One resident's experience designing and running a randomized control trial in orthopedic surgery.

All ACGME-accredited orthopedic residency programs require residents to participate in research during their training. The levels of evidence adopted for clinical research validate the randomized clinical trial (RCT) as the gold (Level 1) standard. While many residents aspire to conduct or be involved in an RCT during their orthopedic training, I would like to describe my experience as an orthopedic surgery resident designing and running an RCT. O'Donnell PW. J Surg Educ. 2011 May-Jun;68(3):250-3. Epub 2011 Jan 15. PMID: 21481812   PDF

Military Malpractice System Needs Overhaul

Reform of the existing administrative approach to malpractice offers the best hope to improve the military's response to medical injury compensation for veterans, health policy specialists suggested.
For more than 60 years, prevailing doctrine has maintained a "seemingly indefensible inequity between civilians and active-duty service members injured as a result of malpractice." However, eliminating the doctrine would simply "replace one injustice with another," according to an article in the August 18 issue of the New England Journal of Medicine. (PDF) via Medpage Today

Closed Reduction and Early Mobilization in Fractures of the Humeral Capitellum.

Seven consecutive patients with an isolated fracture of the humeral capitellum were treated by a single surgeon at a Level II care facility according to a simple treatment algorithm. Closed reduction was attempted in all cases using a standard technique. After reduction, the arm was splinted at 90° of flexion and mobilized at 14 days. All patients completed a clinical and radiographic follow-up consisting of a radiographic evaluation of reduction, elbow range of motion, Disabilities of the Arm, Shoulder and Hand Questionnaire, and a subjective rating of patient satisfaction. None of the patients required conversion to open reduction internal fixation or excision. Disabilities of the Arm, Shoulder and Hand Questionnaire scores ranged from 6 to 13 points (out of 100; mean, 9). The mean flexion/extension arc of motion obtained was 126° with minimal loss of rotation. Patient satisfaction was rated as excellent in five patients and good in two. All fractures appeared united at the most recent clinical and radiographic review. Closed reduction and early mobilization appears to be a safe and effective method of treating displaced fractures of the humeral capitellum with clinical results comparable to that of open reduction internal fixation. Puloski S, Kemp K, Sheps D, Hildebrand K, Donaghy J. J Orthop Trauma. 2011 Jul 28. [Epub ahead of print] PMID: 21804417  PDF

Towards an assessment of bone fracture healing using pulsed mode ultrasound.

Healing rate of fractured bone differs from one patient to another which may lead to incorrect consequent medical procedures. Thus, quantitative assessment of bone healing after fracture becomes important. In this paper, we present a mathematical model which describes the interaction of a pulsed mode ultrasound waves with a multilayered biological structure. The model is applied to estimate the bone callus thickness and degree of hardness. Different frequencies are utilized to obtain highest measurement sensitivity and accuracy of callus thickness and degree of hardness. It is found that a transducer operating at 1 MHz has the highest sensitivity to the different phases of callus hardening. On the other hand, a 3 MHz transducer yields the highest sensitivity to the thickness of the callus layer. Thus, using both frequencies might prove to be useful for full quantitative assessment of the bone healing process. Qaddoumi N, Al-Nashash H, Sediq AB, Al-Shamsi H, Al-Mehrizi M, Khalaf K. Technol Health Care. 2011 Jan 1;19(4):261-9. PMID: 21849736

Posterior Tibial Tendon Tear After 4-Cortex Syndesmotic Screw Fixation: A Case Report and Literature Review.

We describe a previously unreported problem of a patient who underwent errant 4-cortex syndesmotic screw fixation with resultant posterior tibial tendon tear necessitating removal of hardware and repair of a tendon tear. Kwon JY, Campbell JT, Myerson MS. J Orthop Trauma. 2011 Aug 12. [Epub ahead of print] PMID: 21849910

High-resolution magic angle spinning NMR spectroscopy of human osteoarthritic cartilage.

This indicates that N-acetyl can serve as an important bio-marker of OA disease progression. A decrease in the alanine concentration in OA may be attributed to the degradation of the collagen framework with disease progression and eventual loss of the degradation products that are transported from cartilage into the synovial cavity.  Shet K, Siddiqui SM, Yoshihara H, Kurhanewicz J, Ries M, Li X. NMR Biomed. 2011 Aug 18. doi: 10.1002/nbm.1769. [Epub ahead of print] PMID: 21850648

New 'bionic' leg gives amputees a natural gait

A new lower-limb prosthetic developed at Vanderbilt University allows amputees to walk without the leg-dragging gait characteristic of conventional artificial legs.

The device uses the latest advances in computer, sensor, electric motor and battery technology to give it bionic capabilities: It is the first prosthetic with powered knee and ankle joints that operate in unison. It comes equipped with sensors that monitor its user's motion. It has microprocessors programmed to use this data to predict what the person is trying to do and operate the device in ways that facilitate these movements. Eurekalert!

Fujifilm releases radiology viewing app, allows physicians and radiologists to view medical images on the go

Fujifilm Synapase Mobility is now available in the U.S., and not just on the iPhone, but for the Android and iPad as well.  Fujifilm makes a variety of medical images devices, from ultrasound devices to computed radiology devices (x-rays).

If you use their backend server (Synapse PACS and Synapse RIS), you can now view your images on your mobile devices. Whats really interesting about their mobile suite is that it’s browser independent, scalable, and doesn’t just display static images.
Currently the system isn’t FDA approved, but with the amount of business Fujifilm already has in the medical ecosystem, one would think this would happen sooner than later.

It provides advanced viewing capabilities for physicians to view 3D images as well as to be able to zoom, window and level, and use MIP/MPR just as they would do at a clinical workstation. Synapse® Mobility is for non-diagnostic use only. iMedicalApps

The microbiological basis for a revised antibiotic regimen in high-energy tibial fractures: Preventing deep infections by nosocomial organisms

Following high-energy open fracture, a single prophylactic antibiotic regimen directed against environmental wound contaminants does not provide cover for the organisms responsible for deepest SSI's and may have depopulated the niche, promoting nosocomial contamination prior to definitive closure. We advocate a dynamic prophylactic strategy, tailoring a second wave of prophylaxis against nosocomial organisms at the time of definitive wound closure, and at the same time avoiding the potential complications of prolonged antibiotic use. Glass GE, Barrett SP, Sanderson F, Pearse MF, Nanchahal J. J Plast Reconstr Aesthet Surg. 2011 Mar;64(3):375-80. Epub 2010 Jun 29. PMID: 20591757 PDF

Link to articles that have cited above article since publication

Injury: Articles in Press

Pretraining and posttraining assessment of residents' performance in the fourth accreditation council for graduate medical education competency: patient communication skills.

Patient communication skills need to be taught as part of residency training. With limited training, case-specific skills (herein, involving patients with cancer) are likely to improve more than general communication skills. Chandawarkar RY, Ruscher KA, Krajewski A, Garg M, Pfeiffer C, Singh R, Longo WE, Kozol RA, Lesnikoski B, Nadkarni P. Arch Surg. 2011 Aug;146(8):916-21. PMID: 21844435  PDF

Is Dynamic Gadolinium Enhancement Needed in MR Imaging for the Preoperative Assessment of Scaphoidal Viability in Patients with Scaphoid Nonunion? [Musculoskeletal Imaging]

Because the diagnostic performance of dynamic gadolinium-enhanced MR imaging in the evaluation of scaphoid viability was inferior to that of a standard MR imaging protocol, dynamic acquisition may not be needed in patients with nonunion of scaphoid fractures. Donati OF, Zanetti M, Nagy L, Bode B, Schweizer A, Pfirrmann CW. Radiology. 2011 Jun 28. [Epub ahead of print] PMID: 21712471  PDF

[Reality of provision of care in Germany in the fields of orthopedics and casualty surgery.]

Ewerbeck V. Orthopade. 2011 Aug 17. [Epub ahead of print] German. No abstract available. PMID: 21845478 PDF

Note: Article is in Gernman but is open access. However, the article can be saved as PDF then translated at home (this feature of Google Translate is blocked by the DoD) using this link:

Translate document German to English:

Role Playing Boosts Surgical Residents' Bedside Manner

A quick course in communication skills may improve surgical residents' interactions with some patients, researchers said.

Although it didn't significantly improve general communication skills, a two-hour program involving lectures and role playing resulted in significantly better scores on a case-specific content checklist (P=0.005), Rajiv Chandawarkar, MD, of the University of Connecticut Health Center in Farmington, Conn., and colleagues reported in the August issue of the Archives of Surgery.  MedPage Today

DVT Risk Low After General Surgery (CME/CE)

Deep vein thrombosis (DVT) occurs infrequently following general surgery, but when it does, it often involves a central venous catheter, a review of a large clinical series showed.
DVT occurred in fewer than 2% of 2,189 operations, and catheter-associated clotting caused 60% of the episodes. Medpage Today

Treatment for distal tibial fractures with intramedullary nails and blocking screws

Blocking screws helped to achieve better reduction and alignment with intramedullary nailing of distal tibial fractures by decreasing the effective diameter of the medullary canal. The use of blocking screws enabled to use the intramedullary nailing as an alternative while treating distal tibial fractures.  SpringerLink             

Disability system leaves troops in 'vast unknown'

The government determines the pay and benefits given to wounded, sick or injured troops for their military service. Under the old system, a medical board would determine their level of military compensation and the service member would be discharged. Then the veteran essentially would have to go through the process again with the Veterans Affairs Department to determine benefits. While they waited for their VA claim to be processed, many of the war wounded were going broke.

Under the new system, which started in 2007 and will be completely rolled out at military bases nationwide by the end of September, the service member essentially goes through both disability evaluation systems at the same time before leaving the military. AP

New compound may accelerate bone healing, prevent osteoporosis

Hiroki Yokota, professor of biomedical engineering at Indiana University-Purdue University Indianapolis (IUPUI) and adjunct professor of anatomy and cell biology at the IU School of Medicine, will investigate the effect of salubrinal -- a chemical compound originally developed to encourage insulin production in individuals with diabetes -- on human bone strength and growth. Early laboratory research supported by the Indiana Clinical and Translational Sciences Institute (CTSI) suggests weakened bones treated with salubrinal experience a statistically significant increase in strength, as well as accelerated healing in bones that have been fractured. PhysOrg.com

Archives of Orthopaedic and Tauma Surgery [Epub ahead of print]

15. The virtual isocentric aiming device: a new mechanical targeting concept. Mendel T, Hänni M, Gueorguiev B, Wohlrab D, Hofmann GO. Arch Orthop Trauma Surg. 2011 Aug 13. [Epub ahead of print] PMID: 21842286

16. Interdisciplinary inter-observer agreement and accuracy of MR imaging of the shoulder with arthroscopic correlation. Halma JJ, Eshuis R, Krebbers YM, Weits T, de Gast A. Arch Orthop Trauma Surg. 2011 Aug 13. [Epub ahead of print] PMID: 21842285 PDF

17. Surgical treatment of proximal ruptures of the rectus femoris in professional soccer players.

García VV, Duhrkop DC, Seijas R, Ares O, Cugat R. Arch Orthop Trauma Surg. 2011 Aug 13. [Epub ahead of print] PMID: 21842284

18. Transtendon arthroscopic repair of high grade partial-thickness articular surface tears of the rotator cuff with biceps tendon augmentation: technical note and preliminary results. Ji JH, Shafi M, Jeong JJ, Lee YS, McFarland EG, Kim TK, Chung JY. Arch Orthop Trauma Surg. 2011 Aug 13. [Epub ahead of print] PMID: 21842283

Ultrasound-Guided Injection Techniques for the Low Back and Hip Joint.

This article will review the selected ultrasound-guided injection techniques that are performed in the low-back and hip-joint areas. Sonographic images and schematic illustrations of these ultrasound-guided injection techniques will be shown. Chen CP, Lew HL, Tsai WC, Hung YT, Hsu CC. Am J Phys Med Rehabil. 2011 Aug 12. [Epub ahead of print] PMID: 21844793