Ceramic-on-Metal Hip Implant Wins FDA Nod

The first ceramic-on-metal implant for total hip replacement has been approved by the FDA, the agency announced. The Pinnacle CoMplete Acetabular Hip System is manufactured by DePuy Orthopaedics, a subsidiary of Johnson & Johnson, and based in Warsaw, Ind. The femoral head portion of the implant is made of ceramic and the acetabular (socket) component is a metal alloy.

With this approval, there are now five different combinations of materials from which hip implants can be made. Others already approved include ceramic-on-ceramic, ceramic-on-polyethylene, metal-on-polyethylene, and metal-on-metal. MedPageToday

New treatment for peripheral nerve defects: Reconstruction of a 2 cm, monkey median nerve gap by direct lengthening of both nerve stumps.

We have developed a new treatment for peripheral nerve defects: nerve-lengthening method, and confirmed the efficacy and safety of our method using cynomolgus monkeys. A 20-mm defect in the median nerve of monkey's forearms was repaired through the simultaneous lengthening of both nerve stumps with original nerve-lengthening device. To evaluate nerve regeneration after neurorrhaphy, electrophysiological, histological, and functional recovery were examined and compared to the standard autografting. Nerve conduction velocity, axon maturation, and the result of functional test were superior in the nerve-lengthening method than in the autografting. And there were no adverse events associated with our method. We concluded that this method is practical for clinical application. J Orthop Res. 2011 Jun 10. doi: 10.1002/jor.21476. [Epub ahead of print] PDF

The effect of hip position upon the location of the sciatic nerve: an MRI Study.

Allowance for the positional changes of the sciatic nerve is important when considering the safest position of the leg to perform hip operations, specifically the ischial osteotomy during a pelvic triple or periacetabular osteotomy. As for its proximity to the osteotomy site the sciatic nerve can be injured during these operations with the consequence of severe functional impairment. This is the first in-vivo study that demonstrates the effect of hip position upon the location of the sciatic nerve. J Pediatr Orthop. 2011 Mar;31(2):165-9.

Shoulder Decide beautifully demonstrates and teaches basic shoulder anatomy and pathology to patients

Shoulder Decide, available as separate iPhone and iPad apps, sets out to ameliorate this situation by educating patients about common shoulder problems. If I were to describe the app with one word, it would be “beautiful.” And that design factor, in addition to well-selected content, make this app a great asset to improve patient-physician communication. iMedicalApps

Surgical Technique: Medial Collateral Ligament Reconstruction Using Achilles Allograft for Combined Knee Ligament Injury.

This technique uses allograft that provides bone-to-bone healing on the femur, requires small incisions, and creates isometric reconstruction. When performed with a cruciate reconstruction, knee stability can be restored at 2 to 5 years followup. In patients with MCL with primary ACL reconstruction, return to preinjury activity level in recreational athletes can be achieved. Clin Orthop Relat Res. 2011 Jun 10. [Epub ahead of print]

Electromagnetic field stimulation for treating delayed union or non-union of long bone fractures in adults.

Authors' conclusions: Though the available evidence suggests that electromagnetic field stimulation may offer some benefit in the treatment of delayed union and non-union of long bone fractures, it is inconclusive and insufficient to inform current practice. More definitive conclusions on treatment effect await further well-conducted randomised controlled trials. Cochrane Database Syst Rev. 2011 Apr 13;4:CD008471. Review.

100 most cited articles in orthopaedic surgery.

Science Citation Index Expanded was searched for citations to articles published in any of the 49 journals in the subject category "ORTHOPEDICS." Each of the 49 journals was searched separately using the "cited reference search" to determine the 100 most often cited articles. Each article was reviewed for basic information including year of publication, country of origin, source journal of the article, article type, and level of evidence. We categorized the journal article by field of research where possible. Clin Orthop Relat Res. 2011 May;469(5):1487-97. Epub 2010 Oct 5. PDF

US Army to begin testing 85 smartphone apps

The U.S. Army will begin testing iPhones, Android smartphones, and tablets for use in war starting next week, reports The Wall Street Journal. Last December we reported on the military’s plans to test EMR applications on Apple and Android devices for use in the field, but this week’s announcement includes a handful of other specific applications. mobilehealthnews

At Ramstein, America's military aeromedical mission heats up

RAMSTEIN AIR BASE, Germany--It's warming up in the Middle East, and as the mercury rises, so does the intensity of fighting in Iraq and Afghanistan. And that means the number of seriously injured American soldiers passing through here is also rising every day. cnet

Blast-Induced Lower Extremity Fractures With Arterial Injury: Prevalence and Risk Factors for Amputation After Initial Limb-Preserving Treatment.

The purpose of this study is to determine the rate of late (secondary) amputation and to identify risk factors for amputation in injuries that were initially treated with limb preservation on the battlefield.

Operative complications of combat-related transtibial amputations: a comparison of the modified burgess and modified ertl tibiofibular synostosis techniques.

The complications of bone-bridging amputations remain ill defined. The purpose of this study was to compare the early and intermediate-term complications leading to reoperation between the modified Burgess and modified Ertl tibiofibular synostosis in combat-related transtibial amputations.

Biomechanical analysis of lateral humeral condyle fracture pinning.

The purpose of this study was to determine the optimum pin configuration and the number of pins needed to stabilize the Milch type II lateral humeral condyle fractures in a pediatric bone model.

Unstated factors in orthopaedic decision-making: a qualitative study.

Total joint replacement (TJR) of the hip or knee for osteoarthritis is among the most common elective surgical procedures. There is some inequity in provision of TJR. How decisions are made about who will have surgery may contribute to disparities in provision. The model of shared decision-making between patients and clinicians is advocated as an ideal by national bodies and guidelines. However, we do not know what happens within orthopaedic practice and whether this reflects the shared model. Our study examined how decisions are made about TJR in orthopaedic consultations.

Stem cells in orthopaedics and fracture healing.

Stem cell application is a burgeoning field of medicine that is likely to influence the future of orthopaedic surgery. Stem cells are associated with great promise and great controversy. For the orthopaedic surgeon, stem cells may change the way that orthopaedic surgery is practiced and the overall approach of the treatment of musculoskeletal disease. Stem cells may change the field of orthopaedics from a field dominated by surgical replacements and reconstructions to a field of regeneration and prevention. This review will introduce the basic concepts of stem cells pertinent to the orthopaedic surgeon and proceed with a more in depth discussion of current developments in the study of stem cells in fracture healing.

Borderline femur fracture patients: early total care or damage control orthopaedics?

A recent randomized controlled trial (RCT) favours damage control orthopaedics (DCO) over early total care (ETC) in the management of high-energy femoral shaft fracture (FSF) patients with borderline physiology. The purpose of this study was to compare the borderline physiology FSF demographics, management and outcomes of a Level-1 trauma centre, John Hunter Hospital (JHH) with those of the RCT.

Progress in tissue engineering to repair joint damage in osteoarthritis

Medical scientists now have "clear" evidence that the damaged cartilage tissue in osteoarthritis and other painful joint disorders can be encouraged to regrow and regenerate, and are developing tissue engineering technology that could help millions of patients with those disorders. That's the conclusion of a new analysis of almost 100 scientific studies on the topic, published in ACS's journal Molecular Pharmaceutics.

Evaluation and management of combat-related spinal injuries: a review based on recent experiences.

American and coalition forces are sustaining the highest spine combat casualty rates in recorded history and previously unseen injuries are being encountered with increased frequency. While the CPGs provide useful direction in terms of the evaluation and management of combat casualties with spine injuries, such recommendations may warrant periodic re-evaluation in light of recent combat experiences and evolving scientific evidence within the spine literature.

Influence of screw diameter and number on reduction loss after plating of distal radius fractures.

Additional distal screw rows in volar locking distal radius plates might not add substantially to resistance against loss of reduction in the post-operative period.

First of its kind study conducted by BUSM finds women as resilient to combat stress as men

In what is believed to be the first published study on the topic, researchers affiliated with the Boston University School of Medicine (BUSM) believe female military service-members from Operation Enduring Freedom OEF)/Operation Iraqi Freedom (OIF) may be as resilient to combat-related stress as men. These findings currently appear on-line in the Journal of Abnormal Psychology.

Stem cell treatment may offer option for broken bones that don't heal

Researchers at the University of North Carolina at Chapel Hill School of Medicine have shown in an animal study that transplantation of adult stem cells enriched with a bone-regenerating hormone can help mend bone fractures that are not healing properly.