Introducing an iPad eBook version of the recently published "The Cowboy’s Companion: A Trail Guide for the Arthroscopic Shoulder Surgeon", written by Dr. Stephen Burkhart

Leading Surgeon in Arthroscopic Shoulder Surgery Publishes the First Surgical Animated eTextbook with Integrated Surgical Video The eBook and hardbound book cover a unified approach to shoulder surgery based on sound biomechanical and biological principles. Included are approximately 1,500 high resolution images and illustrations and seven hours of edited video and new surgical techniques, emphasizing new technology and techniques that have evolved over recent years. iMedicalApps

Comment on Military Orthopaedic Residency (Army)

Military Orthopedic Residency: The Good, the Challenging, and the Different (HTML)
Being part of a team means being part of something bigger than yourself—it is one of the most basic life-lessons. If your work is gratify­ing, you put forth a bit more effort than you would otherwise, and devel­op a sense of pride in both your team and your teammates. All of this applies to the military. We are a team and we share a common goal: providing the best possible care to our service members and their families. Our job as orthopedic residents within the military is to make sure we are well trained to succeed in this aim. Krueger CA, Stinner DJ. Am J Orthop (Belle Mead NJ) 2012 Mar;41(3):E51-E52. PMID: 22530205

LE Ortho injuries involving vascular repair

Combined orthopedic and vascular lower extremity injuries: sequence of care and outcomes
We conclude that temporary vascular shunting followed by orthopedic stabilization and then definitive vascular repair is the most reasonable sequence of care for minimizing rates of amputation and revascularization procedures in this cohort of patients. Desai P, Audige L, Suk M. Am J Orthop (Belle Mead NJ). 2012 Apr;41(4):182-6. PMID: 22530222

Study in journal Spine: acute back pain patients with poor prognosis

Patients with acute low back pain have poor prognosis.
Few patients with acute low back pain (LBP), with or without sciatica, declare sick leave; however, approximately half have one or more recurrences and a considerable proportion experience chronic pain six months or longer after the initial episode, according to a study published in the April 15 issue of Spine. MedicalXpress

Study reveals need for better screening, prevention of venous thromboembolism as numbers of outpatient surgeries grow

Outpatient surgery patients also at risk for blood clots.
A University of Michigan Health System study examined who's having outpatient surgery in the U.S. today, and showed 1 in 84 highest-risk patients suffers a dangerous blood clot after surgery. Hospitalized patients are often warned of the possibility of venous thromboembolism, which include blood clots that can form in the veins and travel to the lungs. However these warnings have not necessarily been extended to the outpatient surgery population, says U-M surgeon and lead study author Christopher J. Pannucci, M.D.

Reference: "Identifying patients at high risk for venous thromboembolism requiring treatment after outpatient surgery," Annals of Surgery, April 24, 2012. Eurekalert!

Fiber for bone health

New research underscores the health benefits of fibers, including bone health.
For years, fiber intake among the global population has been extremely low, setting the stage for potentially serious, long-term public health implications.(1) New research commissioned by Tate & Lyle and presented at the 2012 Experimental Biology conference in San Diego adds to the body of emerging research on fibers, including additional support for the role of soluble corn fiber in bone health.

"Years of research point to the health benefits of fiber for cardiovascular health, blood glucose control, digestion and gut health, yet average intake is approximately half the recommended amount," said Joanne Slavin, PhD, RD, of the University of Minnesota and a member of the 2010 Dietary Guidelines Advisory Committee. "With more than 90 percent of adults and children falling short of meeting their daily fiber recommendations, the 2010 Dietary Guidelines for Americans classified fiber as a nutrient of concern, since it's one of the critical nutrients most lacking in people's diets." Eurekalert!

New technique for pediatric limb lengthening

Rice University student engineers automate limb lengthening for kids.
Another day, another four turns of the screw. That's just a part of life for people, primarily children, undergoing the long and difficult process of distraction osteogenesis, a method to correct bone deformities that leave one limb shorter than the other.

A team of Rice University undergraduates has invented a device they hope will make the process safer and easier.

In collaboration with Shriners Hospital for Children in Houston, the students came up with "LinDi," a self-adjusting, automated linear distractor. It eliminates manual manipulation of the screw with a motorized process that makes the gradual growth of new bone a more natural process. And for the first time in such a device, they have built in a force-feedback loop that protects fragile tissues and nerves from being overstressed. Eureklaert!

Physician Executive Journal (PEJ)

Physician Executive Journal (PEJ) for iOS and Android.
The Physician Executive Journal (PEJ) is an award-winning publication covering the world of medical management and physician leadership. Published by the American College of Physician Executives. The journal is powered by Texterity.

Now, read the PEJ on your iOS or Android mobile device.

Learn more about the iOS app here and the Android app here

Two-photon polymerization-generated and micromolding-replicated 3D scaffolds for peripheral neural tissue engineering applications.

New technique may help severely damaged nerves regrow and restore function. Engineers at the University of Sheffield have developed a method of assisting nerves damaged by traumatic accidents to repair naturally, which could improve the chances of restoring sensation and movement in injured limbs. MedicalXpress

Journal of Surgical Education: articles in press

1. Residents Can Successfully Teach Basic Surgical Skills in the Simulation Center. Original Research Article, In Press, Corrected Proof, Available online 16 April 2012; Luise I.M. Pernar, Douglas S. Smink, Gloria Hicks, Sarah E. Peyre. PDF (203 K)  

2. Measuring the Surgical Academic Output of an Institution: The “Institutional” H-Index. Original Research Article, In Press, Corrected Proof, Available online 5 April 2012; Kiran K. Turaga, T. Clark Gamblin. PDF (602 K)

3.  Quality Improvement Requirement. In Press, Corrected Proof, Available online 20 March 2012; John A. Weigelt; PDF (66 K)  

4. Master Surgeons' Operative Teaching Philosophies: A Qualitative Analysis of Parallels to Learning Theory. Original Research Article, In Press, Corrected Proof, Available online 20 March 2012; Luise I.M. Pernar, Stanley W. Ashley, Douglas S. Smink, Michael J. Zinner, Sarah E. Peyre. PDF (283 K)  

5. Cutting Errors in Surgery: Experience Limits Underestimation Bias in a Simulated Surgical Environment. Original Research Article, In Press, Corrected Proof, Available online 3 March 2012. Neha Malhotra, Jamie M. Poolton, Mark R. Wilson, Rich S.W. Masters. PDF (329 K)  

6. Objective Assessment of Surgical Training in Flexor Tendon Repair: The Utility of a Low-Cost Porcine Model as Demonstrated by a Single-Subject Research Design. Original Research Article, In Press, Corrected Proof, Available online 3 March 2012; Elisabeth Zetlitz, Scott Cameron Wearing, Alexander Nicol, Andrew Mackay Hart. PDF (462 K)  

AAOS Now - top stories

Autograft or Allograft for ACL Reconstruction?

Evolving Care During a Decade at War

Flexible IM Nailing for Pediatric Tibial Fractures: Pearls and Pitfalls

Strongly enhanced levels of sclerostin during human fracture healing

Sclerostin (SOST), an antagonist of Wnt signaling, is an important negative regulator of bone formation. However, no data on the role of SOST in the human fracture healing have been published so far. This study addressed this issue. Seventy-five patients with long bone fractures were included into the study and divided in two groups. The first group contained 69 patients with normal fracture healing. Six patients with impaired fracture healing formed the second group. Thirty-four volunteers donated blood samples as control. Serum samples were collected over a period of 1 year following a standardized time schedule. In addition, SOST levels were measured in fracture hematoma and serum of 16 patients with bone fractures. Fracture hematoma contained significantly higher SOST concentrations compared to patient's serum. SOST levels in fracture hematoma and in patient's serum were both significantly higher than in the serum of controls. Highly elevated SOST serum concentrations were found in patients with physiological fracture healing. SOST levels were decreased in patients with impaired fracture healing. However, this difference was not statistically significant. This is the first study to provide evidence of strongly enhanced SOST levels in patients with bone fracture. The results indicate local and systemic involvement of SOST in humans during fracture healing.  Sarahrudi, K., Thomas, A., Albrecht, C. and Aharinejad, S. J. Orthop. Res. Article first published online: 16 APR 2012. PDF

Ultrasound-guided Fascia Iliaca Compartment Block for Hip Fractures in the Emergency Department.

Hip fracture (HFx) is a painful injury that is commonly seen in the emergency department (ED). Patients who experience pain from HFx are often treated with intravenous opiates, which may cause deleterious side effects, particularly in elderly patients. An alternative to systemic opioid analgesia involves peripheral nerve blockade. This approach may be ideally suited for the ED environment, where one injection could control pain for many hours. Haines L, Dickman E, Ayvazyan S, Pearl M, Wu S, Rosenblum D, Likourezos A.

J Emerg Med. 2012 Apr 9. [Epub ahead of print] PMID: 22494596 PDF

Patellar Stress Fracture After Transosseous Extensor Mechanism Repair: Report of 3 Cases

Stress fractures of the patella are reportedly rare. They can be seen in association with knee arthroplasty, anterior cruciate ligament (ACL) surgery, and rarely after impact sports. The fracture pattern is usually transverse. Longitudinal stress fractures do not typically disrupt the extensor mechanism and have not, to our knowledge, ever been identified as a postoperative complication of extensor mechanism repair. James M. Gregory, Seth L. Sherman, Richard Mather, Bernard R. Bach Jr. AJSM PreView, published on April 16, 2012 PDF

Anatomic Femoral Tunnel Drilling in Anterior Cruciate Ligament Reconstruction: Use of an Accessory Medial Portal Versus Traditional Transtibial Drilling

During anatomic anterior cruciate ligament (ACL) reconstruction, we have found that the femoral footprint can best be visualized from the anteromedial portal. Independent femoral tunnel drilling can then be performed through an accessory medial portal, medial and inferior to the standard anteromedial portal. Marc Tompkins, Matthew D. Milewski, Stephen F. Brockmeier, Cree M. Gaskin, Joseph M. Hart, Mark D. Miller. Am J Sports Med April 20, 2012 PDF

Foot and Ankle Clinics: articles in press

1. Update on Stage IV Acquired Adult Flatfoot Disorder:: When the Deltoid Ligament Becomes Dysfunctional. Review Article. In Press, Corrected Proof, Available online 9 April 2012; Jeremy T. Smith, Eric M. Bluman. PDF (1020 K)  

2. Calcaneal Osteotomy in the Treatment of Adult Acquired Flatfoot Deformity. Review Article, In Press, Corrected Proof, Available online 9 April 2012; Abhijit R. Guha, Anthony M. Perera. PDF (1071 K)  

3. Tendon Transfer Options in Managing the Adult Flexible Flatfoot. Review Article

In Press, Corrected Proof, Available online 5 April 2012; Michael S. Aronow. PDF (1946 K)

4. Management of the Recurrent Deformity in a Flexible Foot Following Failure of Tendon Transfer: Is Arthrodesis Necessary? Review Article, In Press, Corrected Proof, Available online 5 April 2012; Safet O. Hatic II, Terrence M. Philbin. PDF (774 K)  

5. Tarsal Coalitions in the Adult Population: Does Treatment Differ from the Adolescent? Review Article, In Press, Corrected Proof, Available online 5 April 2012; Steven W.. Thorpe, Dane K. Wukich. PDF (888 K)  

The Journal of Hand Surgery: articles in press

1. Trapezoid Fractures: Report of 11 Cases. Original Research Article. In Press, Corrected Proof, Available online 21 April 2012; Nakul Kain, Carlos Heras-Palou. PDF (534 K)
2. Applicability of Large Databases in Outcomes Research. In Press, Corrected Proof, Available online 21 April 2012; Sunitha Malay, Melissa J. Shauver, Kevin C. Chung. PDF (354 K)
3. Predictors of Diagnosis of Ulnar Neuropathy After Surgically Treated Distal Humerus Fractures. Original Research Article. In Press, Corrected Proof, Available online 21 April 2012; Jimme K. Wiggers, Kim M. Brouwer, Gijs T.T. Helmerhorst, David Ring. PDF (223 K)
4. Hand Made: An Anatomical Study of the Human Spirit. In Press, Corrected Proof, Available online 14 April 2012; Kristy L. Hamilton. PDF (454 K)
5. Mobile Software Applications for Hand Surgeons. In Press, Corrected Proof, Available online 14 April 2012; Orrin I. Franko. PDF (168 K)
6. Hepatitis C and the Hand Surgeon: What You Should Know. In Press, Corrected Proof, Available online 14 April 2012; Nick Pappas, Donald H. Lee. PDF (419 K)
7. Electrothermal Collagen Shrinkage. In Press, Corrected Proof, Available online 14 April 2012; Pedro K. Beredjiklian, Michael Rivlin. PDF (159 K)
8. Hand Made: Recreating an Ancient Chinese Instrument, the Guqin. In Press, Corrected Proof, Available online 14 April 2012; Montri Daniel Wongworawat. PDF (640 K)
9. Glomus Tumor of Digital Nerve: Case Report. In Press, Corrected Proof, Available online 14 April 2012; Andrew Mitchell, Robert J. Spinner, Ana Ribeiro, Manuela Mafra, Maria M. Mouzinho, Bernd W. Scheithauer. PDF (1618 K)
10. Posterior Elbow Release and Humeral Osteotomy for Patients With Arthrogryposis. Review Article. In Press, Corrected Proof, Available online 5 April 2012 Dan A. Zlotolow, Scott H. Kozin. PDF (2541 K)
11. Biomechanical Measurements of Forearm Pronosupination With Common Methods of Immobilization. Original Research Article. In Press, Corrected Proof, Available online 5 April 2012; Aron M. Trocchia, John C. Elfar, Warren C. Hammert. PDF (519 K)

Recent Ortho related articles by Navy researchers

1. Short-Term Physical and Mental Health Outcomes for Combat Amputee and Nonamputee Extremity Injury Patients. Melcer T, Walker GJ, Sechriest VF 2nd, Galarneau M, Konoske P, Pyo J. J Orthop Trauma. 2012 Apr 9. [Epub ahead of print]

PMID: 22495531

2. Management of contaminated open fractures: A comparison of two types of irrigation in a porcine model. Gaines RJ, Demaio M, Peters D, Hasty J, Blanks J.

J Trauma Acute Care Surg. 2012 Mar;72(3):733-6. PMID: 22491562

3. Perioperative administration of gabapentin for shoulder arthroscopy: a prospective, randomized, double-blind, placebo-controlled study. Spence D, Goff J, Mohan E, Bowen K, Osborne L, Maye J. AANA J. 2011 Aug;79(4 Suppl):S43-50. PMID: 22403966

4. Assessment of the effects of acute and repeated exposure to blast overpressure in rodents: toward a greater understanding of blast and the potential ramifications for injury in humans exposed to blast. Ahlers ST, Vasserman-Stokes E, Shaughness MC, Hall AA, Shear DA, Chavko M, McCarron RM, Stone JR. Front Neurol. 2012;3:32. Epub 2012 Mar 5. PMID: 22403572 Free PMC Article

5. Complex Dismounted IED Blast Injuries: The Initial Management of Bilateral Lower Extremity Amputations With and Without Pelvic and Perineal Involvement. Mamczak CN, Elster EA. J Surg Orthop Adv. 2012 Spring;21(1):8-14. PMID: 22381505

Prevention of Venous Thromboembolism After Hip or Knee Arthroplasty Findings From a 2008 Survey of US Orthopedic Surgeons

A survey was mailed to a representative sample of US orthopedic surgeons to assess protocols for the prevention of venous thromboembolism after lower extremity total joint arthroplasty. Practices were examined by type of operation, annual surgical volume, and opinions of consensus guidelines issued by the American Academy of Orthopaedic Surgeons and the American College of Chest Physicians. Although there was near-unanimous agreement that routine thromboprophylaxis should be the standard practice for patients who undergo hip or knee arthroplasty, surgeons were divided as to the exact management approach. Frederick A. Anderson Jr., Wei Huang, Richard J. Friedman,, Louis M. Kwong, Jay R. Lieberman, Vincent D. Pellegrini, The Orthopaedic Surgeon's Survey Steering Committee. The Journal of Arthroplasty; Volume 27, Issue 5, May 2012, Pages 659–666.e5 PDF

Video Review of the New England Journal of Medicine iPad App

So how does the iPad app stack up? Does it merely take the online version of the NEJM and put PDF files on your iPad? Or, does it utilize the dynamic user interface of the iPad and allow for a transformational reading experience?

We have a video review of the app here: (register for free to view the video). iMedicalApps