severe Head Injury * Neurosurgical Management * Nutrition * Pelvic Fracture Care * Post Splenectomy Vaccination * Prevention of Deep Venous Thrombosis * Trauma Airway Management * Unexploded Ordnance Management * Urologic Trauma Management * Use of Electronic Documentation * Use of MRI in Management of mTBI in the Deployed Setting * Use of Trauma Flow Sheets * Vascular Injury * Ventilator Associated Pneumonia

This is a privately authored news service and educational publication of Progressive Management. Our publications synthesize official government information with original material - they are not produced by the federal government. They are designed to provide a convenient user-friendly reference work to uniformly present authoritative knowledge that can be rapidly read, reviewed or searched. Vast archives of important data that might otherwise remain inaccessible are available for instant review no matter where you are.

The sympathetic innervation of the human foot

The sympathetic innervation of the hand was demonstrated using formaldehyde staining techniques in the 1990s and provides a basis for both medical (botulinum toxin type A) and surgical (sympathectomy) therapeutic approaches. This research investigates the sympathetic innervation of the human foot using tyrosine hydroxylase immunohistochemistry. Dellon AL, Höke A, Williams EH, Williams CG, Zhang Z, Rosson GD. Plast Reconstr Surg. 2012 Apr;129(4):905-9. PMID: 22456362

Sunday, April 1, 2012

Initial Achilles tendon repair strength-synthesized biomechanical data from 196 cadaver repairs.

CONCLUSIONS: Due to the small sample sizes, different study designs, and heterogeneity of strength measurement techniques, definite recommendations on surgical technique cannot be made but presented information might help in the decision making process for foot and ankle surgeons. Sadoghi P, Rosso C, Valderrabano V, Leithner A, Vavken P. Int Orthop. 2012 Mar 31. [Epub ahead of print] PMID: 22460821

Racial Differences in the Incidence of Acute Low Back Pain in US Military Service Members.

Conclusion. Race, gender, and age were all found to be significant risk factors for acute low back pain. The highest rates were identified in Blacks followed by Whites, Hispanics, and American Indian/Alaskan Native and the lowest rates in Asians/Pacific Islanders. Significant differences in the effect of gender and age were identified between the different racial groups. Knox JB, Orchowski JR, Owens B. Spine (Phila Pa 1976). 2012 Mar 27. [Epub ahead of print] PMID: 22460922

From the journal: Knee Surgery, Sports Traumatology, Arthroscopy

Scapular dyskinesis and SICK scapula syndrome following surgical treatment of type III acute acromioclavicular dislocations. Murena L, Canton G, Vulcano E, Cherubino P. Knee Surg Sports Traumatol Arthrosc. 2012 Mar 30. [Epub ahead of print] PMID: 22461014

Effect of graft tensioning on mechanical restoration in a rat model of anterior cruciate ligament reconstruction using free tendon graft. Fu SC, Cheng WH, Cheuk YC, Mok TY, Rolf CG, Yung SH, Chan KM. Knee Surg Sports Traumatol Arthrosc. 2012 Mar 30. [Epub ahead of print] PMID: 22461015

Close-looped graft suturing improves mechanical properties of interference screw fixation in ACL reconstruction. Prado M, Martín-Castilla B, Espejo-Reina A, Serrano-Fernández JM, Pérez-Blanca A, Ezquerro F. Knee Surg Sports Traumatol Arthrosc. 2012 Mar 30. [Epub ahead of print] PMID: 22461016

Clinical features and prognosis of discoid medial meniscus. Chen LX, Ao YF, Yu JK, Miao Y, Leung KK, Wang HJ, Lin L. Knee Surg Sports Traumatol Arthrosc. 2012 Mar 30. [Epub ahead of print] PMID: 22461017

Role of glucosamine in the treatment for osteoarthritis.

Over the last 20 years, several studies have investigated the ability of glucosamine sulfate to improve the symptoms (pain and function) and to delay the structural progression of osteoarthritis. There is now a large, convergent body of evidence that glucosamine sulfate, given at a daily oral dose of 1,500 mg, is able to significantly reduce the symptoms of osteoarthritis in the lower limbs. This dose of glucosamine sulfate has also been shown, in two independent studies, to prevent the joint space narrowing observed at the femorotibial compartment in patients with mild-to-moderate knee osteoarthritis. This effect also translated into a 50 % reduction in the incidence of osteoarthritis-related surgery of the lower limbs during a 5-year period following the withdrawal of the treatment. Some discrepancies have been described between the results of studies performed with a patent-protected formulation of glucosamine sulfate distributed as a drug and those having used glucosamine preparations purchased from global suppliers, packaged, and sold over-the-counter as nutritional supplements. Reginster JY, Neuprez A, Lecart MP, Sarlet N, Bruyere O. Rheumatol Int. 2012 Mar 30. [Epub ahead of print] PMID: 22461188

Another journal of interest: Clinical Cases in Mineral and Bone Metabolism

The management of sacral stress fractures: current concepts. Longhino V, Bonora C, Sansone V. Clin Cases Miner Bone Metab. 2011 Sep;8(3):19-23. PMID: 22461824

Painful hip arthroplasty: definition. Ferrata P, Carta S, Fortina M, Scipio D, Riva A, Di Giacinto S.

Clin Cases Miner Bone Metab. 2011 May;8(2):19-22. PMID: 22461810

Painful knee arthroplasty: definition and overview. Carulli C, Villano M, Bucciarelli G, Martini C, Innocenti M. Clin Cases Miner Bone Metab. 2011 May;8(2):23-5. PMID: 22461811

Painful knee prosthesis: surgical approach. Villano M, Carulli C, Puccini S, Soderi S, Innocenti M.

Clin Cases Miner Bone Metab. 2011 May;8(2):26-8. PMID: 22461812

Chicago Tribune: Surgical intern: Lessons learned A better scenario?

The orthopedic resident told me to put a "thumb spica cast" on the guy's hand and have him follow up in the clinic. As a brand new surgical intern, I had no idea what a thumb spica cast was; let alone how to make one. So I went to Google Images to see what it looked like, clicked on YouTube to figure out how to make a cast and then headed down to the emergency room and pretended I knew what the heck I was doing. The ER attending physician said I had excellent technique and that it looked as if I had been doing it for years. Chicago Tribune

Eplasty - open access journal worth a look

Eplasty

Combining the external fixation and microsurgical osteoseptocutaneous flap transplantation methods for limb salvage. Mateev M, Huang C, Imanaliev A, Ono S, Hyakusoku H, Ogawa R. Eplasty. 2012;12:e16. Epub 2012 Mar 22. PMID: 22461950

Use of Bioabsorbable Pins in Surgical Fixation of Comminuted Periarticular Fractures.

CONCLUSIONS: In highly comminuted periarticular fractures, bioabsorbable pins are an intriguing alternative to traditional fixation methods. They afford similar effectiveness in maintaining stability without evidence of pin migration or other concerns of buried metallic implants. Bassuener SR, Mullis BH, Harrison RK, Sanders R. Clin J Sport Med. 2012 Mar 28. [Epub ahead of print] PMID: 22460347

Current advances in training orthopaedic patients to comply with partial weight-bearing instructions

Partial weight-bearing instructions are commonly given to orthopaedic patients and are an important part of post-injury and/or post-operative care. However, the ability of patients to comply with these instructions is poorly defined. Training methods for instructing these patients vary widely among institutions. Traditional methods of training include verbal instruction and use of a bathroom scale. Recent technological advances have created biofeedback devices capable of offering feedback to partial weight-bearing patients. Biofeedback devices have shown great promise in training patients to better comply with partial weight-bearing instructions. This review examines the background and significance of partial weight bearing and offers insights into current advances in training methods for partial weight-bearing patients. Hustedt JW, Blizzard DJ, Baumgaertner MR, Leslie MP, Grauer JN. Yale J Biol Med. 2012 Mar;85(1):119-25. Epub 2012 Mar 29. PMID: 22461750

Thursday, March 29, 2012

Double Drive Medical Screwdriver to Speed Up Screw Placements

The Kobalt Double Drive ratcheting screwdriver turned out to be popular with Christmas time gift shoppers last year. The device allows its user to crank the attached tool in a single direction even when the handle is turned both clockwise and counterclockwise.

Now the same technology is about to be introduced to the medical market via Double Drive Medical, a company founded to translate the mechanics of the screwdriver to the medical world. MedGadget

Sunday, March 25, 2012

First sterile iPad sleeve for operating room now available, exclusive hands-on review

EchoMedical has partnered with Protek Medical devices to bring to market a disposable sterile iPad sleeve for use in the operating room. iMedicalApps

Gait analysis accuracy: Android app comparable to standard accelerometer methodology

Smartphones are becoming more ubiquitous and many have a built in tri-axial accelerometer, a sensor that measures change in speed in multiple directions. These smartphone accelerometers can be used to assess gait patterns, or walking patterns, an important evaluation in many neurologic or musculoskeletal disorders. However, the reliability and validity of using smartphones to assess gait patterns is not yet fully established evaluated. In Japan, a team of registered physical therapists and other physicians performed a study to do just that. iMedicalapps

Navy (not Medical) Related: Materials inspired by Mother Nature: A 1-pound boat that could float 1,000 pounds

Combining the secrets that enable water striders to walk on water and give wood its lightness and great strength has yielded an amazing new material so buoyant that, in everyday terms, a boat made from 1 pound of the substance could carry five kitchen refrigerators, about 1,000 pounds. PhysOrg.com

Skull resconstruction immediately following traumatic brain injury worsens brain damage

Immediate skull reconstruction following trauma that penetrates or creates an indentation in the skull can aggravate brain damage inflicted by the initial injury, a study by a University of South Florida research team reports. Using a rat model for moderate and severe traumatic brain injury, the researchers also showed that a delay of just two days in the surgical repair of skull defects resulted in significantly less brain swelling and damage.

The study was published March 16, 2012 in the online journal PloS ONE. University of South Florida

Runner's high motivated the evolution of exercise

In the last century something unexpected happened: humans became sedentary. We traded in our active lifestyles for a more immobile existence. But these were not the conditions under which we evolved. David Raichlen from the University of Arizona, USA, explains that our hunter-gatherer predecessors were long-distance endurance athletes. 'Aerobic activity has played a role in the evolution of lots of different systems in the human body, which may explain why aerobic exercise seems to be so good for us', says Raichlen. However, he points out that testing the hypothesis that we evolved for high-endurance performance is problematic, because most other mammalian endurance athletes are quadrupedal. 'So we got interested in the brain as a way to look at whether evolution generated exercise behaviours in humans through motivation pathways', says Raichlen. Eurekalert!

New MRI Technique Visualizes Phosphorus, Opens Potential for Hard Tissue Imaging

The image here shows the interior

spongy bone of a rabbit femoral head,

or the "ball" of the rabbit's hip bone.

Conventional magnetic resonance imaging (MRI) relies on aligning the magnetization of hydrogen atoms in a study sample, which makes it an excellent tool for visualizing water-rich materials like soft tissues and organs.

Yet MRI is not fundamentally limited to focusing on hydrogen atoms, and scientists at Yale have developed a new approach that allows them to visualize phosphorus, opening a way to look into hard tissues like bone. The imaging technology may take some time finding use in clinical practice though, because the process creates too much heat for live tissue to survive. We’re speculating that perhaps it may instead serve as a safer option over therapeutic radiation. MedGadget

Wednesday, March 21, 2012

Two apps you knee(d) to stay hip.

Knee Pro III app will help orthopedic surgeons with patient education

Knee Pro III contains a detailed anatomical overview of the knee region and areas slightly superior and inferior. The attention to detail is excellent and there is a huge number of pins marking anatomical structures which provide a comprehensive overview of the knee joint. iMedicalApps

Hip Pro III another impressive specialist NOVA anatomy app from 3D4Medical

Hip Pro III is primarily focused on the anatomy of the hip region and includes the superior portion of the upper leg. The anatomical detail is excellent and the 3D models really do look impressive with the inclusion of small details like subcutaneous fat adding to the overall positive impression. iMedicalApps

Possible Use for Joint Injections? AxoTrack Needle Guidance Ultrasound Probe Unveiled

Basically, AxoTrack allows traditional ultrasound imaging to be coupled with a virtual needle that points the way for the real needle during all kinds of ultrasound-guided procedures, especially central line placements. The company says that “when tested in vitro, an AxoTrack-equipped ultrasound probe resulted in successful vascular access on the first stick and first pass 99.3% of the time versus just 37.1% of the time when compared to the standard freehand method for ultrasound-guided central venous access.” MedGadget

New study shows vast geographic variation in hip fracture risk

An extensive study of country-specific risk of hip fracture and 10-year probability of a major fragility fracture has revealed a remarkably large geographic variation in fracture risk. Even accounting for possible errors or limitations in the source data, there was an astonishing 10-fold variation in hip fracture risk and fracture probability between countries.

'A systematic review of hip fracture incidence and probability of fracture worldwide', authored by the International Osteoporosis Foundation (IOF) Working Group on Epidemiology and Quality of Life, has today been published in the journal Osteoporosis International. The aim of the study was to update the available information base on the global heterogeneity in the risk of hip fracture. Age-standardised hip fracture rates from 63 countries were compiled. Additionally, the study documents variations in major fracture probability as determined from 45 FRAX models from 40 countries. Eurekalert!

The publication is freely accessible on the Springer website at http://www.springerlink.com/content/r27872850q9t772l/

BUSM study demonstrates tomosynthesis effective in diagnosing knee

A recent study done by researchers at Boston University School of Medicine (BUSM) shows that tomosynthesis may be more beneficial in diagnosing knee osteoarthritis than X-ray imaging. In the study, which is published online in the journal Radiology, tomosynthesis detected more osteophytes (abnormal bony spurs) and subchondral cysts (small collection of fluid within the bone) in the knee joint than conventional X-ray imaging. Boston University

Thromboembolic events are uncommon following ankle fracture surgery

Thromboembolic events – such as deep vein thrombosis (DVT), blood clots developing in the extremities; or pulmonary embolism (PE), a complication that causes a blood clot to move to the lungs – can occur following musculoskeletal injury and related surgery, and are potentially life threatening. In "The Incidence of Thromboembolic Events in Surgically Treated Ankle Fracture," a study appearing in the March 21, 2012 issue of the JBJS, researchers sought to determine the frequency of, and potential risk factors for, thromboembolic events following surgical treatment of an ankle fracture. Eurekalert!

Monday, March 19, 2012

Clinical Orthopedic Exam (CORE) app is a great resource for internists and specialists alike

For those of you who didn’t catch Dr. Felasfa Wodajo’s previous review, the Clinical Orthopedic Exam (CORE) app is a multimedia source of over 250 different musculoskeletal physical exam maneuvers. It is indexed by body area in picture and text format, is comprehensive and very well referenced. It’s certainly not your average app.

Each physical exam test is well described and contains a YouTube video link that demonstrates the proper way to perform the test. Of note, the app also includes a synopsis of the statistical validity of the particular test as well as links to scientific references that describe the test. iMedicalApps

Scott Summit: Beautiful artificial limbs

Prosthetics can’t replicate the look and feel of lost limbs but they can carry a lot of personality. At TEDxCambridge, Scott Summit shows 3D-printed, individually designed prosthetic legs that are unabashedly artificial and completely personal -- from macho to fabulous.

Scott Summit uses his 20 years of experience as an industrial designer to make artificial limbs that help people take personal control of these intimate objects. TED Talks

Venous Thromboembolism Prophylaxis in Orthopedic Surgery: a comparative effectiveness review from AHRQ 13 March 2012

Objectives: This is an evidence report prepared by the University of Connecticut/Hartford Hospital Evidence-based Practice Center (EPC) examining the comparative efficacy and safety of prophylaxis for venous thromboembolism in major orthopedic surgery (total hip replacement [THR], total knee replacement [TKR], and hip fracture surgery [HFS]) and other nonmajor orthopedic surgeries (knee arthroscopy, injuries distal to the hip requiring surgery, and elective spine surgery).

Data Sources: Medline, the Cochrane Central Register of Controlled Trials, and Scopus from 1980 to May 2011 with no language restrictions. (PDF)

Saturday, March 17, 2012

Hip fracture surgery type impacts future fracture risk

Patients with a primary proximal femoral fracture who undergo closed reduction and percutaneous pinning have a significantly increased risk of subsequent contralateral hip fracture compared with those who undergo arthroplasty, according to a study published in the March 7 issue of The Journal of Bone & Joint Surgery. MedicalXpress

European Society of Musculoskeletal Radiology: ESSR Ultrasound Group Protocols

ESSR Ultrasound Group Protocols:

Shoulder

Elbow

Wrist

Hip

Knee

Ankle

John Theurer Cancer Center Surgeon Co-Authors the Only Guide on Orthopedic Oncology Tumor Surgery

James C. Wittig, M.D., Chief Orthopedic Oncology and Co-Chief, Skin and Sarcoma at the John Theurer Cancer Center at Hackensack University Medical Center, one of the nation’s top 50 best hospitals for cancer, joined leading experts to co-author the only step by step guide of all operative procedures in orthopedic oncology titled “Operative Techniques in Orthopaedic Surgical Oncology.” John Theurer Cancer Center

Nano rescues skin

Nanoparticles containing chitosan have been shown to have effective antimicrobial activity against Staphylococcus saprophyticus and Escherichia coli. The materials could be used as a protective wound-healing material to avoid opportunistic infection as well as working to facilitate wound healing.

Chitosan is a natural, non-toxic and biodegradable, polysaccharide readily obtained from chitin, the main component of the shells of shrimp, lobster and the beak of the octopus and squid. Its antimicrobial activity is well known and has been exploited in dentistry to prevent caries and as preservative applications in food packaging. It has even been tested as an additive for antimicrobial textiles used in clothing for healthcare and other workers.

Now, Mihaela Leonida of Fairleigh Dickinson University, in Teaneck, New Jersey and colleagues writing in the International Journal of Nano and Biomaterials describe how they have prepared nanoparticles of chitosan that could have potential in preventing infection in wounds as well as enhancing the wound-healing process itself by stimulating skin cell growth. Eurekalert!

Calculate is an essential free download for all Android users

When it comes to medical apps and mobile technology, one of the most well used resources is the medical calculator. These apps take user input information and apply defined formulae to calculate a range of useful information.

These apps allow physicians to save time and effort but more importantly reduce the chance of making a mistake. QxMD have developed a highly successful medical calculator called Calculate for iPhone which has recently been ported to Android.

Calculate by QxMD is an incredibly useful free app for Android. It contains over 150 medical calculators and clinical support tools which are all easily accessible from the home menu. iMedicalApps

Supraacetabular Fossa (Pseudodefect of Acetabular Cartilage): Frequency at MR Arthrography and Comparison of Findings at MR Arthrography and Arthroscopy.

Purpose:To evaluate the frequency of the supraacetabular fossa (SAF) (pseudodefect of acetabular cartilage) at magnetic resonance (MR) arthrography of the hip and to compare the MR findings with those from arthroscopy. Dietrich TJ, Suter A, Pfirrmann CW, Dora C, Fucentese SF, Zanetti M. Radiology. 2012 Mar 13. PMID: 22416250

Johns Hopkins: Health apps should have disclaimers

Baltimore-based Johns Hopkins University’s Global mHealth Initiative has undertaken what the Baltimore Sun calls “one of the broadest efforts to assess mHealth strategies” with 49 official studies underway by dozens of university faculty members. According to the report, the initiative is evaluating which mHealth services can help physicians, community health workers and consumers “in ways equal to other more traditional methods” like clinic visits or in-person coaching. (Maybe even in ways superior to existing and legacy methods?) Mobile Health News

Wednesday, March 14, 2012

Arc Sterile Turns Any Room into OR

Surgical theaters are not only clean inside, but the air supplied to them is delivered in laminar flow and filtered to maximize sterility. This commonly requires a proper ventilation system built into the infrastructure of the building. What if you’re a hospital administrator and a need arises for another operating room, but upgrading the ventilation system would be way too expensive? MedGadget

New England Journal of Medicine Now Available as iPad App

Massachusetts Medical Society has released an iPad version of its venerable NEJM. In addition to all the content from the print version, the iPad app also includes audio and video materials from the NEJM.org website.

The software is free to download, and includes one complete New England Journal of Medicine issue, but subscriptions are $14.99 per month and $5.99 for a single issue. MedGadget

University of Chicago study demonstrates efficiency gains from using iPads in medicine

Ever since the first iPad was released in early 2010, physicians have been adopting tablet devices in droves. According to a survey by QuantiaMD in May ’11, 80% of physicians surveyed owned a smartphone or tablet and 30% owned a tablet device. And from this individual adoption, physicians are increasingly using their mobile devices in their clinical duties, creating headaches for many IT managers out there. iMedicalApps

Clinical news alert: Journal of the American Academy of Orthopaedic Surgeons highlights

Highlights of new research articles appearing in the March 2012 issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), as well as the full table of contents. Each news highlight, and listed title in the table of contents, includes a link to the study abstract. AAOS

Italian researchers found how to stop low back pain

Italian researchers at the Catholic University of Sacred Heart in Rome found an important molecular mechanism responsible for low back pain and other acute vertebral problems like cervical axial pain, all due to aging and degeneration of the vertebral column.

The team led by Dr. Luigi Aurelio Nasto and Enrico Pola also developed an experimental drug to inhibit this degenerative mechanism, by blocking its principal culprit, the molecule, "NF-kB" and tested it successfully in mice. The study was carried out in collaboration with the University of Pittsburgh research team led by Paul Robbins, James Kang and Nam Vo (e-mail: von@upmc.edu).

Researchers reported their findings in the February 16 online edition of the journal Spine. Eurekalert!

Storage time for cartilage transplant tissue doubled by MU researchers

In a study due to be published in the Journal of Knee Surgery, Cook and Aaron Stoker from MU's Comparative Orthopaedic Laboratory, Clark Hung and Eric Lima from Columbia University, and James Stannard, the J. Vernon Luck Sr. Distinguished Professor in Orthopaedic Surgery in the MU School of Medicine, tested tissue using their patented system, which includes storing the tissue at room temperature in a specially designed container and storage solution. The researchers found that their system preserved transplant-quality tissue for as long as 63 days. The collaborative team of researchers also developed a way to monitor the quality of the stored tissue simply by testing a few drops of their patented storage solution. Eurekalert!

Monday, March 12, 2012

Two new open-access Ortho related journals

Bone & Joint Research
"A new 'open access' journal set to revolutionise research communication in the field of orthopaedics and the musculoskeletal sciences."

Skeletal Muscle
Skeletal Muscle is a peer-reviewed, open access, online journal that publishes articles investigating molecular mechanisms underlying the biology of skeletal muscle. A wide range of skeletal muscle biology is included: development, metabolism, the regulation of mass and function, aging, degeneration, dystrophy and regeneration. The emphasis is on understanding adult skeletal muscle, its maintenance, and its interactions with non-muscle cell types and regulatory modulators.

Delay in surgery can cause irreparable meniscus tears in children with ACL injuries

For children aged 14 and under, delaying reconstructive surgery for anterior cruciate ligament (ACL) injuries may raise their risk of further injury, according to a new study by pediatric orthopaedic surgeons. If surgery occurs later than 12 weeks after the injury, the injury may even be irreparable.

"Treating ACL injuries in these children is controversial, because they are still growing and the surgery has a small risk of causing a growth disturbance," said study leader J. Todd Lawrence, M.D., Ph.D., an orthopaedic surgeon at The Children's Hospital of Philadelphia. "However, we found that the risk of additional injury outweighs the risk of growth disturbance in most children."

Lawrence's study appeared in a recent issue of The American Journal of Sports Medicine. Eurekalert!

A lifetime of research may be leading to a life-saving treatment for shock

A 200-patient Phase 2 clinical pilot study will be initiated this month to test the efficacy and safety of a new use, and method of administering, an enzyme inhibitor for critically ill patients developed by University of California, San Diego Bioengineering Professor Geert Schmid-Schönbein. Conditions expected to qualify for the study include new-onset sepsis and septic shock, post-operative complications, and new-onset gastrointestinal bleeding. MedicalXpress

Wednesday, March 7, 2012

Knee Replacement Outcome Data Fall Short

Long-term data on total knee replacement surgery is largely limited to revision, leaving clinicians and patients in the dark about outcomes such as residual pain and disability, researchers said.

Currently the best data come from national procedure registries, but the traditional outcome measure is subsequent revision surgery, which "can underestimate problems [because] patients can remain with pain or poor function without necessarily undergoing revision," according to Andrew J. Carr, FMedSci, of the University of Oxford in England, and colleagues.

More than 600,000 knee replacement procedures are performed in the U.S. annually, according to the Agency for Healthcare Research and Quality.

Writing online in The Lancet (PDF), Carr and colleagues outlined four directions for the future of knee replacement surgery:

More consistent patient selection for knee replacement

Long-term monitoring with patient-oriented outcomes, as well as revision, as endpoints

Approval of new designs only after large randomized trials that demonstrate cost-effectiveness as well as clinical efficacy

Better management of young people with early arthritis to avoid need for replacement surgery MedPage Today

Merck Manual app is a useful mobile resource despite one or two interface issues

The Merck Manual is well known as one of the key reference texts for internal medicine physicians.

Unbound Medicine, developers of other well known reference apps including Johns Hopkins POC-IT series, Harriet Lane Handbook, have recently released the latest edition (19th) of the popular Merck Manual of Diagnosis and Therapy.

This app review will not focus on the core content of the Merck Manual but rather examine the app itself. iMedicalApps

Exercise changes your DNA

You might think that the DNA you inherited is one thing that you absolutely can't do anything about, but in one sense you'd be wrong. Researchers reporting in the March issue of Cell Metabolism, a Cell Press publication, have found that when healthy but inactive men and women exercise for a matter of minutes, it produces a rather immediate change to their DNA. Perhaps even more tantalizing, the study suggests that the caffeine in your morning coffee might also influence muscle in essentially the same way. MedicalXpress

Some new Clinical Guidelines for Ortho via MD Consult

2012 Prevention of VTE in Orthopedic Surgery Patients

American College of Chest Physicians (ACCP)

2012 The Perioperative Management of Antithrombotic Therapy

American College of Chest Physicians (ACCP)

Antibiotics I-Pocketcards app assists healthcare providers with antimicrobial choices

Faced with innumerable micro-organisms, evolving susceptibility patterns, and patient antibiotic allergies, clinicians –especially those in training like myself—often struggle with antimicrobial regimen choices in the management of infectious diseases, in both the inpatient as well as outpatient settings.

What antibiotics should I order (or not order) for a penicillin-allergic postpartum patient with a fever, a hypotensive nursing home resident with a sacral ulcer, an otherwise healthy middle-aged man with dysuria, a diabetic with foot cellulitis, or a cystic fibrosis patient with an infiltrate on chest x-ray?

Borm Bruckmeier Publishing LLC, founded in 1992 by two German physicians, has brought us the expansive I-Pocketcards series of apps for the iPhone/iPad, including the most recently reviewed Smoking Cessation I-Pocketcards. To assist in clinical decision making, Borm Bruckmeier Publishing LLC has developed an I-Pocketcards App for Antibiotics. iMedicalApps

Surgery less than 24 hours after traumatic cervical spinal cord injury leads to improved outcomes

Researchers at the Rothman Institute at Jefferson have shown that patients who receive surgery less than 24 hours after a traumatic cervical spine injury suffer less neural tissue destruction and improved clinical outcomes. The results of their study, the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS) are available in PLoS One.

"This practice-changing study is the first to show that the timing of surgery after traumatic spinal cord injury (SCI) matters," says Alexander Vaccaro, MD, PhD, professor of Orthopaedics and Neurosurgery at Jefferson Medical College of Thomas Jefferson University and attending surgeon at Thomas Jefferson University Hospital, the largest spinal cord injury center in the country. Eurekalert!

Vitamin D intake may be associated with lower stress fracture risk in girls

Vitamin D may be associated with a lower risk of developing stress fractures in preadolescent and adolescent girls, especially among those very active in high-impact activities, according to a report published Online First by Archives of Pediatrics & Adolescent Medicine. MedicalXpress

Test Would Speed Treatment of Joint Replacement Infections

Infection poses one of the most serious risks to patients getting a hip or knee replaced, and a major U.S. drugmaker is developing a test to quickly identify the pathogens responsible so doctors can treat problems sooner.

Abbott Diagnostics Group, a unit of Abbott Laboratories, is working with privately held Genetics Laboratory Inc., whose expertise is in orthopedics, to develop the test.

It will be based on Abbott's PLEX-ID system for identifying microbes, and is expected to help doctors detect infections that become rooted in the body's joints long before they become apparent through physical symptoms. NewsMax Health

Ekso Bionics Sells Its First Commercial Exoskeleton

Ekso Bionics (Berkeley, CA) has recently delivered the ready-to-wear, battery-powered Ekso exoskeleton to its first customer, the Craig Hospital in Denver, an institution dedicated to spinal cord injury and traumatic brain injury rehabilitation. The Ekso system is strapped on to the user over clothing, enabling paraplegics to stand and walk. The company will deliver more units over the next few months. MedGadget

Study reveals how anesthetic isoflurane induces Alzheimer's-like changes in mammalian brains

The association of the inhaled anesthetic isoflurane with Alzheimer's-disease-like changes in mammalian brains may by caused by the drug's effects on mitochondria, the structures in which most cellular energy is produced. In a study that will appear in Annals of Neurology and has received early online release, Massachusetts General Hospital (MGH) researchers report that administration of isoflurane impaired the performance of mice on a standard test of learning and memory – a result not seen when another anesthetic, desflurane, was administered. They also found evidence that the two drugs have significantly different effects on mitochondrial function. Eurekalert!

Sunday, March 4, 2012

AAOS Now and Ortho Supersite are two apps that provide orthopedic and musculoskeletal news and information

Many apps are small versions of their respective web site. Others carry out one distinct function that works well in the portable world. Still others augment the main web site’s functionality.

AAOS NOW and OrthoSupersite, known as reliable sources of orthopedic print and web information, have ventured out with their own respective apps. iMedicalApps

Study shows brain flexibility, gives hope for natural-feeling neuroprosthetics

Opening the door to the development of thought-controlled prosthetic devices to help people with spinal cord injuries, amputations and other impairments, neuroscientists at the University of California, Berkeley, and the Champalimaud Center for the Unknown in Portugal have demonstrated that the brain is more flexible and trainable than previously thought.

Their new study, to be published Sunday, March 4, in the advanced online publication of the journal Nature, shows that through a process called plasticity, parts of the brain can be trained to do something it normally does not do. The same brain circuits employed in the learning of motor skills, such as riding a bike or driving a car, can be used to master purely mental tasks, even arbitrary ones. Eurekalert!

Open PubMed with NMCP LinkOut Before Accessing Articles