Mobile Devices and Medical Liability: Some Important Considerations

As mobile devices become more and more integrated into clinical practice, our health system will have to not only figure out how this technology will change the face of medicine, but also how it will change the system of medical liability. Physicians and administrators alike shudder at the thought of malpractice, but considering the fact that 60% of physicians over the age of 55 have been sued at least once during their career, we have to carefully think about how all of our new tools fit into the liability picture. Michelle Mello, a Harvard health law professor, offered some insight at the World Congress Leadership Summit on mHealth. iMedicalApps

Kienböck Disease

Article in Press: Treatment of Kienböck Disease by Lunate Core Decompression  Mehrpour S, Kamrani S, Aghamirsalim M, Sorbi R, Kaya A. The Journal of Hand Surgery , Corrected Proof  PDF

1 - 3 From PubMed: 

1. Arthroscopic core decompression of the lunate in early stage Kienbock disease of the lunate. Bain GI, Smith ML, Watts AC. Tech Hand Up Extrem Surg. 2011 Mar;15(1):66-9. PMID:  21358528

2. Systematic review of the treatment of Kienböck's disease in its early and late stages. Innes L, Strauch RJ. J Hand Surg Am. 2010 May;35(5):713-7, 717.e1-4. Review. PMID: 20438990 PDF

3. Core decompression of the distal radius for the treatment of Kienböck's disease: a biomechanical study. Sherman GM, Spath C, Harley BJ, Weiner MM, Werner FW, Palmer AK. J Hand Surg Am. 2008 Nov;33(9):1478-81. PMID: 18984326 PDF

Surgical treatment of syndesmotic diastasis: emphasis on effect of syndesmotic screw on ankle function.

Fifty-two consecutive adult patients with syndesmotic diastasis (SD) were treated with closed anatomical reduction and stable fixation by a trans-syndesmotic cancellous screw. A short leg splint was prescribed for a six week postoperative period. Treatment outcomes of syndesmotic screw removal at various time points were studied and compared (group 1 at six weeks, group 2 at three months and group 3 at an average of nine months).  Hsu YT, Wu CC, Lee WC, Fan KF, Tseng IC, Lee PC. Int Orthop. 2011 Mar;35(3):359-64. Epub 2010 Nov 11. PMID: 21069524

Associations between repeated deployments to OEF/OIF/OND, October 2001-December 2010, and post-deployment illnesses and injuries, active component, U.S. Armed Forces.

Since 2001, 1,347,731 U.S. military members have deployed to Afghanistan or Iraq; of these, approximately 40% deployed to Afghanistan or Iraq more than once. We assessed relationships between multiple deployments and diagnoses of diseases and injuries (as defined by 3-digit ICD-9-CM codes) among all male and female deployers within one year after returning from first through fifth deployments. For most illnesses and injuries, the proportions of deployers affected within one year post-deployment hardly varied in relation to the number of prior deployments. Back and joint disorders, sleep disorders, hypercholesterolemia, hypertension, chronic sinusitis, and allergic rhinitis were "excessive" among repeat compared to first-time deployers. Some conditions may be caused or exacerbated by repeat wartime deployments. On the other hand, repeat deployments may select for the most inherently resilient service members and/or incrementally increase the resilience of repeat deployers. Armed Forces Health Surveillance Center (AFHSC). MSMR. 2011 Jul;18(7):2-11. PMID: 21815709 PDF

Effectiveness of the Saline Load Test in Diagnosis of Traumatic Elbow Arthrotomies.

The purpose of this study was to investigate the amount of fluid required and the sensitivity of the saline load test to identify an intra-articular arthrotomy of the elbow. Feathers T, Stinner D, Kirk K, Kirby J, Hsu JR; Skeletal Trauma Research Consortium (STReC); Brooke Army Medical Center. J Trauma. 2011 Jul 15. [Epub ahead of print] PMID: 21768902 PDF

The Modern "Deck-Slap" Injury-Calcaneal Blast Fractures From Vehicle Explosions.

Calcaneal injuries following under-vehicle explosions are commonly associated with significant multiple injuries including severe lower limb injury. The frequency of associated spinal injuries mandates radiologic evaluation of the spine in all such patients. The severity of the hindfoot injury is reflected by the high infection rate and amputation rate. Only a small proportion of casualties were able to return to preinjury military duties.

 Ramasamy A, Hill AM, Phillip R, Gibb I, Bull AM, Clasper JC. J Trauma. 2011 Jul 29. [Epub ahead of print] PMID: 21808204 PDF

Impact of Stress on Resident Performance in Simulated Trauma Scenarios.

In trainees, some aspects of performance and immediate recall appear to be impaired in complex clinical scenarios in which they exhibit elevated subjective and physiologic stress responses. The findings of this study highlight a potential threat to patient safety and demand further investigation. Future studies should strive to further elucidate the effects of stress on specific components of performance and investigate ways to reduce its negative impact.  Harvey A, Bandiera G, Nathens AB, Leblanc VR. J Trauma. 2011 Jul 29. [Epub ahead of print] PMID: 21808212  PDF

Died of wounds on the battlefield: causation and implications for improving combat casualty care.

Understanding the epidemiology of death after battlefield injury is vital to combat casualty care performance improvement. The current analysis was undertaken to develop a comprehensive perspective of deaths that occurred after casualties reached a medical treatment facility.  Eastridge BJ, Hardin M, Cantrell J, Oetjen-Gerdes L, Zubko T, Mallak C, Wade CE, Simmons J, Mace J, Mabry R, Bolenbaucher R, Blackbourne LH. J Trauma. 2011 Jul;71(1 Suppl):S4-8. PMID: 21795876

The Role of Platelet-rich Plasma in Rotator Cuff Repair.

Injections of platelet-rich plasma (PRP) have led to reduced pain and improved recovery in other degenerate pathologies areas together with the restoration of function. This study reviews the current literature on PRP and in particular discusses its relevance in the treatment of rotator cuff tears. Mei-Dan O, Carmont MR. Sports Med Arthrosc. 2011 Sep;19(3):244-50. PMID: 21822108

Treatment of femur fractures in school-aged children using elastic stable intramedullary nailing: a systematic review.

Femur fractures are common long-bone injuries in school-aged children (6-12 years). Among the various acceptable treatment options, elastic stable intramedullary nailing (ESIN) has gained popularity over recent years although the level of evidence for ESIN is low. This study was a systematic review of the literature to examine the outcomes and complications of ESIN in school-aged children and to critically evaluate the quality of the available literature.  Baldwin K, Hsu JE, Wenger DR, Hosalkar HS. J Pediatr Orthop B. 2011 Sep;20(5):303-8. PMID: 21829144

Meniscal Repair Versus Partial Meniscectomy: A Systematic Review Comparing Reoperation Rates and Clinical Outcomes

Whereas meniscal repairs have a higher reoperation rate than partial meniscectomies, they are associated with better long-term outcomes. E. Scott Paxton, Michael V. Stock, Robert H. Brophy, Arthroscopy: The Journal of Arthroscopic and Related Surgery - 08 August 2011 (10.1016/j.arthro.2011.03.088)

Platelet-Rich Plasma Intra-Articular Injection Versus Hyaluronic Acid Viscosupplementation as Treatments for Cartilage Pathology: From Early Degeneration to Osteoarthritis

Autologous PRP injections showed more and longer efficacy than HA injections in reducing pain and symptoms and recovering articular function. Better results were achieved in younger and more active patients with a low degree of cartilage degeneration, whereas a worse outcome was obtained in more degenerated joints and in older patients, in whom results similar to those of viscosupplementation have been observed.
Elizaveta Kon, Bert Mandelbaum, Roberto Buda, Giuseppe Filardo, Marco Delcogliano, Antonio Timoncini, Pier Maria Fornasari, Sandro Giannini, Maurilio Marcacci, Arthroscopy: The Journal of Arthroscopic and Related Surgery - 11 August 2011 (10.1016/j.arthro.2011.05.011) PDF

Long-term results of the surgical treatment of type III acromioclavicular dislocations: AN UPDATE OF A PREVIOUS REPORT.

 According to the Imatani and UCLA scores, there was no difference between the operated shoulder and the opposite shoulder (p > 0.05). Given the same situation, 35 (92.1%) patients would opt for the same surgical treatment again. Operative treatment of type III acromioclavicular joint injuries produces satisfactory long-term results.  Lizaur A, Sanz-Reig J, Gonzalez-Parreño S. J Bone Joint Surg Br. 2011 Aug;93(8):1088-92. PMID: 21768634

Clinical Orthopaedics and Related Research: [Epub ahead of print]

1. Risk Factors for Peroneal Nerve Injury and Recovery in Knee Dislocation. Peskun CJ, Chahal J, Steinfeld ZY, Whelan DB. Clin Orthop Relat Res. 2011 Aug 6. [Epub ahead of print] PMID: 21822573 PDF
2. Lateral Unicompartmental Knee Arthroplasty Through a Lateral Parapatellar Approach Has High Early Survivorship. Berend KR, Kolczun MC 2nd, George JW Jr, Lombardi AV Jr. Clin Orthop Relat Res. 2011 Aug 6. [Epub ahead of print] PMID: 21822570 PDF
3. A More Reliable Method to Assess Acetabular Component Position. Tiberi JV, Pulos N, Kertzner M, Schmlazried TP. Clin Orthop Relat Res. 2011 Aug 6. [Epub ahead of print] PMID: 21822569 PDF
4. Can Stress Radiography of the Knee Help Characterize Posterolateral Corner Injury? Gwathmey FW Jr, Tompkins MA, Gaskin CM, Miller MD. Clin Orthop Relat Res. 2011 Aug 6. [Epub ahead of print] PMID: 21822568 PDF
5. Can Surgeons Predict What Makes a Good TKA?: Intraoperative Surgeon Impression of TKA Quality Does Not Correlate With Knee Society Scores. Lee GC, Lotke PA. Clin Orthop Relat Res. 2011 Aug 6. [Epub ahead of print] PMID: 21822567 PDF

Position of shoulder arthroplasty and clinical outcome in proximal humerus fractures.

Four-part proximal humeral fractures are frequently treated with shoulder replacement. Outcome of this procedure has not been standardized, and there are controversy data on range of motion (ROM) and active function of the shoulder. The aim of this study is to compare shoulder prosthesis position (SPP) in terms of version of humeral head and height of stem with clinical subjective and objective outcome. Padua R, Padua L, Galluzzo M, Ceccarelli E, Alviti F, Castagna A. Musculoskelet Surg. 2011 Jul;95 Suppl :55-8. PMID: 21479866

Skeletal Radiology: Osteochondral Lesions

1. Limitations of radiographs in evaluating non-displaced osteochondral lesions of the talus. Dheer S, Khan M, Zoga AC, Morrison WB. Skeletal Radiol. 2011 Aug 9. [Epub ahead of print]  PMID: 21826614
2. High-resolution MR imaging of talar osteochondral lesions with new classification. Griffith JF, Lau DT, Yeung DK, Wong MW. Skeletal Radiol. 2011 Aug 9. [Epub ahead of print] PMID: 21826613

Lawson scientist presents joint pain treatment 2.0

When patients have OA in the knee, the fluid in their joint breaks down, causing pain and preventing natural shock absorption. To treat this condition, gel-like substances called "viscosupplements" are injected into the knee. This acts as a supplement for the fluid loss and provides temporary pain relief. In the COR1.0 study, Dr. Petrella and his colleagues compared Synvisc-One, the leading market viscosupplement for OA in the knee, to Hydros-TA Joint Therapy. Hydros-TA is a unique dual-action treatment combining steroids within a viscosupplement. It is believed to provide faster acting, longer lasting pain relief than either treatment alone. Eurekalert!

Curry spice could offer treatment hope for tendinitis

A derivative of a common culinary spice found in Indian curries could offer a new treatment hope for sufferers of the painful condition tendinitis, an international team of researchers has shown.  In a paper due to be published in the Journal of Biological Chemistry, the researchers at The University of Nottingham and Ludwig Maximilians University in Munich have shown that curcumin, which also gives the spice turmeric its trademark bright yellow colouring, can be used to suppress biological mechanisms that spark inflammation in tendon diseases. Eurekalert!

The Dedicated Orthopedic Trauma Operating Room

The development and implementation of a dedicated orthopedic trauma operating room (OTOR) that is used for the treatment of orthopedic trauma patients has changed and improved the practice of orthopedic trauma surgery. Advantages noted with OTOR implementation include improvements in morbidity and complication rates, enhancements in the professional and personal lifestyles of the on-call surgeon, and increased physician recruitment and retention in orthopedic traumatology. However, the inappropriate use of the OTOR, which can waste valuable resources and delay the treatment of emergent cases, must be monitored and avoided.

Min, William; Wolinsky, Philip R. Journal of Trauma-Injury Infection & Critical Care. 71(2):513-515, August 2011. PDF

Telemedicine to a moving ambulance improves outcome after trauma in simulated patients.

TM to a moving ambulance improved the care of simulated trauma patients. Furthermore, procedurally naïve EMTs were able to perform needle thoracostomy and pericardiocentesis with TM guidance. Charash WE, Caputo MP, Clark H, Callas PW, Rogers FB, Crookes BA, Alborg MS, Ricci MA. J Trauma. 2011 Jul;71(1):49-55. PMID: 21818014  PDF