Bone tissue composition varies across anatomic sites in the proximal femur and the iliac crest.

Thus, the average cortical tissue mineral content and the widths of the distributions of cortical crystal size/perfection differ at the subtrochanteric femur relative to the greater trochanter and the iliac crest. In particular, the cortex of the iliac crest has lower mineral content relative to that of the subtrochanteric femur and may have limited utility as a surrogate for subtrochanteric bone. Donnelly E, Meredith DS, Nguyen JT, Boskey AL. J Orthop Res. 2011 Oct 27. doi: 10.1002/jor.21574. [Epub ahead of print] PMID: 22034199

Multi-touch table system for medical visualization: application to orthopedic surgery planning.

Medical imaging plays a central role in a vast range of healthcare practices. The usefulness of 3D visualizations has been demonstrated for many types of treatment planning. Nevertheless, full access to 3D renderings outside of the radiology department is still scarce even for many image-centric specialties. Our work stems from the hypothesis that this under-utilization is partly due to existing visualization systems not taking the prerequisites of this application domain fully into account. We have developed a medical visualization table intended to better fit the clinical reality. The overall design goals were two-fold: similarity to a real physical situation and a very low learning threshold. This paper describes the development of the visualization table with focus on key design decisions. The developed features include two novel interaction components for touch tables. A user study including five orthopedic surgeons demonstrates that the system is appropriate and useful for this application domain. Lundström C, Rydell T, Forsell C, Persson A, Ynnerman A. IEEE Trans Vis Comput Graph. 2011 Dec;17(12):1775-84. PMID: 22034294

Must Read: M.R.I.’s, Often Overused, Often Mislead, Doctors Warn

Dr. James Andrews, a widely known sports medicine orthopedist in Gulf Breeze, Fla., wanted to test his suspicion that M.R.I.’s, the scans given to almost every injured athlete or casual exerciser, might be a bit misleading. So he scanned the shoulders of 31 perfectly healthy professional baseball pitchers.

The pitchers were not injured and had no pain. But the M.R.I.’s found abnormal shoulder cartilage in 90 percent of them and abnormal rotator cuff tendons in 87 percent. “If you want an excuse to operate on a pitcher’s throwing shoulder, just get an M.R.I.,” Dr. Andrews says. Published: October 28, 2011 in The NYT

Journal of Surgical Education: in press, corrected proofs

Operating Room Fatigue: Is Your Twentieth Surgical Knot as Strong as Your First? PDF

Self-Regulated Learning Strategies Used in Surgical Clerkship and the Relationship with Clinical Achievement PDF

Learning Styles of First-Year Orthopedic Surgical Residents at 1 Accredited Institution PDF

Mastery Learning Simulation-Based Curriculum for Laparoscopic TEP Inguinal Hernia Repair PDF

Descriptive Operative Reports: Teaching, Learning, and Milestones to Safe Surgery PDF

Sleep, Supervision, Education, and Servi Views of Junior and Senior Residents PDF

The American Journal of Sports Medicine: PreView articles

Long-term Results of Surgical Decompression of Chronic Exertional Compartment Syndrome of the Forearm in Motocross Racers

The Incidence and Clinical Relevance of Graft Hypertrophy After Matrix-Based Autologous Chondrocyte Implantation

Relationship Between Proximal Femoral and Acetabular Alignment in Normal Hip Joints Using 3-Dimensional Computed Tomography

Man gets smartphone dock built into prosthetic arm

Source: The Telegraph

A British man has become the world's first ever patient to have a smartphone docking system built into his prosthetic arm. Trevor Prideaux, who was born without his left arm, used to have to balance the smartphone on his prosthetic arm or put it on a flat surface to use it.

But now Mr Prideaux, 50, can call and text his loved ones without moving the mobile, which is embedded into his fibreglass and laminate limb. The Telegraph

Extracorporeal shockwave-induced expression of lubricin in tendons and septa.

Lubricin, a lubricating glycoprotein that facilitates tendon gliding, is upregulated by mechanical as well as biochemical stimuli, prompting this study of its induction by extracorporeal shockwave therapy (ESWT). The objective of this study was to characterize and quantify the effect of ESWT on lubricin expression in tendons and septa in a rat model. Hindlimbs of six rats were treated with low-dose ESWT and those of another six with high-dose ESWT, using contralateral limbs as controls. After 4 days, resected samples were processed for immunolocalization of lubricin using a purified monoclonal antibody. ESWT was found to increase lubricin expression in both low-dose and high-dose ESWT-treated tendons and also in septa. Lubricin expression generally increased with increasing dose of ESWT. Increased lubricin expression may contribute to the beneficial effects of ESWT in providing pain and symptom relief in musculoskeletal disorders by decreasing erosive wear. Zhang D, Kearney CJ, Cheriyan T, Schmid TM, Spector M. Cell Tissue Res. 2011 Oct 19. [Epub ahead of print] PMID: 22009294 

Lubricin PubMed RSS Search

An Introduction to Inkling – the future of medical education

If you have been a regular reader of iMedicalApps.com, then you will have heard of Inkling, the interactive electronic textbook company.

If you haven’t, then allow me to introduce you to one aspect of the future of medical education. Inkling has enjoyed a meteoric rise since their humble beginnings in 2010, and we are a massive fan of their body of work. In the first of this series on Inkling, we are going to look at their company profile and the impact they are making in the medical education sector. iMedicalApps

Understanding The Orthopedic Surgeon Salary | Apparent Articles

The area of orthopedic surgery had grown in popularity and has increased the competition in this field. Even with the competition, the Bureau of Labor Statistics is predicting that this area of specialty will continue to grow. The range for orthopedic surgeon salary starts at three hundred and fifty thousand annually, and can go over five hundred thousand annually. The highest salaries are earned by doctors who work in a private practice. Apparent Articles

Epocrates app for iPhone gets major facelift, akin to Facebook app

Epocrates has done a tremendous facelift on their mobile app for the iPhone. Gone are the basic menu trees, and replacing them are moveable icons, similar to an older version of the Facebook app, before it’s recent reincarnation. iMedicalApps

Lower dose of corticosteroids just as effective as higher for shoulder pain

Although corticosteroid injections are one of the most common treatments for shoulder pain, there have been relatively few high-quality investigations of their efficacy and duration of action. In a study scheduled for publication in the December issue of the Archives of Physical Medicine and Rehabilitation, researchers report on the first comparative study of the two most commonly corticosteroid doses administered for shoulder pain. They found that lower doses were just as effective as higher doses in terms of reduction of pain, improved range of motion and duration of efficacy. Eurekalert!  PDF

PubMed Alternative? NLMplus is Featured by the NLM

NLMplus ( http://nlmplus.com) is an innovative semantic search and discovery application, developed by WebLib LLC, a small business in Maryland, in response to a challenge contest by the National Library of Medicine (NLM) to make use of NLM’s vast collection of biomedical data and services for the benefit of the Library’s diverse worldwide user communities. ScienceRoll

Six year outcome excision of the trapezium for trapeziometacarpal joint osteoarthritis: is it improved by ligament reconstruction and temporary Kirschner wire insertion?

This randomized prospective study compared the treatment of trapeziometacarpal joint osteoarthritis with a) trapeziectomy with no ligament reconstruction, no soft tissue interposition and no temporary Kirschner wire stabilization (Group T); b) trapeziectomy with flexor carpi radialis ligament reconstruction and interposition and temporary K-wire stabilization (Group T+LRTI). Salem H, Davis TR. J Hand Surg Eur Vol. 2011 Oct 24. [Epub ahead of print] PMID: 22025011

Hyponatremia and bone: an emerging relationship.

Hyponatremia is the most common electrolyte disorder and is mainly known for its neurological complications. New studies suggest previously unrecognized complications of hyponatremia, including falls, osteoporosis and fractures. Because these novel associations are mainly derived from epidemiological studies, it remains unclear whether hyponatremia has a direct effect on bone or whether it is a surrogate marker of another etiology. Hoorn EJ, Liamis G, Zietse R, Zillikens MC. Nat Rev Endocrinol. 2011 Oct 25. [Epub ahead of print] PMID: 22024973

Fourth and fifth carpometacarpal fracture and dislocation of the hand: new classification and treatment

Cain’s classification of fourth and fifth carpometacarpal (CMC) fracture and dislocation does not include the intraarticular metacarpal (MC) base fracture that may influence the treatment outcome. We reviewed 37 cases of fourth and fifth CMC fracture and dislocation treated with operative method, and we have devised a new classification based on the articular surface of the hamate and the involvement of the MC base. Sang-Uk Lee, Il-Jung Park, Hyoung-Min Kim, Changhoon Jeong and Jin-Rok Oh. European Journal of Orthopaedic Surgery & Traumatology;  DOI: 10.1007/s00590-011-0887-6. Epub ahead of print.

Clinical Use of High-Resolution Ultrasonography for the Diagnosis of Type II Accessory Navicular Bone.

Medial foot pain is a common complaint in rehabilitation clinics. The differential diagnoses include many musculoskeletal disorders like tendonitis and inflammation of ossicles. Posterior tibialis tendonitis is a common cause of foot pain in adults. The accessory navicular (AN) bone is occasionally observed and considered as a secondary ossification center of the navicular bone. Occasionally, posterior tibialis tendonitis and AN bone may cause acute or chronic medial foot pain with varying degrees of dysfunction. Chuang YW, Tsai WS, Chen KH, Hsu HC. Am J Phys Med Rehabil. 2011 Oct 22. [Epub ahead of print] PMID: 22024638

Journal of Orthopaedic Trauma: epub ahead of print

Early Radial Head Excision for Displaced and Comminuted Radial Head Fractures: Considerations and Concerns at Long-Term Follow-Up

An Off-Loading Triceps Suture for Augmentation of Plate Fixation in Comminuted Osteoporotic Fractures of the Olecranon

Infection After Spanning External Fixation for High-Energy Tibial Plateau Fractures: Is Pin Site-Plate Overlap a Problem?

Pelvic Ring Injury Is Associated With Sexual Dysfunction in Women

Mechanical stress can help or hinder wound healing depending on time of application

A new study demonstrates that mechanical forces affect the growth and remodeling of blood vessels during tissue regeneration and wound healing. The forces diminish or enhance the vascularization process and tissue regeneration depending on when they are applied during the healing process.

The study found that applying mechanical forces to an injury site immediately after healing began disrupted vascular growth into the site and prevented bone healing. However, applying mechanical forces later in the healing process enhanced functional bone regeneration. The study's findings could influence treatment of tissue injuries and recommendations for rehabilitation.

The study was published last month in the journal Proceedings of the National Academy of Sciences. The research was supported by the National Institutes of Health, the Armed Forces Institute of Regenerative Medicine and the U.S. Department of Defense. Eurekalert!

Musculoskeletal neoplasms: biopsy and intervention.

Percutaneous core needle biopsy and fine-needle aspiration are safe and cost-effective methods and can be important steps in the workup of a bone or soft tissue lesion. These procedures should be performed in collaboration with the orthopedic oncologist who performs the definitive surgery. In the extremities, attention to compartmental anatomy is paramount. With frozen section evaluation at the time of biopsy, the chances of a nondiagnostic specimen necessitating rebiopsy are minimized. The principles underlying the percutaneous approach to various lesions are valuable and can be applied to minimally invasive percutaneous therapy for bone and soft tissue lesions. Huang AJ, Kattapuram SV. Radiol Clin North Am. 2011 Nov;49(6):1287-305. PMID: 2202429

Military Medicine Works on Managing Pain

Military medicine is seeking additional ways to help patients manage their pain instead of just prescribing powerful drugs, the chief of staff of the Army’s pain management task force said here today. Col. Kevin Galloway told the Defense Writers Group that the military had to start looking at pain comprehensively. DoD