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0 | Performance evaluation of a sensorless adaptive optics multiphoton microscope | Upper Eyelid and Brow Surgery | A wavefront sensorless adaptive optics technique was combined with a custom-made multiphoton microscope to correct for specimen-induced aberrations. A liquid-crystal-on-silicon (LCoS) modulator was used to systematically generate Zernike modes during image recording. The performance of the instrument was evaluated in samples providing different nonlinear signals and the benefit of correcting higher order aberrations was always noticeable (in both contrast and resolution). The optimum aberration pattern was stable in time for the samples here involved. For a particular depth location within the sample, the wavefront to be precompensated was independent on the size of the imaged area (up to �360 � 360 μm2). The mode combination optimizing the recorded image depended on the Zernike correction control sequence; however, the final images hardly differed. At deeper locations, a noticeable dominance of spherical aberration was found. The influence of other aberration terms was also compared to the effect of the spherical aberration. | 65,535 |
0 | Patterns of womac function in people with or at high risk of knee osteoarthritis: The osteoarthritis initiative | Surgical Management of Osteoarthritis of the Knee CPG | Background/Purpose: Despite people with knee osteoarthritis (OA) being at high risk of poor physical function, little is known of changes in physical function over time. Understanding these patterns of change and identifying risk factors of decline could help in preventing the development of poor physical function. We described the trajectories of change in physical function over time and evaluated factors associated with these trajectories of change. Methods: Knee-specific WOMAC physical function scores were assessed in the participants at baseline and at three subsequent annual visits in the Osteoarthritis Initiative. We restricted this analysis to knees with 3 or 4 WOMAC function scores. We used SAS PROC TRAJ, a group-based finite mixture modeling, to identify distinctive sub-groups of knees that follow similar trajectories of physical function over time. The | 32,233 |
0 | Evaluation of silicone as an artificial lubricant in osteoarthrotic joints | OAK 3 - Non-arthroplasty tx of OAK | Silicone 300 has been evaluated as an artificial lubricant in osteoarthrotic joints by means of a pilot study in five inpatients and a control trial of 25 outpatients with 40 osteoarthrotic knees. Sequential analysis showed a significant benefit from saline compared with silicone at one week followâ?up and no significant difference at one month.Measurement of stiffness with a knee arthrograph showed no difference in reduction of stiffness between the two substances. In a study of 18 rabbits there was no evidence that silicone was retained in the joint cavity for longer than 48 hours. There was a failure of clearance of iodinated serum albumin for as long as three to four days after the injection of silicone, suggesting some obstruction to lymphatic outflow. Experimentally produced cartilaginous defects did not heal quicker with the injection of silicone into the joint. | 112,929 |
1 | Postoperative survival and ambulatory outcome in metastatic spinal tumors : prognostic factor analysis | MSTS 2022 - Metastatic Disease of the Humerus | OBJECTIVE: The purposes of this study are to estimate postoperative survival and ambulatory outcome and to identify prognostic factors thereafter of metastatic spinal tumors in a single institute.
METHODS: We reviewed the medical records of 182 patients who underwent surgery for a metastatic spinal tumor from January 1987 to January 2009 retrospectively. Twelve potential prognostic factors (age, gender, primary tumor, extent and location of spinal metastases, interval between primary tumor diagnosis and metastatic spinal cord compression, preoperative treatment, surgical approach and extent, preoperative Eastern Cooperative Oncology Group (ECOG) performance status, Nurick score, Tokuhashi and Tomita score) were investigated.
RESULTS: The median survival of the entire patients was 8 months. Of the 182 patients, 80 (44%) died within 6 months after surgery, 113 (62%) died within 1 year after surgery, 138 (76%) died within 2 years after surgery. Postoperatively 47 (26%) patients had improvement in ambulatory function, 126 (69%) had no change, and 9 (5%) had deterioration. On multivariate analysis, better ambulatory outcome was associated with being ambulatory before surgery (p=0.026) and lower preoperative ECOG score (p=0.016). Survival rate was affected by preoperative ECOG performance status (p<0.001) and Tomita score (p<0.001).
CONCLUSION: Survival after metastatic spinal tumor surgery was dependent on preoperative ECOG performance status and Tomita score. The ambulatory functional outcomes after surgery were dependent on preoperative ambulatory status and preoperative ECOG performance status. Thus, prompt decompressive surgery may be warranted to improve patient's survival and gait, before general condition and ambulatory function of patient become worse. | 157,316 |
0 | Does cognitive functioning predict chronic pain? Results from a prospective surgical cohort | OAK 3 - Non-arthroplasty tx of OAK | It is well established that chronic pain impairs cognition, particularly memory, attention and mental flexibility. Overlaps have been found between the brain regions involved in pain modulation and cognition, including in particular the prefrontal cortex and the anterior cingulate cortex, which are involved in executive function, attention and memory. However, whether cognitive function may predict chronic pain has not been investigated. We addressed this question in surgical patients, because such patients can be followed prospectively and may have no pain before surgery. In this prospective longitudinal study, we investigated the links between executive function, visual memory and attention, as assessed by clinical measurements and the development of chronic pain, its severity and neuropathic symptoms (based on the 'Douleur Neuropathique 4' questionnaire), 6 and 12 months after surgery (total knee arthroplasty for osteoarthritis or breast surgery for cancer). Neuropsychological tests included the Trail-Making Test A and B, and the Rey-Osterrieth Complex Figure copy and immediate recall, which assess cognitive flexibility, visuospatial processing and visual memory. Anxiety, depression and coping strategies were also evaluated. In total, we investigated 189 patients before surgery: 96% were re-evaluated at 6 months, and 88% at 12 months. Multivariate logistic regression (stepwise selection) for the total group of patients indicated that the presence of clinical meaningful pain at 6 and 12 months (pain intensity >= 3/10) was predicted by poorer cognitive performance in the Trail Making Test B (P = 0.0009 and 0.02 for pain at 6 and 12 months, respectively), Rey-Osterrieth Complex Figure copy (P = 0.015 and 0.006 for pain at 6 and 12 months, respectively) and recall (P = 0.016 for pain at 12 months), independently of affective variables. Linear regression analyses indicated that impaired scores on these tests predicted pain intensity (P < 0.01) and neuropathic symptoms in patients with pain (P < 0.05), although the strength of the association was less robust for neuropathic symptoms. These results were not affected by the type of surgery or presurgical pain, similar findings being obtained specifically for patients who initially had no pain. In conclusion, these findings support, for the first time, the notion that premorbid limited cognitive flexibility and memory capacities may be linked to the mechanisms of pain chronicity and probably also to its neuropathic quality. This may imply that patients with deficits in executive functioning or memory because of cerebral conditions have a greater risk of pain chronicity after a painful event. | 108,640 |
0 | Tibiofemoral joint contact force in deep knee flexion and its consideration in knee osteoarthritis and joint replacement | Surgical Management of Osteoarthritis of the Knee CPG | The aim of the study was to estimate the tibiofemoral joint force in deep flexion to consider how the mechanical load affects the knee. We hypothesize that the joint force should not become sufficiently large to damage the joint under normal contact area, but should become deleterious to the joint under the limited contact area. Sixteen healthy knees were analyzed using a motion capture system, a force plate, a surface electromyography, and a knee model, and then tibiofemoral joint contact forces were calculated. Also, a contact stress simulation using the contact areas from the literature was performed. The peak joint contact forces (M +/- SD) were 4566 +/- 1932 N at 140 degrees in rising from full squat and 4479 +/- 1478 N at 90 degrees in rising from kneeling. Under normal contact area, the tibiofemoral contact stresses in deep flexion were less than 5 MPa and did not exceed the stress to damage the cartilage. The contact stress simulation suggests that knee prosthesis having the contact area smaller than 200 mm2 may be problematic since the contact stress in deep flexion would become larger than 21 MPa, and it would lead damage or wear of the polyethylene | 34,704 |
0 | Postoperative urinary retention after general and spinal anesthesia in orthopedic surgical patients | Surgical Management of Osteoarthritis of the Knee CPG | Background: After general, spinal anesthesia and surgery, urinary retention is common. The aim of the study was to compare the effect of general anesthesia versus spinal anesthesia on postoperative urinary retention. Patients and methods: After obtaining local ethics committee approval and written consent, 60 male patients, aged 16-40years, ASA - physical status I and II were divided into two groups (S) 40 patients and (G) 20 patients undergoing surgery of the lower limb lasting up to 90min (knee arthroscopy, internal tibial fixation with plate and screws). Group (S) was taken spinal anesthesia, this group was divided into two groups (S(1)) 20 patients, who were taken plain bupivacaine and group (S(2)) 20 patients who were taken plain bupivacaine plus fentanyl. Group (G) 20 patients were anesthetized by general anesthesia. Results: There were statistically significant differences among groups S1, S2 and G regarding spontaneous micturition, residual volume and time since spinal or general anesthesia till micturition. The percent numbers of patients with retention were 20% in group S1, 35% in group S2 and 8% in group G. Conclusion: Urinary retention is more common after spinal than general anesthesia in orthopedic patients. Adding narcotics to the local anesthetics intrathecally causes more incidence of postoperative urinary retention, which may delay patients discharge and transabdominal ultrasonography is a reliable, noninvasive, inexpensive and simple method to measure bladder volume postoperatively | 28,313 |
0 | A Retrospective Analysis of 287 Patients Undergoing Prophylactic Radiation Therapy for the Prevention of Heterotopic Ossification | MSTS 2022 - Metastatic Disease of the Humerus | Purpose: Heterotopic ossification (HO) is a potentially disabling disorder of ectopic bone formation secondary to orthopedic surgery or trauma. In this retrospective analysis we evaluated the outcomes of patients who received radiation therapy (RT) for HO prophylaxis. Methods and Materials: A total of 287 patients who received RT for HO prophylaxis at a major trauma center from 2007 to 2018 were analyzed. Data collected included types of injury, surgery, time intervals between key events, development of postprophylaxis HO, and secondary malignancies. Associations between various factors and the risk of developing HO were analyzed. Kaplan-Meier analysis was used to estimate failure rates. Results: The most common indication for RT was traumatic acetabular fracture (83.3%). Twelve patients (4.2%) developed postprophylaxis HO with a median time to failure of 8.6 months (2.8-24.5). Kaplan-Meier 1-, 2-, and 5-year failure rates were 3.7%, 4.4%, and 7.4%, respectively. Injury type and timing of RT were not associated with the risk of failure, but we observed a trend of increased risk of failure in patients with longer time between surgery and RT (odd ration [OR] 1.68, P = .056). Current or former smokers (51.7%) were less likely to fail (OR 0.10, P = .03). There was no incidence of in-field secondary malignancy. Conclusions: There was no significant association between injury and fracture type, surgical approach, or timing of RT and development of HO, contrary to published reports of increased HO risk with certain surgical approaches and longer time intervals between injury and surgery, suggesting that prophylactic RT might play a role in mitigating these effects. Decreased risk of postprophylaxis HO among former or current smokers was unexpected. No secondary malignancy in the RT field was identified, although the median follow-up was only 17 months. Compared with published HO incidences (17%-39%) in patients who receive no prophylaxis after traumatic acetabular fractures, our results are highly suggestive of the efficacy of prophylactic RT. | 156,707 |
0 | Clinical factors affecting pathological fracture and healing of unicameral bone cysts | MSTS 2022 - Metastatic Disease of the Humerus | BACKGROUND: Unicameral bone cyst (UBC) is the most common benign lytic bone lesion seen in children. The aim of this study is to investigate clinical factors affecting pathological fracture and healing of UBC.
METHODS: We retrospectively reviewed 155 UBC patients who consulted Nagoya musculoskeletal oncology group hospitals in Japan. Sixty of the 155 patients had pathological fracture at presentation. Of 141 patients with follow-up periods exceeding 6 months, 77 were followed conservatively and 64 treated by surgery.
RESULTS: The fracture risk was significantly higher in the humerus than other bones. In multivariate analysis, ballooning of bone, cyst in long bone, male sex, thin cortical thickness and multilocular cyst were significant adverse prognostic factors for pathological fractures at presentation. The healing rates were 30% and 83% with observation and surgery, respectively. Multivariate analysis revealed that fracture at presentation and history of biopsy were good prognostic factors for healing of UBC in patients under observation.
CONCLUSION: The present results suggest that mechanical disruption of UBC such as fracture and biopsy promotes healing, and thus watchful waiting is indicated in these patients, whereas patients with poor prognostic factors for fractures should be considered for surgery. | 156,920 |
0 | Skeletal impairment in patients with multiple myeloma, review for period of five years 2007-2011 in koroška region | MSTS 2018 - Femur Mets and MM | Background: Multiple myeloma (MM) is a malignant haematological disease which is characterized by proliferation of plasma cell clone in the bone marrow. Among other symptoms of the disease, the important one is bone destruction with pain, pathological fractures and hypercalcemia. Methods: Retrospectively, we collected data on patients with MM treated in the period from 1 January 2007 until 31 December 2011. Diagnosis was confirmed de novo in 19 patients. We treated 15 patients (89 %), 3 patients (16 %) died soon after being diagnosed, without starting the therapy; 1 patient (5 %) continued treatment at the Institute of Oncology and at the Department of Haematology in Ljubljana. All patients received bisphosphonates. Bone disease was diagnosed by x- ray, and in case of pathology, an additional CT scan was performed. At the beginning we found skeletal impairment in 17 / 19 patients (89 %), 5 patients had pathological fractures of the spine and 1 patient destruction of the pelvis. 4 / 19 patients (21 %) had hypercalcemia. All patients were treated with chemotherapy and supporting therapy with bisphosphonates, and despite of that, 6/15 experienced extra fractures. Two patients were operated on, all of them were locally irradiated, immobilized and received analgesics. Conclusions: Supportive therapy with bisphosphonates is an important part of specific treatment for MM. With the availability of additional imaging by MRI or PET CT scan we can diagnose more bone impairments. | 77,716 |
1 | Health-related quality of life and self-reported ability concerning ADL and IADL after hip fracture: a randomized trial | Management of Hip Fractures in the Elderly | BACKGROUND: It is not known whether postoperative occupational therapy is of value for hip fracture patients. In this randomized trial we evaluated the effects of an individualized, postoperative, occupational training (OT) program on the patient's self-reported health-related quality of life (HRQL) and self-reported abilities to perform activities of daily living (ADL) and instrumental activities of daily living (IADL). PATIENTS AND METHODS: 100 eligible patients (aged >or= 65 years) were randomized 50:50 to an OT or control group (termed the C group: conventional care). The OT group received individualized OT from day 3 or 4 after surgery and until discharge, and also a home visit. The patients answered the Swedish Health-Related Quality of Life questionnaire (SWED-QUAL) and the modified Disability Rating Index (DRI) three times: 3-4 days after surgery, at discharge, and at follow-up after 2 months. RESULTS: We found no statistically significant differences between the groups at discharge and at follow-up regarding mean SWED-QUAL scores. However, on comparing each group over time, 2 months after the fracture the OT group had regained their self-reported pre-fracture HRQL status in 10 of 12 SWED-QUAL subscales, and the C group in 6 subscales. Statistically significant differences (p < 0.05) were found between the groups after 2 months regarding self-reported IADL (moving around indoors, performance of light housework, and getting in and out of a car). INTERPRETATION: Our findings indicate that the individualized occupational training improved the ability to perform IADL and appeared to speed up the recovery in some HRQL areas | 13,978 |
0 | Surgical algorithm for management of HIV lipodystrophy | Panniculectomy & Abdominoplasty CPG | BACKGROUND: The accepted standard for treatment of human immunodeficiency virus disease, highly active antiviral therapy, may cause significant side effects, such as facial lipoatrophy and lipodystrophy. Facial wasting or a buffalo hump deformity may be pathognomonic for treated human immunodeficiency virus disease. In addition to facial wasting, cystic parotid degeneration may further distort the face. The authors outline the defects as a series of triangles defined by anatomical boundaries. METHODS: In a group of 27 patients, 17 were treated for buffalo hump (three isolated and 14 with associated facial wasting). Another 10 patients were treated for isolated facial wasting. RESULTS: The 14 patients who underwent liposuction of the buffalo hump with subsequent injection of the aspirate into the face had approximately 40 to 50 percent of the grafts survive. Recurrent or severely fibrous humps were treated with ultrasound-assisted liposuction. In six patients, autografts to the lypoatrophic face were utilized. Two patients undergoing gynecomastia reduction had successful grafting with the resected breast. Three patients with cystic degeneration of the parotid underwent superficial parotidectomy with rotation or grafting of the parotid into the defect, for a total of six individual procedures. CONCLUSION: The authors present an algorithm for treatment of buffalo hump and facial wasting deformities associated with human immunodeficiency virus lipodystrophy syndrome, with an emphasis on long-term results with autogenous tissue. | 124,103 |
0 | Immunosuppressive therapy with cyclosporine for cardiac transplantation | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | Cardiac transplantation under cyclosporine therapy can be regarded as a major therapeutic approach to the patient with intractable heart failure. Improvement of allograft survival to 75% with reduced morbidity and mortality from infection has accompanied the use of CsA, an agent with an excellent immunosuppressive index for inhibition of alloresponsiveness while sparing nonspecific host resistance. However, CsA-induced nephrotoxicity presents a major complication, and a significant cause of immediate and long-term postoperative renal dysfunction. Because of the nephrotoxicity, the trend is toward a reduction of the dose of CsA used, with anticipated lower immunosuppression. Thus, the optimal CsA regimen is not known. Marked interindividual differences in the pharmacokinetic variables of absorption, distribution, metabolism, and elimination combined with a lack of consensus about the analytic method, matrix, and target drug concentrations have led to physicians taking an empiric approach to CsA therapy. Furthermore, differences in pharmacodynamic sensitivity to CsA therapy as evidenced by immunologic tests in vitro further complicate the correlation between pure pharmacokinetic variables and clinical outcome. Clearly, CsA has reduced the severity, and to a lesser extent the incidence, of allograft rejection episodes. Combination immunosuppressive regimens in which CsA, prednisone, azathioprine, ALS are used are being widely applied to achieve better rejection prophylaxis in spite of a lack of documented clinical efficacy in randomized trials or a firm scientific basis. Future progress will depend on results of controlled trials to discern the optimal mixture of immunosuppressive agents that achieves synergistic activity with low toxicity | 18,677 |
0 | Effect of simvastatin treatment on bone mineral density and bone turnover in hypercholesterolemic postmenopausal women: a 1-year longitudinal study | Management of Hip Fractures in the Elderly | Although several studies have reported a lower risk of osteoporotic fracture in hypercholesterolemic patients treated with statins, so far longitudinal studies on the effects of statins on bone are lacking. The aim of the present study was to evaluate bone mineral density (BMD) and bone turnover changes induced by 1-year simvastatin treatment on postmenopausal women. Thirty consecutive postmenopausal hypercholesterolemic women (61.2 +/- 4.9 years) were treated for 12 months with 40 mg/day simvastatin and 30 normocholesterolemic age-matched postmenopausal women provided control data. In all subjects, at baseline and at 3-month intervals, serum lipids, calcium, phosphate, total and bone alkaline phosphatase (Bone-ALP), and carboxy-terminal fragment of type I collagen (CTx) were measured in a fasting blood sample. At baseline and after 6 and 12 months BMD was measured at lumbar spine (BMD-LS) and at femur (BMD-Ftot) and at femoral neck (BMD-Fn) by DXA. In the simvastatin-treated group Bone-ALP showed a significant increase (P < 0.05) with respect to baseline from the sixth month, whereas serum CTx showed a weak and nonsignificant increase over the study period. In treated women BMD-LS, BMD-Fn, and BMD-Ftot increased respectively by 1.1, 0.9, and 0.4% at Month 6; and by 2.8, 1.0, and 0.8% at Month 12. In controls BMD-LS, BMD-Fn, and BMD-Ftot at the end of the study period decreased by 1.6, 1.4, and 1.2%, respectively. The difference between controls and simvastatin-treated patients was significant (P < 0.05) for both BMD-LS and BMD-Fn only at Month 12. In conclusion our results, although obtained from a small sample of postmenopausal hypercholesterolemic women, suggest a probable positive effect of simvastatin on bone formation and BMD | 6,734 |
0 | Plantar pressure differences between cases with symptoms of clinically diagnosed chronic exertional compartment syndrome and asymptomatic controls | DOD - Acute Comp Syndrome CPG | Background Anterior chronic exertional compartment syndrome of the leg has been hypothesised to develop due to excessive muscle activity and foot pronation. Plantar pressure variables related to lower limb muscle activity and foot type may therefore provide insight into this condition. Methods 70 male cases and 70 asymptomatic controls participated. A clinical diagnosis was established from typical symptoms, with clinical examination excluding other pathologies. Plantar pressure variables during walking, hypothesised to be related to foot type, toe extensor activity or had shown predictive validity for general exercise-related lower leg pain, were extracted. Findings Cases were shorter in height (mean difference 2.4 cm), had greater body mass (mean difference 4.4 kg) and had reduced ankle dorsiflexion range of motion than controls (mean difference 1.5 cm). Plantar pressure variables indicative of foot-type and toe extensor activity did not differ between groups (P > 0.05). The magnitude of medial forefoot loading was the strongest plantar pressure predictor of the presence of chronic exertional compartment syndrome (Odds ratio:0.87, P = 0.005). There was also some evidence of greater lateral heel loading at 5% of stance time (P = 0.049â??0.054). Interpretation The lack of association with foottype-related and toe extensor activity-related plantar pressure variables suggest that these are not risk factors for the development of chronic exertional compartment syndrome, contrary to earlier hypotheses. The greater lateral to medial loading could theoretically represent increased Tibialis anterior muscle activity at heel strike but a subsequent loss of control as the ankle is lowered. Future studies directly investigating muscle activity and function are now required. | 63,062 |
0 | Osteochondrosis dissecans of the knee | Osteochondritis Dissecans 2020 Review | Osteochondritis dissecans of the knee in consequence of disturbed blood flow in the bone appears more often in children with high physical activity. Treatment is recommended according to the stage of disease (grade I and II predominantly conservative, grade III and IV operative). Physical capacity is commonly reduced for one year. | 139,598 |
0 | The clinical impact of the age-adjusted charlson comorbidity index on esophageal cancer patients who receive curative treatment | MSTS 2022 - Metastatic Disease of the Humerus | Background/Aim: We investigated the impact of the age-adjusted Charlson comorbidity index (ACCI) on esophageal cancer survival and recurrence after curative treatment. Patients and Methods: This study included 122 patients who underwent curative surgery followed by adjuvant chemotherapy for esophageal cancer between 2005 and 2017. The risk factors for the overall survival (OS) and recurrencefree survival (RFS) were identified. Results: An ACCI of 5 was regarded as the optimal critical point of classification considering the survival rates. The OS rates at 3 and 5 years after surgery were 64.2% and 54.4% in the low-ACCI group, respectively, and 42.3% and 29.2% in high-ACCI group, respectively (p=0.035). The RFS rates at 3 and 5 years after surgery were 50.2% and 43.6% in the low-ACCI group, respectively, and 28.5% and 21.3% in high-ACCI group, respectively (p=0.021). A multivariate analysis demonstrated that ACCI was a significant independent risk factor for both the OS and RFS. Conclusion: ACCI is a risk factor for survival in patients who undergo curative treatment for esophageal cancer. An effective plan for the perioperative care and surgical strategy should be developed according to ACCI. | 155,864 |
1 | Management of neglected lateral condyle fractures of humerus in children: A retrospective study | The Treatment of Pediatric Supracondylar Humerus Fractures AUC | BACKGROUND: Late presentation of humeral lateral condylar fracture in children is a surgical dilemma. Osteosynthesis of the fracture fragment or correction of elbow deformity with osteotomies and ulnar nerve transposition or sometimes both procedures combined is a controversial topic. We retrospectively evaluated open reduction and fixation cases in late presentation of lateral humeral condyle fracture in pediatric cases with regards to union and functional results. MATERIALS AND METHODS: Twenty two pediatric (</=12 years) patients with fractures of lateral condyle presenting 4 weeks or more post injury between the study period of 2006 and 2010 were included. Multiple K-wires / with or without screws along with bone grafting were used. At final evaluation, union (radiologically) and elbow function (Liverpool Elbow Score, LES) was assessed. RESULTS: There were 19 boys and 3 girls. Followup averaged 33 months. Pain (n=9), swelling (n=6), restriction of elbow motion (n=6), prominence of lateral condylar region (n=4), valgus deformity (n=4) were the main presenting symptoms. Ulnar nerve function was normal in all patients. There were nine Milch type I and 13 type II fractures. Union occurred in 20 cases. One case had malunion and in another case there was resorption of condyle following postoperative infection and avascular necrosis. Prominent lateral condyles (4/12), fish tail appearance (n=7), premature epiphyseal closure (n=2) were other observations. LES averaged 8.12 (range, 6.66-9.54) at final followup. CONCLUSIONS: There is high rate of union and satisfactory elbow function in late presenting lateral condyle fractures in children following osteosynthesis attempt. Our study showed poor correlation between patient's age, duration of late presentation or Milch type I or II and final elbow function as determined by LES | 25,102 |
0 | Intraoperative Platelet-Rich Plasma Does Not Improve Outcomes of Total Knee Arthroplasty | Surgical Management of Osteoarthritis of the Knee CPG | This randomized controlled study was conducted to assess the effects of platelet-rich plasma (PRP) on outcomes of total knee arthroplasty (TKA). Forty patients who underwent unilateral TKA were evaluated prospectively; 20 received intraoperative PRP and 20 served as control subjects. The results showed no significant differences in reduction of bleeding, range of motion, swelling around the knee joint, muscle power recovery, pain, Knee Society Scores, and Knee Injury and Osteoarthritis Outcome Score between the 2 groups. Additionally, no distinct clinical characteristics were found in patients who received intraoperative PRP. Therefore, we conclude that intraoperative PRP does not improve outcomes of TKA | 36,556 |
0 | Evaluation of Deep Thermal Rehabilitation System Using Resonant Cavity Applicator During Knee Experiments | OAK 3 - Non-arthroplasty tx of OAK | This paper evaluates experiments on the knee using a new heating rehabilitation system. For effective thermal rehabilitation of osteoarthritis, it is necessary to heat the deep tissue inside the knee joint. Our new rehabilitation system is based on the re-entrant type resonant cavity applicator which was developed for deep hyperthermia treatment in our previous studies. Our experimental results using agar phantoms showed our heating system is able to heat the deep tissue inside the knee without physically contacting the surface skin. In this study, we developed a prototype applicator and experimented on a healthy human subject's knee under clinical conditions. To evaluate heating performance, we conducted heating experiments with our resonant cavity applicator and a conventional microwave diathermy system and compared the results. The experimental results of temperature increase distributions inside the human body were estimated by ultrasound imaging techniques. The estimated results from our knee experiments show that our heating system is able to heat knee tissue more deeply than microwave diathermy systems can and thus would be effective for deep thermal rehabilitation applications in clinics. | 102,393 |
0 | The Long-Term Outcome After Early and Late Anterior Cruciate Ligament Reconstruction | OAK 3 - Non-arthroplasty tx of OAK | PURPOSE: To compare long-term clinical and radiographic outcomes in patients undergoing either early (group A) or late (group B) surgery after anterior cruciate ligament (ACL) injury.
METHODS: ACL reconstruction using hamstring tendon autografts was performed in 30 patients in group A (median age, 23 years; range, 17-49 years) and 31 patients in group B (median age, 27 years; range, 17-38 years). The patients in group A were operated on within 5 months (median, 3 months; range, 2-5 months) of injury, whereas those in group B were operated on more than 24 months (median, 30 months; range, 24-48 months) after injury. The follow-up period was 10 years (median, 117 months [range, 77-222 months] in group A and 129 months [range, 77-206 months] in group B; P = .44). Multiple objective clinical evaluation tests and patient-reported outcome measures were obtained preoperatively and at follow-up. At follow-up, radiographic assessments of knee osteoarthritis (OA) bilaterally were performed.
RESULTS: The frequency of meniscectomy at the index operation was significantly lower in group A (20%) than in group B (52%) (P = .01). There were no significant differences between the groups in terms of Tegner and Lysholm scores and laxity tests both preoperatively and at follow-up. Both groups improved over time in terms of Tegner and Lysholm scores (P < .05). At follow-up, significantly more medial-compartment OA in the index knee was found in group B than in group A (P = .037) according to the Ahlback classification system. The index knee showed significantly more OA than the contralateral knee in both groups (P < .01).
CONCLUSIONS: Patients who underwent early ACL reconstruction required significantly fewer meniscectomies at the index operation than patients who underwent late reconstruction and showed significantly less OA on the medial side of the knee 10 years after reconstruction. However, no significant differences were found between the groups in terms of clinical assessments.
LEVEL OF EVIDENCE: Level III, retrospective comparative study. | 110,306 |
0 | Extensor Pollicis Longus Ruptures Following Distal Radius Osteotomy Through a Volar Approach | Distal Radius Fractures | PURPOSE: To investigate the cause and pathological process of extensor pollicis longus (EPL) ruptures after correction of distal radius malunion through a volar approach.
METHODS: We included patients with EPL ruptures who underwent distal radius osteotomies performed through a volar approach. Data were pooled from members of the International Wrist Investigators Workshop. Patient demographics, initial injury parameters, imaging studies, preoperative and postoperative examination, intraoperative findings, surgical technique, and outcomes were compared and analyzed. Preoperative and postoperative radiographic images were evaluated and compared.
RESULTS: We evaluated 6 cases from 5 surgeons in 4 institutions. Length of follow-up ranged from 1 to 5 years. On initial radiographic evaluation all malunions were healed with dorsal angulation (20degree to 60degree) and with positive ulnar variance. Deformity correction in the sagittal plane was 25degree to 55degree. Osteotomies were fixed with volar locking plates with autologous bone graft except for one patient who received calcium phosphate-based bone void filler. Postoperative x-rays suggested prominent osteotomy resection edges, osteophytes, or dorsal bony prominence resulting from healed callus. Average time from osteotomy to EPL rupture was 10 weeks (range, 2-17 weeks). Two patients initially refused to undergo tendon transfers. One was pleased with the outcome despite the ruptured EPL. The other patient ruptured 2 more tendons and chose to have tendon transfers. One patient also ruptured the transferred tendon after 2 months and underwent successful tendon grafting.
CONCLUSIONS: In the absence of screw prominence and technical flaws, it is likely that dorsal callus, prominent osteotomy resection edges, and osteophytes may contribute to attritional rupture of the EPL tendon after a corrective osteotomy through a volar approach. Exposure and debridement of excessive callus, dorsal ridge, or a prominent Lister tubercle performed during the osteotomy may reduce subsequent EPL rupture.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV. | 120,934 |
0 | Damage control surgery and open abdominal management: recent advances and our approach | DOD - Acute Comp Syndrome CPG | The concept of damage control and improved understanding of the pathophysiology of abdominal compartment syndrome (ACS) have been proven to be great advances in the management of both traumatic and nontraumatic surgical conditions. The practice of damage control surgery includes 3 components: 1) abbreviated resuscitative surgery for rapid control of hemorrhage and abdominal contamination by gastrointestinal contents, followed by temporary abdominal wall closure for planned reoperation and prevention of ACS; 2) restoration of physiologic function, including rewarming and correction of coagulopathy and hemodynamic stabilization in the intensive care unit; and 3) re-exploration for the definitive management of injuries and abdominal wall closure. Although this new approach can decrease the mortality rate of patients with severe physiological derangement, the establishment of clearly defined indications is necessary. For patients who require damage control surgery, interventional radiology should be integrated into the strategy for achieving hemostasis. Angiographic evaluation and embolization should be considered immediately after initial operation, especially for patients with combined intraperitoneal and retroperitoneal hemorrhage, severe hepatic injury, or ongoing hemorrhage after damage control surgery. In many patients who require conventional open abdominal management following damage control surgery or decompressive laparotomy for ACS, the granulating abdominal contents are covered with only a skin graft, which is associated with a risk of enterocutaneous fistula. These patients will ultimately require complex abdominal wall reconstruction at a later stage. We have performed early fascial closure using an anterior rectus abdominis sheath turnover flap method. This technique may reduce the need for skin grafting and subsequent reconstruction and can be considered as an alternative method for the early management of patients with open abdomen. [References: 45] | 64,625 |
0 | Progression of a fracture site impaction as a prognostic indicator of impacted femoral neck fracture treated with multiple pinning | Management of Hip Fractures in the Elderly | BACKGROUND: We evaluated the clinical and radiologic results of impacted femoral neck fractures treated with multiple pinning and determined the influence of the progression of impaction at the fracture site on clinical outcome. METHODS: There were 34 patients with a mean age of 65.5 years. The mean follow-up period was 3.4 years. Progression of fracture site impaction was measured using an articulo-trochanteric distance index and the percentage decrease in the articulo-trochanteric distance index between follow-up intervals. The failure of treatment was clarified as non-union and avascular necrosis. Other characteristics of the patients, including mean waiting time for surgery, preoperative Singh index score, and body mass index, were also measured to evaluate the influence on the clinical outcome of surgery. RESULTS: There were 6 fractures which were not treated successfully (3 non-union, 8.8% and 3 avascular necrosis, 8.8%). The mean percentage decrease of the articulo-trochanteric distance index within the first 6 weeks after surgery was 4.5% in the successful group and 25.1% in the failure group (p < 0.001). There was also a significant mean percentage decrease in the articulo-trochanteric distance index between 6 weeks and 3 months (p < 0.001). CONCLUSIONS: Primary stabilization with Knowles pins for impacted femoral neck fractures had a reasonable clinical outcome with low morbidity. Despite a significant difference of a mean percentage decrease in the articulo-trochanteric distance index between the successful group and the failure group, we could not verify it as a risk factor for failure of treatment because the odds ratio was not statistically significant | 11,671 |
0 | Open reduction and internal fixation in AO type C distal humeral fractures using olecranon osteotomy: Functional and clinical results | Pediatric Supracondylar Humerus Fracture 2020 Review | BACKGROUND: To investigate the outcomes of patients undergoing open reduction and internal fixation with olecranon osteotomy due to AO type13C fractures of the distal humerus. METHODS: Data of 39 patients (mean age, 44.7 years; males, 56.4%) undergoing surgery with the diagnosis of AO type 13C distal humeral fractures were retrospectively evaluated. Patients' demographic characteristics, medical history, and radiological and functional outcomes were recorded. The patients were evaluated at the final follow-up according to the Mayo Elbow Performance Index (MEPI). RESULTS: The mean degrees of flexion and extension loss were 102.2 degrees (range, 60-120 degrees) and 11.4 degrees (range, 0-25 degrees), respectively, at the final follow-up. According to the MEPI score, outcomes were excellent in seven, good in 12, fair in 13, and poor in seven patients. All patients achieved a radiological union of the fracture site within the first postoperative six months. It was found that the loss of extension was more severe, the range of flexion was decreased, and the mean MEPI score was lower in the patients with type C3 fractures than in those with type C1 and type C2 fractures. No significant difference was determined between fixation techniques (tension band vs. cannulated screw) regarding the functional outcomes. CONCLUSION: Our results revealed better prognosis in AO type C1 and type C2 fractures than in AO type C3 fractures and no different effects of two fixation techniques in olecranon osteotomy on the outcomes. | 142,524 |
1 | Local antibiotic therapy for severe open fractures. A review of 1085 consecutive cases | DoD SSI (Surgical Site Infections) | We reviewed 1085 consecutive compound limb fractures treated in 914 patients at the University of Louisville over a nine-year period. Of these fractures, 240 (group 1) received only systemic antibiotic prophylaxis and 845 (group 2) were managed by the supplementary local use of aminoglycoside-polymethylmethacrylate (PMMA) beads. There were no significant differences in age, gender, fracture type, fracture location or follow-up between the two groups. All had copious wound irrigation, meticulous debridement and skeletal stabilisation, but wound management and the use of local antibiotic depended on the surgeon's individual preference and there was no randomisation. In group 1 there was an overall infection rate of 12% as against 3.7% in group 2 (p<0.001). Both acute infection and local osteomyelitis showed a decreased incidence in group 2, but this was statistically significant only in Gustilo type-IIIB and type-IIIC fractures for acute infection, and only in type-II and type-IIIB fractures for chronic osteomyelitis. Our review suggests that the adjuvant use of local antibiotic-laden PMMA beads may reduce the incidence of infection in severe compound fractures. | 151,775 |
0 | Comparison of simultaneous bilateral with unilateral total knee arthroplasty in terms of perioperative complications | Surgical Management of Osteoarthritis of the Knee CPG | BACKGROUND: Previous studies have demonstrated an increased rate of perioperative complications and morbidity following simultaneous bilateral total knee arthroplasty compared with the rate following unilateral total knee arthroplasty. The purpose of this study was to compare the rate of perioperative complications and morbidity associated with simultaneous bilateral total knee arthroplasty with that associated with unilateral total knee arthroplasty. METHODS: The records on all bilateral total knee arthroplasties performed between January 1994 and June 2000 and unilateral total knee arthroplasties performed between January 1995 and June 2000 were retrospectively reviewed. The records on 514 unilateral total knee arthroplasties and 255 bilateral total knee arthroplasties were analyzed to determine demographic information, preoperative comorbidities, perioperative complications, and thirty-day and one-year mortality rates. RESULTS: The rates of some perioperative complications, including myocardial infarction, postoperative confusion, and the need for intensive monitoring, were greater after the bilateral arthroplasties. However, the thirty-day and one-year mortality rates and the risks of pulmonary embolism, infection, and deep venous thrombosis were similar for the two groups. CONCLUSIONS: The risk of perioperative complications associated with bilateral simultaneous total knee arthroplasty was slightly increased compared with that associated with unilateral total knee arthroplasty, but the mortality rates were similar. Ultimately, the decision to proceed with simultaneous knee replacement should depend on patient preference through informed choice | 30,471 |
0 | Association of a common allelic polymorphism (C677T) in the methylene tetrahydrofolate reductase gene with a reduced risk of osteoporotic fractures. A case control study in Danish postmenopausal women | Management of Hip Fractures in the Elderly | Twin studies indicate a substantial genetic component in the development of osteoporosis. One of the latest studied candidate genes is the one coding for methylene tetrahydrofolate reductase (MTHFR) (C677T) in which a point mutation gives rise to a thermolabile variant of MTHFR. The aim of this study was to investigate the influence of this mutation on peripheral measures of bone density and on the odds ratios (OR) for hip and lower forearm fracture in a case control study of Danish postmenopausal women. A total of 74 women with lower forearm fracture, 41 women with hip fracture, and 207 age-matched controls were included. All had broadband ultrasound attenuation (BUA) and speed of sound (SOS) measured at the heel as well as bone mineral density (BMD) measured by dual X-ray absorptiometry at the distal forearm. The MTHFR (C677T) genotypes were determined using polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP). Only 2 of 21 individuals with the TT genotype had sustained a fracture as opposed to 46 of 142 with the CT genotype and 67 of 159 with the CC genotype (P = 0.007). Using logistic regression, the following odds ratios were found when comparing the individuals homozygotic for the C-allele with those homozygotic for the T-allele: lower forearm fracture OR = 3.93 (1.25; 12.40, P = 0.02), hip fracture OR = 6.99 (l.35; 36.92, P = 0.02) and the fractures combined OR = 4.33 (1.73; 10.81, P = 0.002). In this study, the MTHFR (C677T) genotypes were not significantly associated with BMD at the lower forearm or with ultrasound parameters measured at the calcaneus. However, a significant increase in the odds ratio of fracture was found for the wild-type C-allele | 5,192 |
0 | Medullary thyroid microcarcinoma: a clinicopathologic retrospective study of 38 patients with no prior familial disease | MSTS 2018 - Femur Mets and MM | Thirty-eight patients (25 women, 13 men; mean age, 57.8 [32 to 91]) showing one or more medullary thyroid microcarcinomas (ie, < 1 cm), with no prior MEN II or medullary thyroid carcinoma history in their family, were reviewed. Follow-up was available for 29 patients (mean, 53.6 months [1 to 147]). 21 patients (72.4%) are alive and free of disease, four patients (13.8%) died during follow-up without disease, 2 patients are alive with disease (local recurrence and persistent hypercalcitoninemia) after 80 and 99 months, respectively, and 2 patients died of disease after 24 and 46 months. Most tumors were incidental pathological findings (19 of 38) or were discovered by systematic blood calcitonin measurement for a nodular thyroid disease (15 of 38). Only the four patients who had an unfavorable outcome were symptomatic cases (palpable micro-MTC, diarrhea, cervical lymph node metastasis and pulmonary metastatic disease). The two patients with metastatic disease at diagnosis died during follow-up. In univariate analysis, a symptomatic medullary thyroid carcinoma was a strong predictor of an unfavourable outcome (p < .00008), as were the preoperative calcitonin level (P = .007) and an elevated postoperative calcitonin level (P = .004). Among 30 histopathological criteria, only the presence of amyloid correlated with an unfavorable outcome (P = .018). | 78,684 |
0 | Minimally invasive plate osteosynthesis for humeral shaft fracture: a reproducible technique with the assistance of an external fixator | Distal Radius Fractures | BACKGROUND: Minimally invasive plate osteosynthesis (MIPO) has become a popular option for treatment of humeral shaft fractures. However, indirect reduction might risk unpromising results, with mal-alignment/mal-union or nonunion. The purpose of this study was to describe a reproducible MIPO technique that used an external fixator during the procedure as a tool for reduction and maintenance, and to assess the outcomes in patients with humeral shaft fracture.
METHODS: Of 31 consecutive cases of humeral shaft fracture in 30 patients, 29 were included in this study. There were seven simple (type A) and 22 comminuted (type B or C) fractures. After the insertion of one Schanz pin on each proximal and distal humerus, a provisional reduction was achieved by connecting the pins with a monolateral external fixator. The MIPO procedure was then performed over the anterior aspect of the humerus. To evaluate the efficacy of the provisional reduction by external fixator, coronal and sagittal alignments were assessed. We also assessed bony and functional results, including complications, from this technique.
RESULTS: There was no case of mal-union >10degree, and mean angulation was 1.3degree (range 0degree-9degree) in the coronal plane and 1.2degree (range 0degree-8degree) in the sagittal plane. Twenty-eight of 29 fractures were united, including three delayed unions, with a mean union time of 19.1 weeks (range 12.3-38.4 weeks) and a mean follow-up of 20.8 months (range 13.5-31.0 months). There was one hypertrophic nonunion that healed after fixing with two additional screws. Except one patient with associated injury in the elbow, all patients recovered to pre-injury joint motion. There were two cases of postoperative radial nerve palsy that both recovered completely. We attributed them to manipulation, and not to the Schanz pins or plate fixation.
CONCLUSIONS: Surgical treatment of humeral shaft fractures with external fixator-assisted reduction and MIPO resulted in excellent reductions and high union rates. | 117,887 |
0 | Factors influencing long-term recovery of total knee arthroplasty | Surgical Management of Osteoarthritis of the Knee CPG | Background/Purpose: Although a number of studies have examined short term outcomes after total knee arthroplasty (TKA), few have prospectively examined the long term trajectory of recovery of health-related quality of life. The aim of this study was to identify patient-related outcomes that explained the pattern of pain and functional recovery over 10 years for TKA. Methods: This is a prospective observational study that followed a community-based cohort of patients receiving elective primary TKA within a month before surgery 6 months 3 years and 10 years after surgery. Data were collected from patient interviews, chart reviews and regional administrative databases. Joint pain and function were measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Health status was evaluated over time using the SF-36. Effect sizes were calculated to measure change over time. Pre-operative and operative factors were inspected as possible variables that predicted the pattern of recovery. Linear mixed models for pain and functional recovery were used to evaluate changes over time while adjusting for covariates. Results: Of the 289 patients followed, the mean age was 69.4 (SD 9.2) yrs;170 (59%) were female. At 10 years 145 patients responded. The mean number of comorbid conditions was 3.5 (SD 2.0) at baseline and 4.7 (SD 2.3) at 10 years. WOMAC pain score mean difference from baseline to 6 months was 33.0 (95% 30.5, 35.5) with the largest effect size (ES) of 1.89. Long-term change was much smaller from 6 months to 3 years (ES 0.18) and from 3 to10 years (ES 0.03). Smaller changes were seen with function; baseline to 6 months (ES 1.65), 6 months to 3 years (ES 0.07) and 3 to 10 years (ES -0.13). The ES of the SF-36 physical summary score at 6 months was 1.17 and over the 10 years was 1.87. After adjusting for age and gender, the 10 year trajectory for pain was explained by baseline health status (SF-36 summary scores), and baseline WOMAC pain (p< 0.05). The 10 year trajectory for function had similar covariates which explained the trajectory, in that baseline WOMAC function and health status were significant factors. In-hospital complications, prosthesis-type, and obesity did not impact longterm recovery pattern. Conclusion: Pain and functional recovery after TKA occurs primarily within 6 months after surgery with negligible change from 3 to 10 years. Greater pain, dysfunction and lower overall health at baseline explained slower long-term recovery patterns for TKA | 32,403 |
0 | Predicting cutaneous hypersensitivity reactions to cotrimoxazole in HIV-infected individuals receiving primary Pneumocystis carinii pneumonia prophylaxis | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | OBJECTIVES: To measure the incidence of cutaneous hypersensitivity reactions to cotrimoxazole in the setting of primary Pneumocystis carinii pneumonia (PCP) prophylaxis: to measure the incidence of severe reactions: and to identify predictors for these outcomes. DESIGN: Retrospective cohort study. SETTING: One university-based outpatient HIV clinic and one university-affiliated internal medicine and infectious disease medical practice. PATIENTS: Two hundred thirty-six HIV-infected individuals receiving cotrimoxazole for primary PCP prophylaxis. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Occurrence of a cutaneous hypersensitivity reaction, defined as rash, fever, or pruritus that resulted in permanent discontinuation of cotrimoxazole. Severe reactions were defined as those resulting in hospital admission or systemic treatment with a corticosteroid. Cox regression was used to calculate relative rates (RRs) and 95% confidence intervals (CIs) for a number of clinical and laboratory variables. MEASUREMENTS AND MAIN RESULTS: Forty-eight (20%) subjects developed cutaneous hypersensitivity reactions, with six (12.5%) of these being severe. In the unadjusted analysis, the following factors demonstrated at least borderline association: male gender [RR (95% CI) = 0.46 (0.21-0.99)], higher CD4 percentage [RR (95% CI) = 0.95 (0.90-1.00)], syphilis history [RR (95% CI) = 0.37 (0.13-1.04)], and higher total protein [RR (95% CI) = 0.70 (0.45-1.09)]. Adjustment for potential confounding by measured variables did not meaningfully change these results. CONCLUSIONS: Cutaneous hypersensitivity reactions to cotrimoxazole in the setting of primary PCP prophylaxis are common. Although male gender, higher CD4 percentage, syphilis history, and higher total protein have at least borderline associations with these reactions, routinely collected clinical and laboratory variables do not appear to be sufficiently associated with the reactions to permit development of a clinically useful prediction rule | 18,377 |
0 | In vivo kinematic analysis of a high-flexion posterior stabilized fixed-bearing knee prosthesis in deep knee-bending motion | Surgical Management of Osteoarthritis of the Knee CPG | The objective of this study was to evaluate in vivo kinematics of a high-flexion, posterior-stabilized fixed-bearing, total knee arthroplasty in weight-bearing deep knee-bending motion. A total of 20 knees implanted with the Scorpio Non-Restrictive Geometry knee system in 17 patients were assessed in this study. The Scorpio Non-Restrictive Geometry is a recent implant design with modifications made to accommodate a higher flexion range of motion and greater axial rotation, particularly during more functionally demanding activities. Patients were examined during a deep knee-bending motion using fluoroscopy, and femorotibial motion was determined using a 2-dimensional to 3-dimensional registration technique. The average flexion angle was 126.5 degrees (110 degrees -149 degrees ). The femoral component demonstrated a mean of 13.5 degrees (5.2 degrees -21 degrees ) external rotation. The external rotation increased up to maximum flexion. The pivot pattern was a medial pivot pattern similar to that reported in normal knee kinematics | 29,113 |
0 | The Frank Stinchfield award: Dislocation in revision THA: Do large heads (36 and 40 mm) result in reduced dislocation rates in a randomized clinical trial? | Management of Hip Fractures in the Elderly | Background: Dislocation after revision THA is a common complication. Large heads have the potential to decrease dislocation rate, but it is unclear whether they do so in revision THA. Questions/purposes: We therefore determined whether a large femoral head (36 and 40 mm) resulted in a decreased dislocation rate compared to a standard head (32 mm). Methods: We randomized 184 patients undergoing revision THA to receive either a 32-mm head (92 patients) or 36- and 40-mm head (92 patients) and stratified patients by surgeon. The two groups had similar baseline demographics. The primary end point was dislocation. Quality-of-life (QOL) measures were | 3,978 |
0 | Failure of the polyethylene liner leading to notching of the femoral component in bipolar prostheses | Management of Hip Fractures in the Elderly | Polyethylene wear is an increasingly recognized problem in joint replacement surgery. Three cases of polyethylene wear in bipolar hip prostheses are presented. Owing to failure of the polyethylene liner, impingement of the metal shell produced notching of the femoral component | 4,723 |
0 | Supracondylar fractures of the elbow: open reduction, internal fixation | The Treatment of Pediatric Supracondylar Humerus Fractures AUC | This principle-based approach for fixing distal humerus fractures has many advantages. Complex fractures are able to be fixed with sufficient stability to permit immediate intensive rehabilitation. Some fractures believed to be unfixable have been fixed satisfactorily by applying the principles outlined in this article. More straightforward fractures are fixed easily using the same techniques. In the author's experience, the stability achieved with this approach is so much greater than that with traditional methods of fixing distal humerus fractures that bone graft has been required only rarely, despite the severity of injuries so typical of the tertiary referral nature of the author's practice. The key points are that the plates should be placed in parallel configuration medially and laterally and that the screws passing through these plates in the distal fragments should interdigitate and lock together | 22,900 |
0 | Morbidity in combined-procedure associating abdominoplasty and breast surgery: A systematic review | Panniculectomy & Abdominoplasty CPG | OBJECTIVES: Combined aesthetic procedures are an increasing procedure and demands of the patients. The authors have assembled concrete arguments detailing the risks of combined-surgery associating abdominoplasty and mammoplasty relative to abdominoplasty alone. The purpose of this study was to compare abdominoplasty alone versus abdominoplasty combined with breast surgery in terms of short-term complications, in support of surgical choices. RESEARCH STRATEGY: Through application of the PRISMA criteria, we have realized a systematic review of the literature from 1969 to April 2015 in English and French languages by searching in MEDLINE®, PubMed central, Embase and Cochrane Library databases. DATA COLLECTION AND ANALYSIS: The levels of evidence for each article were evaluated. Statistical analysis of the results was carried out through association parameters including statistical tests and Odds ratios were calculated for each complication when data was available. RESULTS: We included 32 observational studies that met the inclusion criteria but only four with usable data. We highlighted a combined Odds ratio of respectively 5.35 and 14.71 for major complications in these studies for combined-surgery compared with abdominoplasty alone. CONCLUSIONS: The results of this systematic review appears in favor of an increase in major complications related to abdominoplasty combined with breast surgery compared to abdominoplasty alone but the level of evidence of included studies is low or moderate. Prospective cohort comparative studies are necessary to provide strong evidence. However, we recommend to avoid this procedure in massive weight loss patients or patients with thromboembolism history. | 127,489 |
1 | Comparison of compression hip screw and gamma nail for treatment of peritrochanteric fractures | Management of Hip Fractures in the Elderly | Twenty-seven peritrochanteric fractures in 27 patients were evaluated and treated prospectively. Ten fractures were internally fixed with compression hip screws (CHS) (Omega Howmedica, Rutherford, NJ) and 135 degrees, four-hole side plates. Internal fixation of the posteromedial fragment was not done. Eleven fractures were internally fixed with Gamma nails with distal screws. Six fractures were internally fixed with Gamma nails without distal screws. Each group was evaluated for surgical time, blood loss, hospital days, collapse of the fracture, infections, cut out of the lag screw from the femoral head, fracture healing, perioperative femoral shaft fractures, and implant failure. Surgery time did not differ significantly in either group. Blood loss and hospital days were less in the Gamma nail group. There were no infections, cut out of the lag screw, implant fractures, or pulmonary complications in either group. Fracture healing was the same in both groups. Those fractures treated with Gamma nails, both with and without distal screws, had 50% less collapse than those treated with CHS. There were two femoral shaft fractures in the Gamma nail group (11.76%). There were no femoral shaft fractures in the CHS group. Fractures of the femoral shaft were believed to be caused by two factors: a mismatch of the nail design and the normal geometry of the proximal femur and stress risers in the femoral shaft caused by repeatedly missing the screw hole with the drill bit. Although the Gamma nail is an excellent device for stabilizing and preventing collapse of unstable peritrochanteric fractures, the learning curve is high, and femoral shaft fractures can occur. We believe precautions outlined in this report are helpful in preventing these complications | 14,308 |
0 | MRI of Little Leaguer's shoulder | The Treatment of Pediatric Supracondylar Humerus Fractures AUC | The MRI appearance of 'Little Leaguer's shoulder' has not been previously reported in the radiology literature. Purported etiologies include proximal humeral epiphyseolysis, osteochondrosis of the proximal humeral epiphysis, stress fracture of the proximal humeral epiphyseal plate, and rotational stress fracture of the proximal humeral epiphyseal plate. We describe magnetic resonance imaging findings in four patients and review the literature | 22,879 |
0 | Effect of low appendicular lean mass, grip strength, and gait speed on the functional outcome after surgery for distal radius fractures | Distal Radius Fractures | Patients with low appendicular lean mass plus slow gait speed or weak grip strength are at risk for poor functional recovery after surgery for distal radius fracture, even when they have similar radiologic outcomes.
INTRODUCTION: Loss of skeletal muscle mass and consequent loss in muscle function associate with aging, and this condition negatively impacts the activities of daily living and increases elderly individuals' frailty to falls. Thus, patients with low appendicular lean mass would show different functional recovery compared to those without this condition after surgery for distal radius fracture (DRF). This study compares the functional outcomes after surgery for DRF in patients with or without low appendicular lean mass plus slowness or weakness.
METHODS: A total of 157 patients older than 50 years of age with a DRF treated via volar plate fixation were enrolled in this prospective study. A definition of low appendicular lean mass with slowness or weakness was based on the consensus of the Asian Working Group for Sarcopenia. The researchers compared functional assessments (wrist range of motion and Michigan Hand Questionnaire [MHQ]) and radiographic assessments (radial inclination, volar tilt, ulnar variance, and articular congruity) 12 months after surgery between patients with and without low appendicular lean mass plus slowness or weakness. Multivariable regression analyses were performed to determine whether appendicular lean mass, grip strength, gait speed, patient demographic, or injury characteristics accounted for the functional outcomes.
RESULTS: Patients with low appendicular lean mass plus slowness or weakness showed a significantly lower recovery of MHQ score than those in the control group throughout 12 months. There was no significant difference in the range of motion between the groups. The radiologic outcomes showed no significant difference between groups in terms of volar tilt, radial inclination, or ulnar variance. According to multivariable regression analysis, the poor recovery of MHQ score was associated with an increase in age, weak grip strength, and lower appendicular lean mass, and these three factors accounted for 37% of the variation in the MHQ scores.
CONCLUSION: Patients with low appendicular lean mass plus slowness or weakness are at risk for poor functional recovery after surgery for DRF, even when they have similar radiologic outcomes. | 119,374 |
0 | Symmetrical vs asymmetrical total knee replacement--a medium term comparative analysis | Surgical Management of Osteoarthritis of the Knee CPG | Modifications of established implants can result in deleterious effects, as with the Capitol and the matt coated Exeter hips. In 1991 the Kinemax plus modification of the Kinematic knee was introduced in Bristol, the design changes having been made to reduce patello-femoral complications. We carried out a comparative analysis of the prospective recorded data on a consecutive series of 182 total knee replacements (95 Kinematic and 87 Kinemax plus knees) performed between 1991 and 1993. The same instrumentation and surgical technique was used. Since the design had introduced a broader trochlear, offset patella and had changed from an asymmetrical to a symmetrical femoral component, particular attention was paid to tracking and range of movement. All patients were reviewed at 5 years using the Bristol knee score and radiographs. There was no difference in the overall score (both prosthesis scoring 85-86) but the Kinemax plus group with a symmetrical trochlear had a significantly greater improvement in the range of movement (14 degrees as opposed to 4 degrees; P<0.05). In addition, secondary intervention for mal-tracking was significantly less in the Kinemax group. No deleterious effect of the changed geometry was observed. It is concluded that the introduction of a symmetrical femoral component with an offset patella reduced patello-femoral complications without detectable disadvantages | 34,308 |
0 | Bone cysts: Unicameral and aneurysmal bone cyst | MSTS 2018 - Femur Mets and MM | Simple and aneurysmal bone cysts are benign lytic bone lesions, usually encountered in children and adolescents. Simple bone cyst is a cystic, fluid-filled lesion, which may be unicameral (UBC) or partially separated. UBC can involve all bones, but usually the long bone metaphysis and otherwise primarily the proximal humerus and proximal femur. The classic aneurysmal bone cyst (ABC) is an expansive and hemorrhagic tumor, usually showing characteristic translocation. About 30% of ABCs are secondary, without translocation; they occur in reaction to another, usually benign, bone lesion. ABCs are metaphyseal, excentric, bulging, fluid-filled and multicameral, and may develop in all bones of the skeleton. On MRI, the fluid level is evocative. It is mandatory to distinguish ABC from UBC, as prognosis and treatment are different. UBCs resolve spontaneously between adolescence and adulthood; the main concern is the risk of pathologic fracture. Treatment in non-threatening forms consists in intracystic injection of methylprednisolone. When there is a risk of fracture, especially of the femoral neck, surgery with curettage, filling with bone substitute or graft and osteosynthesis may be required. ABCs are potentially more aggressive, with a risk of bone destruction. Diagnosis must systematically be confirmed by biopsy, identifying soft-tissue parts, as telangiectatic sarcoma can mimic ABC. Intra-lesional sclerotherapy with alcohol is an effective treatment. In spinal ABC and in aggressive lesions with a risk of fracture, surgical treatment should be preferred, possibly after preoperative embolization. The risk of malignant transformation is very low, except in case of radiation therapy. | 83,427 |
0 | Clinicopathological correlation of Kruppel-like factor 5 and matrix metalloproteinase-9 expression and cartilage degeneration in human osteoarthritis | OAK 3 - Non-arthroplasty tx of OAK | The present study was designed to investigate the clinicopathological correlation between the expression of KLF5 and MMP-9, which are associated with extracellular matrix degradation and cartilage degeneration in human knee osteoarthritis (OA). Tibiofemoral joint samples from 20 patients with OA, treated with surgery alone, were divided into two groups: 0=no change (NC, n=17), and severe changes with a higher mean score (>= 3) (SC, n=29). The latter group contains samples with severe damages in cartilages and subchondral bones at medial tibial plateaux. The expression of the proteins was detected by immunofluorescence and quantitative RT-PCR, respectively. Neurovascular invasion was evaluated by protein gene product (PGP) 9.5 and CD34-positive staining and scanning electron microscopy, respectively. Safranin O staining showed that the sections from the SC group had increased cartilage degeneration. The number of vascular invasions in the SC group (16/29, 55.2%) was higher than that in NC controls (2/17, 11.7%, P<0.05). The expression of KLF5 and MMP-9 increased, and was co-localized in the same cells of SC cartilages. The severity of cartilage degeneration and vascular invasion was associated with upregulation of the two protein expressions and was significantly different between SC and NC samples (P<0.05). Taken together, the expression of KLF5 and MMP-9 may be involved in cartilage degeneration, contributing to human OA. | 101,930 |
0 | An open-label, phase 2 trial of denosumab in the treatment of relapsed or plateau-phase multiple myeloma | MSTS 2018 - Femur Mets and MM | RANKL is a key mediator of osteoclast differentiation, activation, and survival. Preclinical data suggest that aberrant production and activation of osteoclasts may influence proliferation of multiple myeloma (MM) cells in the bone marrow. Reports have also shown that inhibiting RANKL may have a direct effect on RANK-expressing myeloma cells and a therapeutic role in treating the disease. In mouse myeloma models, inhibition of RANKL led to reduced serum paraprotein levels and tumor burden. Based on this hypothesis, this proof-of-concept, single-arm study investigated whether RANKL inhibition with denosumab could reduce serum M-protein levels in relapsed or plateau-phase myeloma subjects. All subjects received denosumab monthly, with loading doses on days 8 and 15 of month one, until disease progression or subject discontinuation. Results of this ongoing study demonstrated that no subjects in either cohort met the protocol-defined objective response criteria of complete response (CR) or partial response (PR), but that denosumab effectively inhibited the RANKL pathway regardless of previous exposure to bisphosphonates, as evidenced by suppressed levels of the bone turnover marker, serum C-terminal telopeptide of type 1 collagen (sCTx). Eleven (21%) subjects who relapsed within 3 months before study entry maintained stable disease for up to 16.5 months. Nineteen (46%) subjects with plateau-phase myeloma maintained stable disease for up to 18.3 months. The adverse event (AE) profile for denosumab and its dosing schedule in these populations was consistent with that for advanced cancer patients receiving systemic therapy. Additional controlled clinical studies of denosumab in subjects with both relapsed and plateau-phase MM are warranted. | 81,793 |
0 | Parosteal osteoma of bones other than of the skull and face | MSTS 2022 - Metastatic Disease of the Humerus | BACKGROUND: Osteoma of the skull and facial bones is not uncommon, is usually asymptomatic, and may be associated with Gardner's syndrome. Osteomas involving other bones are unusual.
METHODS: The authors describe 14 cases (eight men and six women from age 21-66 years) of parosteal osteoma of bones other than of the skull and face.
RESULTS: Thirteen lesions involved long bones, and one involved the clavicle. A long-standing (18 months to 31 years) mass was reported in seven patients. Symptoms of pain, a mass, or both were present in all except three patients who were asymptomatic. Lesions ranged from 2.5 to 20 cm in greatest dimension. Histologically, they blended with the cortex, did not infiltrate the medullary cavity, and consisted of dense sclerotic lamellar bone with haversian systems, similar to the architecture of normal cortical bone. There was no spindle cell proliferation. Nine patients underwent resection, four had biopsy, and one had debulking. With a follow-up of 1-23 years, no recurrence or metastasis was reported.
CONCLUSIONS: Parosteal osteoma must be distinguished from parosteal osteosarcoma, a low grade malignant neoplasm. If radiographs do not identify areas of radiolucency and sections do not contain spindle cells, the diagnosis of parosteal osteoma is justified. | 153,731 |
0 | Biomechanical Comparison of Titanium Locking Fragment-Specific and Volar Locking Plates for AO B1 and B2 Fractures of the Distal Radius | Distal Radius Fractures | PURPOSE: This biomechanical study compared the stability of volar locking plates (VLPs) and locking fragment-specific (LFS) dorsal and radial styloid plates for the fixation of dorsal (AO 23-B2) and radial styloid (AO 23-B1) shear fractures of the distal radius, respectively.
METHODS: Two groups of 6 composite radii were fixed with a VLP or an LFS dorsal plate over a simulated dorsal shear fracture. Two additional groups of 6 radii received the same VLP or an LFS radial plate to fix a radial styloid fracture. Each plated radius was tested under cyclic axial compression by a servohydraulic testing machine that recorded axial displacement per cycle. Construct stiffness was calculated from the slope of the force-displacement curve.
RESULTS: In the dorsal shear fracture model, the dorsal LFS plate exhibited less displacement than the VLP (0.32 +/- 0.04 vs 0.43 +/- 0.07 mm, respectively) and showed greater average stiffness (645 +/- 64 vs 433 +/- 88 N/mm, respectively). Plate type was responsible for 53.1% of the variation in displacement and 68.6% of the variation in stiffness. In the radial styloid fracture model, variations due to number of cycles elapsed and plate type were similar for displacement and stiffness in both groups. The average stiffness during cyclical nondestructive testing was 566 +/- 45 and 573 +/- 60 N/mm for VLP and LFS radial plating groups, respectively.
CONCLUSIONS: For AO 23-B2 (dorsal rim) fractures, the dorsal LFS plates exhibited significantly less displacement and greater stiffness in axial loading than VLPs. For AO 23-B1 (radial styloid) fractures, the VLP displayed similar displacement and stiffness to the radial LFS plates.
CLINICAL RELEVANCE: All constructs tested could be expected to withstand axial compressive forces typical of early postoperative rehabilitation. | 119,052 |
1 | Does preoperative rehabilitation improve patient-based outcomes in persons who have undergone total knee arthroplasty? A systematic review | Surgical Management of Osteoarthritis of the Knee CPG | BACKGROUND: Common clinical practice includes attempts to improve pain, function, motion, and patient independence before total knee arthroplasty (TKA) surgery. Although preoperative rehabilitation often is prescribed, it is unknown whether this care improves patient outcomes after TKA surgery. OBJECTIVE: To focus on how TKA preoperative rehabilitation affects quality of life, pain, and physical outcomes after surgery. DATA SOURCES: A computerized search was performed in February 2011. We searched PubMed, Ageline, CIHNAL, and SPORTDiscus from 1950 through February 2011 using combinations of the terms knee, rehabilitation, arthroplasty, preoperative, and presurgical. Searches were limited to "human" and "English" studies reported in peer-review journals. STUDY SELECTION: Seven studies met the inclusion criteria. For all variables, none was consistently favorable toward preoperative rehabilitation over alternative or control treatment. DATA EXTRACTION: Means and standard deviations (SDs) for each category of the Western Ontario and McMaster Osteoarthritis Index (WOMAC), range of motion, and length of stay (LOS) were obtained and served to calculate point measures and measures of variability. Specifically, bias-adjusted Hedges' g effect sizes, along with 95% confidence intervals, were calculated to assess the magnitude of the treatment effect for each outcome, with separate meta-analyses performed as a summary of the treatment response for each outcome. DATA SYNTHESIS: A total of 240 studies were identified in the search of the literature. On the basis of the title, abstract, or study content, 203 studies were excluded. Of the remaining 37 studies, 30 were excluded on the basis of study design and choice of outcome measures. The results of this review indicate that preoperative rehabilitation likely had no true treatment effect on WOMAC scores, range of motion, and LOS because all effect sizes were weak (<0.4) and confidence intervals crossed zero. CONCLUSION: For all outcomes, none was consistently favorable toward preoperative rehabilitation over the alternative for patients undergoing TKA with the exception of LOS in favor of the treatment group | 37,865 |
1 | Does open fasciotomy contribute to morbidity and mortality after acute lower extremity ischemia and revascularization? | DOD - Acute Comp Syndrome CPG | A retrospective review was undertaken of 127 lower extremity fasciotomies performed for compartment syndrome after acute ischemia and revascularization in 73 patients with vascular trauma and 49 patients with arterial occlusive disease. One hundred twelve (88%) fasciotomies were performed early (at the time revascularization); 15 (12%) were delayed because of late compartment syndrome diagnosis. Ninety-four (77%) patients had more than one accepted indication for fasciotomy. Double-incision fasciotomy was used in 98 (77%) extremities, single-incision fasciotomy was used in 19 (15%), and fasciotomy-fibulectomy was used in 10 (8%). Fasciotomies were closed in 88 (69%) patients an average of 14 days after surgery. Seven patients needed multiple skin grafting procedures or myocutaneous flaps to close the wound; none compromised limb salvage. Five other patients had minor wound infections that resolved. Functional status returned to preoperative levels by the time of discharge from the hospital in 59 (48%) patients. Thirty-one (24%) patients had residual lower extremity disability related to delayed union of the fracture (five), chronic neuropathy (20), leg swelling (one), or ischemic nonhealing fasciotomy wounds (three); two patients had unrelated disabilities. Fourteen (11%) amputations were required for refractory limb ischemia; two (1.6%) were required for wet gangrene of the foot, which infected the fasciotomy site; the others had open noninfected incisions. Eighteen (15%) patients died of cardiopulmonary failure or multisystem failure or both, without fasciotomy-related problems. Open fasciotomy for compartment syndrome after acute lower extremity ischemia and revascularization was associated with an increased risk of minor wound morbidity. However, limb loss and death resulted from persistent ischemia and underlying systemic disease processes or injuries, but not from open fasciotomy wound complications. | 64,860 |
0 | Meniscal allografts | Surgical Management of Osteoarthritis of the Knee CPG | Loss of the meniscus has been proved to be associated with increased joint pressures, mechanical changes, and ultimately hyaline cartilage degradation. Since the first arthritic changes following meniscectomy were appreciated, attempts have been made to alter and reverse the joint deterioration that occurs after removal of the knee fibrocartilage. Replacement of the fibrocartilage with either a prosthetic or biologic implant appears to be the only method of restoring normal joint anatomy. By inserting a meniscus substitute for the removed meniscus, the development of joint pathology should be avoided. This article focuses on the procedure of allogenic implants. Allogenic meniscal implants have been performed in humans for over 8 years. Recent clinical work has shown a rapid increase in the number of implants in the last 3 years with clinical review only now being presented. At present, the orthopedic surgeon has available cryopreserved, fresh-frozen, or frozen and irradiated tissue. Although much work has been performed in the animal with fresh-frozen tissue, the newly appreciated risk of disease transmission may require that all future implants be secondarily sterilized. Regardless of the type of implant, the early results of cell viability studies appear the same. Allogenic implants sustain new cellular ingrowth from the host and the DNA is replaced with host DNA. The ultimate success of this operation is not whether allogenic collagen can be transplanted into a host knee, but whether this tissue can be made to function and to preserve hyaline cartilage. Available data suggest that the technique being used to transplant the meniscus does not preserve normal meniscus function. These menisci may not function as they did in the donor. Additionally, few surgical techniques have been tested mechanically to compare meniscus function after transplantation. For these reasons, although transplant surgery for the meniscus remains an exciting and encouraging procedure to save the knee in a person who has had a total meniscectomy, the operation is currently being limited to those involved in study groups and investigational protocols. The long-term follow-up is at present limited or nonexistent. Objective parameters for evaluating posttransplant meniscus function are only now being collected and reviewed. Meniscal transplantation remains a cautiously optimistic treatment for the future | 33,761 |
0 | Reduced bone density of the hip in elderly patients with Parkinson's disease | Management of Hip Fractures in the Elderly | Parkinson's disease (PD) is a major cause of falls and reduced mobility in elderly people. Fractures often occur as a result of these falls but there have been no studies of bone mineral density (BMD) in PD. We have prospectively studied 29 elderly women (mean age 77 years) and 26 elderly men (mean age 74 years) with PD over 2 years and compared them with similar numbers of age- and sex-matched controls. Bone mineral density was measured by dual X-ray absorptiometry. Women were more likely to sustain fractures (38% compared with 8% of men). Mean BMD of the lumbar spine was similar in the 55 combined PD patients compared with combined controls. However, the total hip BMD was 10% lower (p = 0.014) and the neck of femur BMD 12% lower (p < 0.004) in the 51 PD patients compared with controls. The relatively lower hip BMD in elderly PD men and women combined with their abnormal gait and tendency to fall backwards or to the side may explain their excess risk of hip fractures, particularly in women. The neuromuscular deficit in PD may differentially reduce hip BMD relative to other sites and may thus be amenable to measures designed to improve mechanical loading in the lower limbs in the early stages of PD | 10,459 |
0 | Wrist splint versus conventional casting for the management of wrist fractures | Distal Radius Fractures | INTERVENTION: This is a RCT with two arms â? intervention group and control. The intervention group will have their distal radius fracture managed with the adaptable wrist splint (low risk medical device) to immobilise the fracture. This will be applied by the fracture clinic staff who are qualified nurses and doctors. Their management of clinic attendance will follow the same protocol as the control group (traditional plaster cast) in terms of follow up appointment and Xâ?rays. The researcher (registered physiotherapist) will moniter both groups weekly with telephone questionnaires and identify any risks as appropriate to refer onto the orthodpaedic consultant. The adaptable wrist splint is a custom fitted, prefabricated ride device which allows for adjustment and adaptation for fracture reduction and stabilisation. It consists of a volar plate, dorsal plate, proximal strap and ratchetâ?legs linking the volar and dorsal plates together. Once the plates are pressed together guided by the ratchet legs , it is then locked. The device is not able to be removed by participants at any time. The overall duration of splint wear is for 6 weeks. CONDITION: Distal wrist fractures PRIMARY OUTCOME: The modified Patient Reported Wrist Evaluation looks at pain and function. This is a. composite outcome. The pain rating is the average amount of pain in the wrist over the past week. The scale is from zero (never) to 10 (always). It specifically asks for ratings at rest; when doing a task with a repeated wrist movement when lifting a heavy object; when it is at its worst and how often you have pain. The function looks at specific activities where you rate the amount of difficulty you experience over the past week performing on a scale of; zero (no difficulty) to 10 (it was so difficult you were unable to do it). The specific activities are turn a door knob using my affected hand; cut meat using a knife in my affected hand; fasten buttons on my shirt; use my affected hand to push up fro a chair;carry a 4.5 kg object in my affected hand and use bathroom tissue with my affected hand. The usual activities rate again from zero (you did not experience any difficulty) to 10 (it was so difficult you were unable to do it) included; personal care activities (washing, dressing); household work (cleaning, maintenance); when lifting a heavy object; work (your job or usual everyday work) and recreational activities). SECONDARY OUTCOME: Maintenance of fracture position Health care users perception of comfort and convenience of adaptable wrist splint. Health professionals experience of using adaptable wrist splint INCLUSION CRITERIA: Nonâ?displaced distal radius fracture. Able to give informed consent. Age 65 and over. | 117,608 |
0 | Multidisciplinary rehabilitation for older people with hip fractures (Cochrane review) [with consumer summary] | Management of Hip Fractures in the Elderly | BACKGROUND: Hip fracture is a major cause of morbidity and mortality in older people and its impact on society is substantial. OBJECTIVES: To examine the effects of multidisciplinary rehabilitation, in either inpatient or ambulatory care settings, for older patients with hip fracture. SEARCH STRATEGY: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (April 2009), The Cochrane Library (2009, Issue 2), MEDLINE and EMBASE (both to April 2009). SELECTION CRITERIA: Randomised and quasi-randomised trials of post-surgical care using multidisciplinary rehabilitation of older patients (aged 65 years or over) with hip fracture. The primary outcome, 'poor outcome' was a composite of mortality and decline in residential status at long-term (generally one year) follow- up. DATA COLLECTION AND ANALYSIS: Trial selection was by consensus. Two review authors independently assessed trial quality and extracted data. Data were pooled where appropriate. MAIN RESULTS: The 13 included trials involved 2,498 olde r, usually female, patients who had undergone hip fracture surgery. Though generally well conducted, some trials were at risk of bias such as from imbalances in key baseline characteristics. There was substantial clinical heterogeneity in the trial interventions and populations. Multidisciplinary rehabilitation was provided primarily in an inpatient setting in 11 trials. Pooled results showed no statistically significant difference between intervention and control groups for poor outcome (risk ratio 0.89; 95% confidence interval 0.78 to 1.01), mortality (risk ratio 0.90, 95% confidence interval 0.76 to 1.07) or hospital readmission. Individual trials found better results, often short-term only, in the intervention group for activities of daily living and mobility. There was considerable heterogeneity in length of stay and cost data. Three trials reporting carer burden showed no evidence of detrimental effect from the intervention. Overall, the evidence indicates that multidiscip linary rehabilitation is not harmful. The trial comparing primarily home-based multidisciplinary rehabilitation with usual inpatient care found marginally improved function and a clinically significantly lower burden for carers in the intervention group. Participants of this group had shorter hospital stays, but longer periods of rehabilitation. One trial found no significant effect from doubling the number of weekly contacts at the patient's home from a multidisciplinry rehabilitation team. AUTHORS' CONCLUSIONS: While there was a tendency to a better overall result in patients receiving multidisciplinary inpatient rehabilitation, these results were not statistically significant. Future trials of multidisciplinary rehabilitation should aim to establish both effectiveness and cost effectiveness of multidisciplinary rehabilitation overall, rather than evaluate its components. Residents of some countries have free access to the full text of the systematic reviews in the Cochrane Libra ry at: http://www.thecochranelibrary.com NO | 4,486 |
0 | Prevention of early postmenopausal bone loss with cyclical etidronate | Management of Hip Fractures in the Elderly | Cyclical etidronate has been shown to be effective in the treatment of established postmenopausal osteoporosis but less is known about its effects on early menopausal bone loss. The aim of the study was to establish the effects of cyclic etidronate therapy on spinal and proximal femoral bone mineral loss in early postmenopausal women. One hundred and seven women who were within 6 months to 3 years of the menopause were recruited into a 2-year, randomised, placebo-controlled, double-blind trial. Spinal bone mineral density was within 2 SD of the age-matched mean reference value at baseline. Bone mineral density in the lumbar spine and proximal femur was assessed by dual energy X-ray absorptiometry at baseline and thereafter at 6 monthly intervals for 2 years. Urinary collagen cross-links (deoxypyridinoline and pyridinoline) were measured at the same time points. Seventy-seven women completed the study. At the end of the treatment period, the mean bone mineral density change from baseline in the treated group was +0.14% and -0.06% in the lumbar spine and femoral neck, respectively, compared to -1.49 and -2.22 in the control group. Overall, there was a significant difference between the two groups at both these sites (p=0.01 and 0.001, respectively). No significant differences between the groups were demonstrated at the greater trochanter or Ward's triangle. The conclusion was that cyclical etidronate therapy prevents bone loss in the spine and femoral neck in early postmenopausal women. It provides a safe and effective therapeutic option for the prevention of postmenopausal osteoporosis in women who are unwilling or unable to tolerate hormone replacement therapy | 1,225 |
0 | Browlift--a South East Asian experience | Upper Eyelid and Brow Surgery | BACKGROUND: To describe the indications, techniques and outcomes of various browlift procedures in a predominantly East-Asian community. PATIENTS AND METHODS: Retrospective review of patients who underwent browlift procedures performed by 2 oculoplastic surgeons or under their direct supervision, in a tertiary referral hospital in South East Asia from 2002 to 2007. RESULTS: Forty-six patients (30 female, 16 male) had browlift surgery for 89 sides from 2002 to 2007. Mean follow-up period was 10 months (6 to 44 months). 43 patients had bilateral browlift, 3 patients had unilateral browlift, 2 of whom had underlying facial nerve palsy and one had involutional brow ptosis. INDICATIONS: involutional brow ptosis (42), mitochondrial myopathy (2), and facial palsy (2). Ethnicity of patients: Chinese (40), Indian (4) and Malay (2). TECHNIQUES: direct browlift (18), transblepharoplasty browpexy (6), midforehead lift (3), coronal browlift (2) and pretrichial browlift (4), endoscopic browlift (7), limited incision nonendoscopic browlift (5) and temporal browlift (3). Adjuvant procedures included upper blepharoplasty (26), blepharoptosis correction (4), midface lift (2), upper eyelid entropion correction (1), lacrimal gland fixation (1), and upper lid gold implant (1). Encountered complications included: undercorrection 6 (12%), segmental facial nerve palsy 1(2%), visible scar 2 (5%), paraesthesia 2 (5%), suture granuloma 1 (2%). Overall 94% of our patients were satisfied. CONCLUSION: Browlift provides satisfactory results for both patient and surgeon. A comprehensive knowledge and proper surgical technique, along with a thorough discussion with patients about the pros and cons of each procedure are essential to obtain optimal outcomes. | 68,336 |
0 | Budget impact analysis of warfarin reversal therapies among hip fracture patients in Finland | HipFx Supplemental Cost Analysis | BACKGROUND: Hip fractures require operation within 36-48 h, and they are most common in the elderly. A high International Normalized Ratio should be corrected before surgery. In the current study, we analyzed the budget impact of various warfarin reversal approaches. METHODS: Four reversal strategies were chosen for the budget impact analysis: the temporary withholding of warfarin, administration of vitamin K, fresh frozen plasma (FFP), and a four-factor prothrombin complex concentrate (PCC). RESULTS: We estimated that, annually, 410 hip fracture patients potentially require warfarin reversal in Finland. The least costly treatment was vitamin K, which accounted for euro289,000 in direct healthcare costs, and the most costly treatment option was warfarin cessation, which accounted for euro1,157,000. In the budget impact analysis, vitamin K, PCC and FFP would be cost-saving to healthcare compared with the current treatment mix. CONCLUSION: The various warfarin reversal strategies have different onset times, which may substantially impact the subsequent healthcare costs | 52,687 |
0 | Pathology and the posture of the La Chapelle-aux-Saints Neandertal | The Treatment of Pediatric Supracondylar Humerus Fractures AUC | The depiction of the Neandertals as incompletely erect was based primarily on Boule's (1911, 1912a, 1913) analysis of the La Chapelle-aux-Saints 1 partial skeleton. The inaccurate aspects of Boule's postural reconstruction were corrected during the 1950s. However, it has come to be believed, following Straus and Cave (1957), that Boule's errors of reconstruction were due to the diseased condition of the La Chapelle-aux-Saints 1 remains, rather than to Boule's misinterpretation of morphology. The abnormalities on the La Chapelle-aux-Saints 1 postcranium include: lower cervical, upper thoracic, and lower thoracic intervertebral degenerative joint disease (DJD), a distal fracture of a mid-thoracic rib, extensive DJD of the left hip, DJD of the right fifth proximal interphalangeal articulation, bilateral humeral head eburnation, and minor exostosis formation on the right humerus, ulna, and radius. These were associated with extensive alveolar inflammation including apical abscesses and antemortem tooth loss, some temporomandibular DJD, bilateral auditory exostoses, and minimal occipital condyle DJD. None of these abnormalities significantly affected Boule's Neandertal postural reconstruction, and a review of his analysis indicates that early twentieth century interpretations of skeletal morphology (primarily of the cranium, cervical vertebrae, lumbar and sacral vertebrae, proximal femora and tibiae, posterior tarsals, and hallucial tarsometatarsal joint), combined with Boule's evolutionary preconceptions, were responsible for his mistaken view of Neandertal posture | 23,671 |
0 | Zurich Multiple Endpoint Vitamin D Trial in Knee OA Patients | OAK 3 - Non-arthroplasty tx of OAK | This is a 2â?year doubleâ?blind randomized controlled trial in 287 communityâ?dwelling individuals age 60 years or older undergoing uniâ?lateral total knee replacement due to severe OA of the knee.We compare an oral dose of 2000 IU vitamin D3 per day to 800 IU. The primary endpoints are pain and disability related to rehabilitation of the operated knee,and related to the expected high prevalence of OA in the contraâ?lateral knee. Secondary endpoints are change in 25(OH)D levels, muscle strength, balance, lower extremity function, the rate of falls, bone density and bone quality, bone metabolism, general pain, fallâ?related fractures, body composition, bloodâ?pressure, major cardiovascular events, blood glucoseâ?insulin levels, executive cognitive function, rate of upper respiratory tract infections / all infections, tooth loss, dental health, health care utilization, number and size of facial skin keratosis, and radiographic progression of the nonâ?operated knee. Pain and disability will be assessed by the pain and function subscales of the Western Ontarioâ? McMaster Universities Osteoarthritis Index (WOMAC). Randomization will be stratified by WOMAC function prior to surgery, radiological evidence for OA in the contraâ?lateral knee, and hospital. Clinical visits will take place at baseline (6â?8 weeks after TKR), at 6, 12, 18 and 24 months of treatment. In addition, all individuals will receive a phone call every 2 month to assess adverse outcomes and compliance to treatment, supported by a hotline for immediate report of adverse events. Statistical power: We expect more than 80% power with 200 participants completing their 24 month followâ?up, and 260 participants completing their 12 month followâ?up. This is a trial with medicinal product. | 106,534 |
1 | External Fixation and Adjuvant Pins Versus Volar Locking Plate Fixation in Unstable Distal Radius Fractures: A Randomized, Controlled Study With a 5-Year Follow-Up | Distal Radius Fractures | PURPOSE: To determine whether volar locking plates (VLP) are superior to external fixation (EF) with adjuvant pins in unstable distal radius fractures after 5 years of follow-up.
METHODS: We randomized 111 unstable distal radius fractures to treatment with either a VLP or EF using adjuvant pins. The patients' mean age was 54 years (range, 20-84 y). Twenty patients were lost to follow-up. At 5 years, 91 patients (82%) were assessed using the visual analog scale (VAS) pain score, Mayo wrist score, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire, range of motion, and radiological evaluation. The QuickDASH score at 5 years was the primary outcome measure.
RESULTS: The QuickDASH score was not statistically significantly different between the groups (VLP 10 vs EF 13) at 5 years. Patients with VLP had statistically significant better supination (85degree vs 81degree), better radial deviation (18degree vs 16degree), and less radial shortening (1 mm vs 2 mm). For AO/OTA type C2 fractures, the VLP had statistically significant better supination (84degree vs 78degree), flexion (64degree vs 56degree), grip strength (34 kg vs 28 kg), Mayo wrist score (92 vs 76), and less ulnar shortening (1 mm vs 3 mm). The QuickDASH score in the C2 subset analysis showed a difference of 10 (VLP 8 vs EF 18), but this was not statistically significant. In the VLP group, 11 patients (21%) had their plates removed owing to surgically related complications. In the EF group, 5 patients had proximal radial scar correction surgery owing to skin contracture.
CONCLUSIONS: The findings were satisfactory for both groups at 5 years. The VLP provided statistically significantly better results for several clinical outcomes in the C2 subset analysis. However, 21% of the VLPs were removed because of surgical complications.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I. | 122,338 |
0 | The impact of a novel preventive care service on the incidence of hip fractures among the elderly | Management of Hip Fractures in the Elderly | Objective: We wanted to determine the impact of a novel preventive care service (PCS) employing home visits by non-physician experts on the incidence of hip fractures among the elderly. Methods: We estimated an ARMA model for the time series of hip fractures in the Hoganas municipality in Sweden for the years 1987-2008. By means of intervention analysis and out of sample forecasts, we estimated the short- and long-term impact of the novel preventive care service. Results: We found that there is a statistically significant short-term impact of the PCS with about 8.27 fewer incidents of hip fracture. This corresponds to a long-term effect of about 3.74 fewer incidents of hip fracture per year. Conclusion: Since we found a statistically highly significant impact, we concluded that there was an effect on the number of hip fractures. Considering the magnitude of the effect, we found that the examined preventive care service is an economically efficient measure. (copyright) 2010 Springer-Verlag | 6,433 |
0 | Association Between the Single Assessment Numeric Evaluation and the Western Ontario and McMaster Universities Osteoarthritis Index | OAK 3 - Non-arthroplasty tx of OAK | CONTEXT: Patient-reported outcomes (PROs) evaluate how patients describe symptoms as well as level of physical function or quality of life. The Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index is one of the most common PROs used to assess disability in patients with knee osteoarthritis (OA), yet the Single Assessment Numeric Evaluation (SANE) is a single-question instrument that may improve the efficiency associated with the measurement of patient function.
OBJECTIVE: To determine the associations between (1) SANE<sub>Function</sub> and the physical dysfunction subsection of the WOMAC index (WOMAC<sub>Dysfunction</sub>) before rehabilitation and after a 4-week therapeutic exercise intervention as well as (2) the percentage change in SANE<sub>Function</sub> and WOMAC<sub>Dysfunction</sub> in people with knee OA after 4 weeks of therapeutic exercise.
DESIGN: Cross-sectional study.
SETTING: Research laboratory.
PATIENTS OR OTHER PARTICIPANTS: Thirty-six participants (15 men, 21 women) with radiographic knee OA.
INTERVENTION(S): Participants completed 12 sessions (over a 4-week period) of therapeutic exercise to strengthen the lower extremity.
MAIN OUTCOME MEASURE(S): The SANE<sub>Function</sub> and WOMAC<sub>Dysfunction</sub> (WOMAC<sub>Dysfunction</sub> normalized to 100%) scores were collected before and after the 4-week intervention. Percentage change scores over the 4-week intervention were calculated for both measures.
RESULTS: Participants with a higher SANE<sub>Function</sub> score demonstrated a lower WOMAC<sub>Dysfunction</sub> score at baseline (r<sub>s</sub> = -0.44, P = .007) and at the 4-week time point (r<sub>s</sub> = -0.69, P < .001). There was a nonsignificant and weak association between the changes in the SANE<sub>Function</sub> and WOMAC<sub>Dysfunction</sub> scores over the 4 weeks of therapeutic exercise (r<sub>s</sub> = -0.17, P < .43).
CONCLUSIONS: The SANE<sub>Function</sub> and WOMAC<sub>Dysfunction</sub> scores demonstrated moderate to weak associations before and after a 4-week exercise program, respectively, whereas the changes in SANE<sub>Function</sub> and WOMAC<sub>Dysfunction</sub> scores were not associated. These PROs may be measuring different aspects of self-reported function and therefore should not be used interchangeably to determine a therapeutic response. | 108,120 |
0 | Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty: a randomized, double-blind study | AAHKS (4) Acetaminophen | BACKGROUND AND OBJECTIVES: Femoral nerve block (FNB), a commonly used postoperative pain treatment after total knee arthroplasty (TKA), reduces quadriceps muscle strength essential for mobilization. In contrast, adductor canal block (ACB) is predominately a sensory nerve block. We hypothesized that ACB preserves quadriceps muscle strength as compared with FNB (primary end point) in patients after TKA. Secondary end points were effects on morphine consumption, pain, adductor muscle strength, morphine-related complications, and mobilization ability.
METHODS: We performed a double-blind, randomized, controlled study of patients scheduled for TKA with spinal anesthesia. The patients were randomized to receive either a continuous ACB or an FNB via a catheter (30-mL 0.5% ropivacaine given initially, followed by a continuous infusion of 0.2% ropivacaine, 8 mL/h for 24 hours). Muscle strength was assessed with a handheld dynamometer, and we used the percentile change from baseline for comparisons. The trial was registered at clinicaltrials.gov (Identifier: NCT01470391).
RESULTS: We enrolled 54 patients, of which 48 were analyzed. Quadriceps strength as a percentage of baseline was significantly higher in the ACB group compared with the FNB group: (median [range]) 52% [31-71] versus 18% [4-48], (95% confidence interval, 8-41; P = 0.004). There was no difference between the groups regarding morphine consumption (P = 0.94), pain at rest (P = 0.21), pain during flexion of the knee (P = 0.16), or adductor muscle strength (P = 0.39); neither was there a difference in morphine-related adverse effects or mobilization ability (P > 0.05).
CONCLUSIONS: Adductor canal block preserved quadriceps muscle strength better than FNB, without a significant difference in postoperative pain. | 97,244 |
0 | Effect of different postoperative limb positions on blood loss and range of motion in total knee arthroplasty: An updated meta-analysis of randomized controlled trials | OAK 3 - Non-arthroplasty tx of OAK | BACKGROUND: Postoperative limb positioning has been reported to be an efficient and simple way to reduce blood loss and improve range of motion following total knee arthroplasty (TKA). This meta-analysis was designed to compare the effectiveness of two different limb positions in primary TKA.
MATERIALS AND METHODS: A meta-analysis of the PubMed, CENTRAL, Web of Science, EMBASE and Google Search Engine electronic databases was performed. In this meta-analysis, two postoperative limb positions were considered: mild-flexion (flexion less than 60degree) and high-flexion (flexion at 60degree or more). The subgroups were analysed using RevMan 5.3.
RESULTS: Nine RCTs were included with a total sample size of 913 patients. The mild- and high-flexion positions significantly reduced postoperative total blood loss (P = 0.04 and P = 0.01; respectively). Subgroup analysis indicated that knee flexion significantly reduced hidden blood loss when the knee was fixed in mild-flexion (P = 0.0004) and significantly reduced transfusion requirements (P = 0.03) and improved range of motion (ROM) (P < 0.00001) when the knee was fixed in high-flexion. However, the rates of wound-related infection, deep venous thrombosis (DVT) and pulmonary embolism (PE) did not significantly differ between the two flexion groups.
CONCLUSION: This meta-analysis suggests that mild- and high-flexion positions have similar efficacy in reducing total blood loss. In addition, subgroup analysis indicates that the mild-flexion position is superior in decreasing hidden blood loss compared with high-flexion; the high-flexion position is superior to mild-flexion in reducing transfusion requirements and improving postoperative ROM. Thus, the use of the high-flexion position is a viable option to reduce blood loss in patients following primary TKA without increasing the risk of wound-related infection, DVT or PE. | 110,896 |
0 | Ex vivo magnetic resonance microscopy of an osteochondral transfer | Surgical Management of Osteoarthritis of the Knee CPG | A 49-year-old woman with right knee pain and a chondral defect on the medial femoral condyle underwent an osteochondral transfer. The patient initially had pain relief, but then sustained a twisting injury and had progressive chondromalacia and pain on the affected side. She subsequently underwent a total knee replacement, and the tissue from the osteochondral transfer (OATS) site was harvested for analysis. In vitro MR microimaging of the excised joint segment revealed undamaged, full-thickness cartilage on the OATS plug, intact cartilage on the posterior condyle, and severely thinned and damaged cartilage on the anterior condyle. Alcian blue-stained sections revealed that proteoglycans were present throughout the OATS core but were nearly absent in the native cartilage. Quantitative T(1) data acquired after equilibration with Gd-DTPA indicated a distribution of matrix fixed charge in the OATS plug and anterior tissue that agreed well with histology and literature observations, while the posterior native cartilage appeared to have fixed charge similar to that of the OATS tissue. Histology revealed poor graft integration between OATS and native cartilage, with a distinct layer of fibrous tissue at the posterior interface. MRI images, by comparison, showed a hypointense feature at the posterior interface but uniform intensity across the anterior interface. Quantitative T(2), magnetization transfer and T(1) data acquired with and without gadolinium contrast showed dependences on depth, location, and pathology that were consistent with measurements reported in the literature for articular cartilage | 34,336 |
0 | Orthopedic issues in pregnancy | AAHKS (2) Corticosteroids | Pregnancy taxes the musculoskeletal system. The enlarging gravid uterus alters the maternal body's center of gravity, mechanically stressing the axial and pelvic systems, and compounds the stresses that hormone level fluctuations and fluid retention exert. While the pregnant woman is prone to many musculoskeletal injuries, most can be controlled conservatively, but some require emergent surgical intervention. This article describes pregnancy-related orthopedic problems and related conditions, and discusses their pathogenesis, signs, symptoms, physical examination findings, diagnostic work-up, and interventions. Topics specifically covered include the following: pregnancy-related posterior pelvic pain (PRPPP), lumbar disc herniation with cauda equine syndrome, low back pain, kyphoscoliosis and scoliosis issues for anesthesia during pregnancy and delivery, pubic symphysis rupture, transient osteoporosis versus osteonecrosis, management of pregnancy after hip replacement surgery, and carpal tunnel syndrome. Specific musculoskeletal systems discussed in this article include the spine, pelvis, hip joint, and wrist. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians LEARNING OBJECTIVES: After completion of this article, the reader should be able to recall that there are many changes which occur during pregnancy that create a strain on the musculoskeletal system, explain that there are differences in the signs and symptoms in the presentation and differentiation of each of the maladies, and state that treatments vary depending on the acuteness and impairments created by the musculoskeletal disorder. © 2008 Lippincott Williams & Wilkins, Inc. | 84,566 |
0 | Rotational stability of diaphyseal fractures of the radius and ulna fixed with Rush pins and/or fracture bracing | Distal Radius Fractures | The rotational stability of fractures of the radius and ulna treated with Rush pins and/or fracture bracing was studied in six fresh cadaver forearms. Forearm rotation and fracture site motion (rotation) were measured as functions of applied forearm torque and rotation (pronation-supination). Values were obtained from the forearm: (1) intact and with both bones fractured; (2) without fixation; (3) with a fracture brace; (4) with Rush pins; and (5) with a combination of Rush pins and a fracture brace. A brace was ineffectual in reducing fracture site motion when the wrist was rotated to specified angles compared to fracture site motion for the forearm with no fixation treatment rotated to the same angles. When loading to specific torque levels, however, the brace reduced fracture site motion to one-half the motion with no fixation treatment. Under both loading conditions, Rush pin fixation significantly and markedly reduced the fracture site motion (to approximately one-eighth of the motion with no fixation treatment), whereas a brace in conjunction with Rush pins did not significantly further reduce the fracture site motion. The radius showed more motion at fracture site than the ulna. | 120,258 |
0 | Role of pamidronate disodium in the treatment of metastatic bone disease | MSTS 2018 - Femur Mets and MM | AIMS AND BACKGROUND: Bone metastases are a common feature of advanced neoplastic disease and are considered to be among the most frequent causes of pain and complications in oncologic patients. The main objective of the treatment of such patients is to control their symptoms and improve their quality of life. Pamidronate disodium is a second-generation bisphosphonate capable of inhibiting bone resorption (particularly osteoclast activity) without affecting bone remineralization. After a brief introduction concerning the pathophysiology of bone metastases and neoplastic bone pain, we herein present data on the clinical pharmacology and toxicity of bisphosphonates in general, and pamidronate in particular. We conclude by reviewing the literature on the use of pamidronate in phase II and III trials involving patients with metastatic bone disease.
METHODS: The paper is based on a review of articles published between 1984 and 1997 selected from the Cancerline and Medline databases.
RESULTS: In the considered phase II and III studies involving patients with bone metastases (breast cancer and multiple myeloma in particular), pamidronate proved to be efficacious in reducing the incidence of pain and skeletal complications, decreasing the excretion of metabolic markers of bone resorption and improving the quality of life. Intravenous infusions of 60-90 mg over a period of 2 hr every 3-4 weeks did not cause any significant toxic effects and was easily managed.
CONCLUSIONS: Pamidronate is a bisphosphonate that is efficacious in the treatment of symptomatic bone metastases and can be considered an important therapeutic option in association with systemic treatments, radiotherapy and normal supportive care, especially in patients with breast cancer and multiple myeloma. Further randomized studies are necessary to confirm the positive preliminary results in other neoplasms, analyze the cost/benefit ratio of the treatment, and verify the possibility that, in addition to being used for palliative purposes, pamidronate may also prevent or delay the appearance of bone metastases. [References: 132] | 82,316 |
0 | Cervicofacial rhytidectomy without notorious scars: Experience of 29 years | Panniculectomy & Abdominoplasty CPG | Objectives Presentation and evaluation of results of the surgical technique of cervicofacial rhytidectomy used by the senior author (F.P.), using the classification of facial aging to determine the stage of pre- and postsurgical age. Methods The surgical technique was used in 1,181 patients operated on in the past 29 years, starting in 1983. We analyzed retrospectively 318 patients operated on between the years 2001 and 2008, of whom 71 patients met the selection criteria. Postoperative follow-up period was from 6 months to 5 years. Results All patients in stage I showed clinically visible rejuvenation postoperatively. Significant improvement in facial rejuvenation in stages II and III of aging was shown, with a postoperative change of stage. Conclusion The technique of cervicofacial rhytidectomy with short flap, facial superficial musculoaponeurotic system (SMAS) imbrication, cervical SMAS plication, inconspicuous incisions, and postauricular z-plasty allows for successful and sustainable results over time, with short recovery time and minimal complications. The classification of facial aging pre- and postsurgery has been useful for the assessment of surgical results. Copyright © 2013 by Thieme Medical Publishers, Inc. | 126,915 |
0 | Extensor mechanism repair failure with use of bidirectional barbed suture in total knee arthroplasty | Surgical Management of Osteoarthritis of the Knee CPG | Total knee arthroplasty (TKA) continues to advance as innovative devices become available. #2 PDO Quill SRS (Angiotech, Reading, Pa) bidirectional barbed suture was used for 161 primary TKAs at our facility. We report on 3 separate cases of extensor mechanism repair failure after primary TKA in which a barbed suture was used for extensor mechanism closure. Before the implementation of this device, there were no reported failures in 385 primary TKAs. We recommend that surgeons who use this device for extensor mechanism repair of a medial parapatellar arthrotomy in TKA exercise caution when operating on patients with morbid obesity, diabetes, and rheumatoid arthritis. We have discontinued use of the bidirectional barbed suture until more definitive large orthopedic studies establish its efficacy and safety | 30,917 |
1 | Management of long-term sequelae of compartment syndrome involving the foot and ankle | DOD - Acute Comp Syndrome CPG | BACKGROUND: Lower leg compartment syndrome can lead to severe sequelae affecting patient autonomy. Ischemic muscle fibrosis and retraction result in foot and ankle deformities ranging from claw toes to complex multiplanar dislocations with soft tissue impairment requiring amputation. Although these deformities have been reported in relation to compartment syndrome, they have rarely been discussed specifically in the light of a long term follow up.
MATERIALS AND METHODS: Between 1981 and 2006, 151 patients were treated in our hospital for compartment syndrome of the lower limb. Ten of them later required further surgery to treat sequelae on the foot and ankle and were followed up prospectively. Personal data and surgical events were recorded, as well as potential risk factors for sequelae and functional outcome. The data was analyzed and compared to that available in previous literature. We analyzed and describe the different surgical procedures available for the management of this condition including arthroscopic ankle arthrodesis which could be a less invasive and efficient technique in mild equinus deformities.
RESULTS: All ten patients were diagnosed late for compartment syndrome. The anterior and lateral compartments were most often involved but rarely accounted for late sequelae. The deep posterior compartment seems to be the key element in generating after effects. Functional results were good in eight patients. Two required amputation after failed secondary surgery.
CONCLUSION: The late, post-compartment syndrome affecting the foot and ankle can be treated efficiently provided surgery is performed acurately, taking into account the multiplanar deformity. However, the best treatment for this condition remains prevention. | 65,082 |
0 | Phase II evaluation of early oral estramustine, oral etoposide, and intravenous paclitaxel combined with hormonal therapy in patients with high-risk metastatic prostate adenocarcinoma: Southwest Oncology Group S0032 | MSTS 2022 - Metastatic Disease of the Humerus | Objectives: To assess the efficacy of a multiagent taxane-based chemotherapy combined with hormonal therapy in men with metastatic androgen-dependent prostate cancer in a multicenter, cooperative group, single-arm trial. Methods: A total of 41 patients with newly diagnosed metastatic prostate cancer involving both the axial and the appendicular skeletons or viscera were enrolled. Of the 41 patients, 35 were treated with combined androgen blockade and =4 cycles of oral estramustine (280 mg orally 3 times daily) and etoposide (50 mg/m2 daily) for 14 days of each 21-day cycle, with paclitaxel (135 mg/m2 intravenously within 1 hour) on day 2 of each cycle. Chemotherapy was started within 30 days of the initiation of hormonal therapy. The patients were followed up to determine the progression-free survival. Results: The 35 patients received a total of 126 cycles of chemotherapy, with 30 receiving all 4 cycles. The median progression-free survival for the evaluable population was 13 months (95% confidence interval 10-16), with a median overall survival of 38 months (95% confidence interval 28-49). The main toxicities were myelosuppression, with 9 patients experiencing grade 3 or greater neutropenia and 1 developing grade 4 thrombocytopenia. One patient died of neutropenic infection. Thrombosis embolism occurred 4 times (3 of grade 4 and 1 of grade 3), with 1 episode of grade 4 cardiac ischemia. Conclusions: The results of our study have shown that the administration of chemotherapy to this population is feasible, with moderate toxicity. Taxane-based chemotherapy did not demonstrate significant efficacy in this high-risk population of patients with a poor prognosis. © 2011 Elsevier Inc. | 156,035 |
1 | A SNP in CYP2C8 is not associated with the development of bisphosphonate-related osteonecrosis of the jaw in men with castrate-resistant prostate cancer | MSTS 2018 - Femur Mets and MM | A single nucleotide polymorphism (SNP) in CYP2C8 (rs1934951), was previously identified in a genome-wide association study as a risk factor for the development of osteonecrosis of the jaw (ONJ) in patients receiving bisphosphonates (BPs) for multiple myeloma. To determine if the same SNP is also associated with the development of ONJ in men receiving BPs for bone metastases from prostate cancer, we genotyped 100 men with castrate-resistant prostate cancer treated with bisphosphonates for bone metastases, 17 of whom developed ONJ. Important clinical characteristics, including type and duration of bisphosphonate therapy, were consistent among those who developed ONJ and those who did not. We found no significant correlation between the variant allele and the development of ONJ (OR = 0.63, 95% CI: 0.165-2.42, P > 0.47). This intronic SNP in CYP2C8 (rs1934951) does not seem to be a risk factor for the development of bisphosphonate-related ONJ in men with prostate cancer. It is important to note that this is only the second study to investigate the genetics associated with BP-related ONJ and the first to do so in men with prostate cancer. More studies are needed to identify genetic risk factors that may predict the development of this important clinical condition. | 84,199 |
1 | Comparison of peripheral nerve block with periarticular injection analgesia after total knee arthroplasty: a randomized, controlled study | Surgical Management of Osteoarthritis of the Knee CPG | BACKGROUND: Pain after total knee arthroplasty (TKA) is usually severe. Recently, the usefulness of local periarticular injection analgesia (PAI) and peripheral nerve block (PNB) has been reported. We report a prospective blinded randomized trial of PAI versus PNB in patients undergoing primary TKA, in accordance with the CONSORT statement 2010. METHODS: A total of 210 patients undergoing TKA under spinal anesthesia were randomized to receive PNB group or PAI group. In the PNB group, femoral nerve block and sciatic nerve block were performed. In the PAI group, a special mixture containing ropivacaine, saline, epinephrine, morphine hydrochloride, and dexamethasone was injected into the periarticular soft tissue. Pain intensity at rest was assessed using a numerical rating scale (NRS: 0-10) after surgery. Use of a diclofenac sodium suppository (25mg) was allowed for all patients at any time after surgery, and the diclofenac sodium suppository usage was assessed. The NRS for patient satisfaction at 48 hours after surgery was examined. RESULTS: The average NRS for pain at rest up to 48 hours after surgery was low in both groups. Within 48 hours after surgery, the diclofenac sodium suppository usage was similar in both groups. There were no significant differences in the NRS for patient satisfaction in both groups. CONCLUSIONS: The analgesic effects of PAI and PNB are similar. PAI may be considered superior to PNB because it is easier to perform. LEVEL OF EVIDENCE: Therapeutic Level 1 | 37,424 |
0 | Partial epiphyseal preservation and intercalary allograft reconstruction in high-grade metaphyseal osteosarcoma of the knee | MSTS 2018 - Femur Mets and MM | BACKGROUND: The purpose of this study was to analyze a series of patients with a high-grade metaphyseal osteosarcoma of the knee who had been treated with a transepiphyseal resection, with preservation of the distal femoral and the proximal tibial (articular) portions of the epiphysis, and an intercalary allograft reconstruction. METHODS: The cases of thirteen patients with a high-grade metaphyseal osteosarcoma around the knee who had transepiphyseal resection and reconstruction with an intercalary allograft were retrospectively reviewed at a mean of sixty-three months. Complications, disease-free survival of the patient, final preservation of the limb and epiphysis, and functional results according to the Musculoskeletal Tumor Society scoring system were documented at the time of the latest follow-up. RESULTS: At the final follow-up examination, eleven of the thirteen patients continued to be disease-free. One patient died of bone and pulmonary metastases with no evidence of local recurrence, and the remaining patient had no evidence of disease after resection of a local recurrence of the tumor in the soft tissues. No patient had a local recurrence in the remaining epiphysis. Seven patients had complications that included a fracture (three patients), diaphyseal nonunion (two), deep infection (one), and a local recurrence in the soft tissues (one). The allograft was removed in only four of these patients. At the latest follow-up examination, twelve patients were alive with preserved limbs. In one patient, the epiphysis, which originally had been preserved, was resected because of a metaphyseal fracture, and the limb was reconstructed with an osteoarticular allograft. The patients with a preserved epiphysis had an average functional score of 27 points (maximum, 30 points). CONCLUSIONS: Preservation of the epiphysis in high-grade metaphyseal osteosarcoma at the knee is an alternative in carefully selected patients. Crucial factors needed to obtain local tumor control and achieve an acceptable functional result are a positive response to chemotherapy, accurate preoperative assessment of tumor extension to the epiphysis, and appropriate fixation techniques for intercalary allografts. Copyright © 2005 by The Journal of Bone and Joint Surgery, Incorporated. | 76,853 |
0 | Drug delivery strategies for common orofacial diseases | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | There are many types of diseases associated with the oral cavity. As an adjunct to professional oral dental care, various drug delivery systems have been developed to improve the treatment or prevention of these diseases. In this manuscript, the current status of drug delivery strategies for these common orofacial diseases is reviewed. Biomineral-binding drug delivery and on-demand drug release are suggested to be considered in the future design of drug delivery systems for orofacial diseases. Apparently, this research field deserves much more attention from both pharmaceutical scientists and dental health professionals | 19,072 |
0 | Symptomatic nonunion after fracture of the calcaneum. Demographics and treatment | DoD SSI (Surgical Site Infections) | We have treated 14 patients (15 fractures) with nonunion of an intra-articular fracture of the body of the calcaneum. The mean follow-up was six years (2 to 8.5). A total of 14 fractures (93%) had initially been treated operatively with 12 (86%) having non-anatomical reductions. Four feet (27%) had concomitant osteomyelitis. Of the nonunions, 14 (93%) went on to eventual union after an average of two reconstructive procedures. All underwent bone grafting of the nonunion. The eventual outcome was a subtalar arthrodesis in ten (67%) cases, a triple arthrodesis in four (27%) and a nonunion in one (6%). Three patients had a wound dehiscence; all required a local rotation flap. The mean American Orthopaedic Foot and Ankle Society score at latest follow-up was 69, and the mean Visual analogue scale was 3. Of those who were initially employed, 82% (9 of 11) eventually returned to work. We present an algorithm for the treatment of calcaneal nonunion, and conclude that despite a relatively high rate of complication, this complex surgery has a high union rate and a good functional outcome. | 148,330 |
0 | Lateral-compartment Osteophytes are not Associated With Lateral-compartment Cartilage Degeneration in Arthritic Varus Knees | OAK 3 - Non-arthroplasty tx of OAK | BACKGROUND: Progression of arthritis in the lateral compartment is one of the main failure modes of unicompartmental knee arthroplasty (UKA). The decision regarding whether to perform a medial UKA sometimes is made based on whether lateral-compartment osteophytes are visible on plain radiographs obtained before surgery, but it is not clear whether the presence of lateral-compartment osteophytes signifies that the cartilage in the lateral compartment is arthritic.
QUESTIONS/PURPOSES: (1) Is the presence of lateral compartment osteophytes associated with biomechanical properties of lateral-compartment cartilage, and (2) are osteophytes in the lateral compartment associated with particular histologic features of cartilage in the lateral compartment?
METHODS: Between May 2010 and January 2012, we performed 201 TKAs for varus osteoarthritis confirmed on standardized AP hip-to-ankle standing radiographs. All patients with a varus deformity were considered for this prospective study. During the enrollment period, 100 patients (101 knees) were not enrolled for this study because of declined consent or because they were unable to perform all required preoperative radiographic examinations. That left 84 patients (100 knees), of whom an additional 23 patients (27%) were excluded because either radiographic or biomechanical data were missing. For final analysis, 61 patients (71 knees) were available. There were 29 males (48%) and 32 females (52%) with a mean age of 65 years (range, 49-89 years). Their mean BMI was 26 kg/m<sup>2</sup> (range, 17-47 kg/m<sup>2</sup>). Lateral-compartment osteophytes were graded by two observers on AP standing knee radiographs based on a template of the Osteoarthritis Research Society International (OARSI) radiographic atlas. During surgery, osteochondral plugs were harvested from the lateral tibial plateau and the distal lateral femur for biomechanical and histologic assessments. The intrinsic material coefficients aggregate modulus (Ha) and dynamic modulus (DM) were determined by applying a compressive load of 20 g for 1 hour. The histologic analysis was performed according to the qualitative osteoarthritis cartilage histopathology assessment system. The Mann-Whitney U test was performed to compare the distribution of variables. Power analysis was performed for the Mann-Whitney U test using an alpha of 0.05, a power of 80%, and a sample size of 71 resulting in a detectable effect size of 0.6. Owing to the limited sample size, only medium or large effects in changes of biomechanical properties can be excluded with adequate power.
RESULTS: Ha and DM were not different with the numbers available when comparing knees with osteophyte Grades 0, 1, and 2 on the lateral tibia. For Grade 3 tibial osteophytes (n = 3), the lateral tibia cartilage showed low Ha (0.39 MPa; SD, 0.17 MPa) and low DM (2.85 MPa; SD, 2.12 MPa). On the lateral femur, no differences of Ha and DM were observed with the numbers available between Grades 0 to 3 osteophytes. No differences with the numbers available in the OARSI histologic grades on the lateral tibia plateau and the distal lateral femur were observed between the different osteophyte grades.
CONCLUSIONS: Lateral-compartment osteophytes are not associated with biomechanically weaker cartilage or with more-advanced histologic signs of degeneration of lateral-compartment cartilage in knees with varus arthritis. Given the small sample size of 71, the study was underpowered to detect small-to-modest decreases in biomechanical properties. Future studies with larger sample sizes are needed to confirm the current findings.
CLINICAL RELEVANCE: Factors other than the presence or absence of lateral-compartment osteophytes should be considered when evaluating patients with medial-compartment arthritis for medial UKA. Future studies are required to define the limitations of plain radiographs to rule out cartilage degeneration in the lateral compartment of varus knees. | 108,027 |
0 | Strategies for the prevention and management of osteoarthritis of the hip and knee | Surgical Management of Osteoarthritis of the Knee CPG | Osteoarthritis (OA) is one of the most common forms of musculoskeletal disorders and incurs significant economic, social and psychological costs. OA increases in prevalence and also progresses with aging. Clinically OA is characterised by joint pain, crepitus, stiffness after immobility and limitation of movement. Many cases are 'idiopathic' (disease or condition of unknown course or which arises spontaneously), but OA can also be the end result of several other conditions or due to the combination of several other factors. There are various lifestyle factors that increase the risk of developing OA. Preventable or modifiable risk factors include obesity, occupational factors, sports participation, muscle weakness, nutritional factors and hormonal influence. Pharmacological therapies reduce pain and may reduce joint damage. Surgical interventions correct altered biomechanics to prevent OA. For severely damaged joints, partial or total replacement of the joint is possible for all of the large joints that are commonly affected by OA. OA is commonly associated with a limited function that can be improved with a wide variety of rehabilitative interventions: joint specific exercises, physical fitness, physical modalities. Education and self-management are very important to prevent overuse and to use the joints in the most adequate way | 34,712 |
0 | A novel biomarker in patients with knee osteoarthritis: adropin | OAK 3 - Non-arthroplasty tx of OAK | Adropin is newly discovered peptide hormone. Osteoarthritis (OA) is a kind of joint disease characterized by progressive joint cartilage loss and joint pain. The present study was carried out to investigate adropin and tumor necrosis factor alpha (TNF-alpha) levels and the relationship between adropin in patients with knee OA classified by Kellgren-Lawrence (KL). A total of 60 knee OA patients and 30 healthy controls were included in this study. KL grading was carried out using the radiographic findings. Demographic characteristics and laboratory parameters were recorded. Adropin and TNF-alpha levels were determined by using enzyme-linked immunosorbent assay (ELISA). Adropin level was lower in the knee OA patients compared with the healthy controls (p < 0.001), whereas TNF-alpha level was higher (p < 0.001). Adropin level was negatively correlated with TNF-alpha level, blood white blood cell (WBC) count, and neutrophil-lymphocyte ratio (NLR). However, there was a significant decrease in adropin level and an increase in TNF-alpha level parallel to the increase in the KL grade. In addition, serum adropin level was found to be significantly lower in KL grade 1 groups compared with healthy controls (p < 0.01). There was a decrease in adropin level parallel to the increase in the body mass index (BMI), and there was a statistically significant decrease in adropin level in knee OA patients higher than BMI > 30 (p < 0.01). Mean NLR of KL grade 4 was significantly increased compared with other grades (p < 0.05). The consequence of the present study suggested that serum adropin level could be used as a new biomarker indicating the early grade of knee OA. | 102,922 |
0 | Mortality after cervical hip fracture. 3002 patients followed for 6 years | Management of Hip Fractures in the Elderly | In 3002 patients with a femoral intracapsular neck fracture occurring during a 3-year period in the Stockholm area, 79 per cent were admitted from home and the remainder from different types of institutions. The mortality among these fracture patients was higher than in the general population. Patients admitted from institutions had a three to four times higher mortality rate than those coming from home. After 6 years, 54 per cent of the patients admitted from home were still alive compared with only 16 per cent of those admitted from institutions | 12,275 |
0 | Muscle edema | DOD - Acute Comp Syndrome CPG | The many causes of the muscle edema pattern are best appreciated on MRI. An assessment of the morphology and distribution of the findings, combined with knowledge of background clinical information, is essential in formulating an accurate differential diagnosis.Copyright © 2010 by the American Roentgen Ray Society. | 63,650 |
0 | Distant bone metastases from carcinoma of the lip: a report of four cases | MSTS 2018 - Femur Mets and MM | The lip is estimated to be the most frequent location for carcinoma of the oral cavity. It occurs more frequently in men, especially those with a history of exposure to sunlight. Despite the usually effective management, regional and occasionally distant metastases do occur, especially in advanced stages. In this retrospective analysis of patients with labial carcinoma presenting with distant bone metastases in 1995-2003, the extremely limited number of patients did not allow for multivariate data analysis. From a cohort of 415 patients presenting with lip lesions, 186 cases were diagnosed as carcinoma and managed accordingly. Four patients (2.14%) showed distant bone metastases, one with concurrent axillary node metastasis. Patient demographics, tumour characteristics, case management and survival were evaluated. The distant metastasis patients were of clinical stages II-IV; initial management was wide local excision with reconstruction for all cases, with one undergoing concurrent neck dissection and one adjuvant radiotherapy. Time for distant bone metastasis was 9-21 months, subsequent survival 3-14 months and overall survival 13-35 months. Distant metastases from labial carcinoma are rare, not exceeding 2%. Metastasis to bone and axillary lymph nodes is exceptionally rare and can be attributed to either inadequate initial management or aggressive tumour behaviour. © 2007. | 80,990 |
0 | A predictive model for life-threatening neutropenia and febrile neutropenia after the first course of CHOP chemotherapy in patients with aggressive non-Hodgkin's lymphoma | MSTS 2022 - Metastatic Disease of the Humerus | The purpose of this study was to develop a model for predicting the occurrence of life-threatening neutropenia (LN, ANC < or = 0.5 x 10(9)/l) and febrile neutropenia (FN, an ANC < 0.5x10(9)/l in association with a body temperature of > or = 38.3 degrees C) after the first cycle of CHOP therapy in patients newly diagnosed with aggressive NHL. One hundred and forty-five patients, aged > or = 15 years, with newly diagnosed diffuse mixed, diffuse large-cell or large-cell immunoblastic lymphoma (IWF categories, F, G, H), who had been treated with CHOP at King Chulalongkorn Memorial Hospital between June 1994 and December 1998, were entered into the study. The criteria for eligibility included complete work-up for baseline evaluation, treatment with standard CHOP chemotherapy, at least one complete blood count performed during days 8-14 post-treatment or if at any time the patients experienced a BT of > or = 38.3 degrees C and were not treated with any colony-stimulating factors (CSFs). The median age of the patients was 47 years (range, 17-78). Forty-eight percent of the patients were in stage III/IV, 36% had ECOG performance status (PS) II-IV, 30% had > or = 2 extranodal diseases, 59% had serum LDH > 1 x normal and 23% had bone marrow involvement. The frequencies of patients in the low-, low-intermediate, high-intermediate and high risk groups according to the international index were 29%, 28%, 17% and 26%, respectively. Thirty-nine percent of the patients had LN at nadir and 33% developed FN after the first course of CHOP. By using stepwise logistic regression analysis, the pretreatment variables independently predictive of the LN at nadir and the FN were serum albumin concentration of < or = 3.5 g/dl, serum LDH > 1 x normal and whether there was bone marrow involvement of lymphoma at presentation. The model, based on the incorporation of these three factors, identified three risk groups of patients with a predicted probability of developing LN at nadir of 81.5% (95% CI, 68.5-90.7) (high risk), 23.9% (95% CI, 12.6-38.8) (intermediate risk) and 4.4% (95% CI, 0.5-15.1) (low risk). The predicted rate of FN in the three groups were 72.2% (95% CI, 58.4-83.5), 17.4% (95% CI, 7.8-31.4) and 2.2% (95% CI, 0.05-11.8), respectively. In conclusion, our model could be used as a means to identify patients with newly diagnosed aggressive NHL, treated with CHOP, who are at high risk (> or = 50% probability) of developing post-first course LN and FN, in whom CSF and/or antibiotic prophylaxis might be indicated. | 154,873 |
0 | The advantages of free tissue transfer in the treatment of posttraumatic stiff knee | DoD SSI (Surgical Site Infections) | BACKGROUND: Open fractures of the distal femur involving the joint, surrounding ligament, and soft tissues are among the worst types of injuries that may eventually lead to stiff knee. Release procedures have been described as the common treatment option for posttraumatic stiff knee. However, the importance of simultaneously applied free flaps to replace the pliable soft tissue around the knee joint has not been discussed previously. METHODS: Between 1996 and 2002, nine patients with posttraumatic severe stiff knees were operated on. All patients underwent release procedures, such as scar removal, quadricepsplasty, tendon lengthening, and/or capsulotomy. In addition, free tissue transfers were performed at the same stage as the release procedures to cover the resultant soft-tissue defects or carried out at a secondary stage because of wound-healing problems. The mean follow-up period was 38 months. RESULTS: Complete flap survival was 100 percent. There were no infection or wound-healing problems following free tissue transfer. After satisfactory rehabilitation, acceptable range of motion was regained. CONCLUSION: Surgical reconstruction of the posttraumatic stiff knee becomes more straightforward with the use of free flaps to cover soft-tissue defects, providing remarkable advantages for postoperative rehabilitation. ©2007American Society of Plastic Surgeons. | 149,298 |
0 | The effect of rotational fixation error of the tibial cutting guide and the distance between the guide and the bone on the tibial osteotomy in total knee arthroplasty | Surgical Management of Osteoarthritis of the Knee CPG | Computed tomography based computer simulation studies were made on fifty consecutive patients with osteoarthritis scheduled for TKA. Proximal tibial cutting was simulated with the cutting guide placed at different rotational errors (-10 degrees , 0 degrees , 10 degrees and 20 degrees of internal rotation) and different distances (4 cm and 8 cm) between the alignment rod and the bone. Only ten degrees of rotation error with 8 cm of distance resulted in over 3 degrees of varus or valgus tibial cut. Our study demonstrated that rotational mismatch between the proximal and distal part of the tibia should be avoided and the distance between the alignment rod and the bone should be as short as possible to achieve proper tibial alignment | 35,632 |
1 | Postoperative effects of neuromuscular exercise prior to hip or knee arthroplasty: a randomised controlled trial | Surgical Management of Osteoarthritis of the Knee CPG | OBJECTIVE: To investigate the postoperative efficacy of a supervised programme of neuromuscular exercise prior to hip or knee arthroplasty. METHODS: In this assessor-blinded randomised controlled trial, we included 165 patients scheduled for hip or knee arthroplasty due to severe osteoarthritis (OA). An 8-week preoperative neuromuscular supervised exercise programme was delivered twice a week for 1 h as adjunct treatment to the standard arthroplasty procedure and compared with the standard arthroplasty procedure alone. The primary outcome was self-reported physical function measured on the activities of daily living (ADL) subscale in the Hip disability and Osteoarthritis Outcome Score (HOOS) and the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaires for patients with hip and knee OA, respectively. Primary endpoint was 3 months after surgery. RESULTS: 165 patients randomised to the two groups were on average 67+/-8 years, 84 (51%) had hip OA and 92 (56%) were women. 153 patients (93%) underwent planned surgery and were evaluated postoperatively. There was no statistically significant difference in effects between hip or knee patients (p=0.7370). Three months postoperatively, no difference was found between groups for ADL (4.4, 95% CI -0.8 to 9.5) or pain (4.5, 95% CI -0.8 to 9.9). However, there was a statistically significant difference indicating an effect of exercise over the entire period (baseline to 3-months postoperatively) (p=0.0029). CONCLUSIONS: Eight weeks of supervised neuromuscular exercise prior to total joint arthroplasty (TJA) of the hip or knee did not confer additional benefits 3 months postoperatively compared with TJA alone. However, the intervention group experienced a statistically significant short-term benefit in ADL and pain, suggesting an earlier onset of postoperative recovery. TRIAL REGISTRATION: ClinicalTrials NCT01003756 | 37,339 |
0 | Biomechanical comparison of internal fixation techniques for the treatment of unstable basicervical femoral neck fractures | Management of Hip Fractures in the Elderly | OBJECTIVES: The optimal method of internal fixation of basicervical femoral neck fractures is controversial. This area represents a transition zone between the intracapsular femoral neck fracture, usually fixed with multiple cancellous screws, and the extracapsular interochanteric fracture, fixed with a sliding screw device [sliding hip screw (SHS)] and derotation screw (DRS) device. The authors' specific aim was to biomechanically compare these two methods of fixation in a cadaveric model of a basicervical femoral neck fracture with posteromedial comminution.DESIGN: The authors compared the average peak force during cyclic loading and the maximum axial force sustained by matched pairs of specimens stabilized with either fixation and subjected to axial and torsional loading while flexing and extending the hip. The average peak force was defined as the mean of the peak force values measured in each loading cycle with the maximum displacement of the materials tester actuator the same for each cycle (displacement control) as opposed to the maximum force being held constant (load control).RESULTS: The cancellous screw group maintained a significantly lower average peak force, 470 Newtons (SD = 145 Newtons), compared with 868 Newtons (SD = 186 Newtons) for the SHS and DRS composite group (p < 0.01). Similarly, the cancellous screw group demonstrated a lower ultimate load to failure, 1,863 Newtons (SD = 475 Newtons) compared with 3,557 Newtons (SD = 215 Newtons) for the SHS and DRS composite group (p < 0.01).CONCLUSION: The results support the use of an SHS and DHS composite compared with three cancellous screws in the treatment of unstable basicervical femoral neck fractures | 1,748 |
0 | Total knee replacement in King Abdullah University Hospital, early results | Surgical Management of Osteoarthritis of the Knee CPG | Objectives: To look at the early results of total knee replacement in King Abdulla University Hospital (KAUH), and decide whether we should continue offering this service or not? Methods: We retrieved the files of all patients who underwent total knee joint replacement in KAUH since its commissioning on 2002. We looked at certain epidemiological factors such as age, sex, weight and risk factors. We explained our preoperative plan, surgical techniques, types of prosthesis inserted, and the complications encountered. Results: The number of patients was 210, while the number of knees replaced were 267 joints. 80% of our patients were females, right and left side knees were replaced equally. The mean age of patients was 63.3 years, while the mean weight was 84.6 kgms. Only thirty patients were free of any co-morbidity, and the rest of them had at least one symptom of co-morbidity. The vast majority of patients have advanced primary osteoarthritis. Mobile bearing prosthesis were mostly used. The complications rate was 20%, most of which were in the form of superficial wound infection. Conclusions: Total knee replacement is a thriving surgery in Jordan, to keep going we must stick to the sound principles. Such a major surgery should be done in specialized centers. So far, we think that our results are satisfying and we will continue doing this type of surgery. (copyright) 2009 DAR Publishers/University of Jordan. All Rights Reserved | 36,929 |
0 | Infections in patients with multiple myeloma in the era of high-dose therapy and novel agents | MSTS 2018 - Femur Mets and MM | The introduction of stem cell transplantation and the novel anti-myeloma agents, bortezomib, thalidomide, and lenalidomide, have improved the outcome of patients with multiple myeloma. These advances have transformed myeloma into a chronic condition, with multiple relapses and salvage therapies, all of which result in cumulative immunosuppression and higher risk of infection. In addition to the immunodeficiency related to myeloma and its complications, the type of anti-myeloma therapy used also plays a role in the development of infection. Therapy with bortezomib increases the risk for reactivation of herpes simplex and herpes zoster viruses, whereas the application of stem cell transplantation has broadened the spectrum of infection to include those caused by Clostridium difficile, cytomegalovirus, and opportunistic moulds. Key to the management of infection is the understanding of the specific risk factors and periods during which patients are at risk; this allows the anticipation of the likely pathogen(s) and the application of risk-adjusted prophylactic and treatment strategies. © 2009 by the Infectious Diseases Society of America. All rights reserved. | 79,907 |
0 | Long-term effects of giving nursing home residents bread fortified with 125 microg (5000 IU) vitamin D(3) per daily serving | Management of Hip Fractures in the Elderly | BACKGROUND: In older adults, a serum 25-hydroxyvitamin D [25(OH)D] concentration >75 nmol/L lowers the risk of fracture. An oral intake of 125 microg (5000 IU) vitamin D(3)/d may be required to achieve this target.OBJECTIVE: The objective was to characterize the safety and efficacy of fortifying bread with a biologically meaningful amount of vitamin D(3).DESIGN: In a single-arm design, 45 nursing home residents consumed one bun daily that had been fortified with 125 microg (5000 IU) vitamin D(3) and 320 mg elemental calcium.RESULTS: The initial mean (+/-SD) serum 25(OH)D concentration was 28.5 +/- 10.8 nmol/L. After 12 mo, the 25(OH)D concentration was 125.6 +/- 38.8 nmol/L, and it exceeded 74 nmol/L in 92% of the patients. At every 3-mo follow-up, serum parathyroid hormone was lower than at baseline (P = 0.001). No changes in serum calcium or cases of hypercalcemia were observed at the follow-up assessments. Both mean total urinary calcium and the mean urinary calcium-creatinine ratio increased from baseline at one follow-up time point (P < 0.05). Between baseline and the 12-mo visit, z scores for bone mineral density at the lumbar spine and the hip both increased significantly (P < 0.001).CONCLUSIONS: Fortification of bread with much more vitamin D than used previously produced no evident adverse effects on sun-deprived nursing home residents and improved bone density measures. Fortification of bread with 5000 IU vitamin D(3)/d provided reasonable assurance that vitamin D-deficient older adults attained a serum 25(OH)D concentration greater than the desirable objective of >75 nmol/L. This trial was registered at (ClinicalTrials.gov) as: NCT00789503 | 7,174 |
0 | Improvement on the Neo-umbilicoplasty Technique and Review of the Literature | Panniculectomy & Abdominoplasty CPG | INTRODUCTION: The umbilicus is an important component of body esthetics, and its absence or dysmorphia may give rise to psychological discomfort, making it a common concern in surgical planning. Many techniques of umbilicus reconstruction have been proposed, each with its own limitations in terms of esthetics, risk of stenosis or final positioning. Reconstruction techniques may involve skin grafting, cartilage, purse-string suture and flaps. One of the most promising approaches is scarless neo-umbilicoplasty. OBJECTIVE: To improve the technique of neo-umbilicoplasty, creating a deeper and more natural-looking umbilicus, and propose a reoperation technique for shallow umbilici. PATIENTS AND METHODS: The sample consisted of 108 patients aged 25-67Â years submitted to abdominoplasty and scarless neo-umbilicoplasty under epidural anesthesia performed by the same surgeon and at the same hospital between July 2013 and October 2015. RESULTS: Follow-up lasted from 6 to 24Â months. The new umbilici were scarless. DISCUSSION: Many different techniques may be used to reconstruct the umbilicus. The main purpose is to create an adequately localized structure with a natural, youthful appearance and minimal scarring. To do so, we used ten (rather than six) attachment stitches and mobilized the adipose tissue toward the center of the new umbilicus to achieve greater depth, even in lean patients. Techniques which involve suturing the umbilical stalk onto the incised skin of the abdominal flap tend to produce unesthetic results, such as visible scars and umbilical skin islands of varying size. Scarless neo-umbilicoplasty does not require suture removal and poses no risk of dehiscence, secretion or umbilical stenosis, as observed with other techniques. CONCLUSION: The localization of the new umbilicus in the space between the rectus abdominis muscles, the use of ten rather than six stitches and the mobilization of the adipose tissue toward the periumbilical area constitute an improvement on the neo-umbilicoplasty technique. The resulting umbilici were scarless and very natural-looking. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . | 127,031 |
0 | The Use of Hyaluronan After Arthroscopic Surgery of the Knee | AAHKS (4) Acetaminophen | Viscosupplementation is defined as the use of intra-articular hyaluronan therapy for symptomatic osteoarthritis (OA). Originally used for the treatment of ophthalmic disorders, viscosupplementation has been available for over a decade in the United States for the treatment of pain secondary to OA of the knee in patients who have not responded adequately to conservative oral pharmaceuticals including nonsteroidal anti-inflammatories and simple analgesics. The majority of patients with symptomatic knee OA will have evidence of meniscal and/or articular surface pathology, and most orthopaedic surgeons include arthroscopic surgery as a possible treatment modality for the symptomatic patient. Although arthroscopic meniscectomy is the most commonly performed orthopaedic procedure in the United States, in patients with concomitant OA, disease-related pain can persist after arthroscopic surgery. This article reviews some of the more recent evidence recommending the use of viscosupplementation for the management of symptomatic knee OA and pain relief after arthroscopy. © 2010 Arthroscopy Association of North America. | 96,745 |
0 | Candidiasis | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | Candida spp. are the most common fungal pathogens isolated in immunocompromised hosts, particularly cancer patients. Numerous clinical manifestations of candidiasis have been recognized, including localized infection such as oropharyngeal candidiasis or focal hepatic candidiasis, and disseminated infection resulting from hematogenous spread, with or without documented fungemia. Granulocytopenic patients are particularly at risk. Candida albicans is isolated in approximately 40% of cases of fungemia, other Candida spp. now also commonly being isolated. The rate of morbidity and mortality secondary to candidiasis is still significant despite numerous attempts to develop better diagnostic techniques, and more effective means of chemoprophylaxis and therapy. Currently, new antifungal agents and galenic preparations of amphotericin B are being evaluated with the aim of improving the prognosis of candidiasis in immunocompromised hosts | 19,350 |
1 | The Mayo cementless femoral component in active patients with osteoarthritis | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | This prospective study reports the clinical and radiological results of a single-surgeon series using the Mayo conservative hip stem in a district hospital. 30 total hip arthroplasties were performed in 26 physically active patients. There were 18 women and 8 men, with a mean age of 57.4 years (range 36-79). 4 cases were bilateral. The operation was performed for severe primary or secondary osteoarthritis of the hip .Duration of follow-up ranged from 67-87 months (mean 81 months). There were no early complications relating to the surgical procedure. There was one case of traumatic fracture of the femur during rehabilitation,while late complications included two cases of late infection (4 months and 16 months after surgery)both revised in two-stage procedures. There was considerable improvement in Merle d'Aubignescore following surgery. There were no revisions for aseptic loosening, but we identified 2 implants with significant radiolucent lines and subsidence six years after the index operation. Neither patient experienced pain in the hip or restriction of activity. Therefore, the aseptic loosening survival rate was 100%(end point = revision operation). Taking radiological loosening as the end point survivorship was 93.3%.The use of the Mayo short stem component in active patients may preserve bone and enable subsequent revision operations to proceed using primary implants. Our results suggest that conservative designs of this type may be of benefit in selected individuals | 21,902 |
0 | Prism adaptation to a rightward optical deviation rehabilitates left hemispatial neglect | Upper Eyelid and Brow Surgery | A large proportion of right-hemisphere stroke patients show hemispatial neglect-a neurological deficit of perception, attention, representation, and/or performing actions within their left-sided space, inducing many functional debilitating effects on everyday life, and responsible for poor functional recovery and ability to benefit from treatment. The frequent parietal locus of the lesion producing neglect reflects the impairment of coordinate transformation used by the nervous system to represent extrapersonal space. Given that adaptation to a visual distortion can provide an efficient way to stimulate neural structures responsible for the transformation of sensorimotor coordinates, the aim of our study was to investigate the effect of prism adaptation on various neglect symptoms, including the pathological shift of the subjective midline to the right. All patients exposed to the optical shift of the visual field to the right were improved on their manual body-midline demonstration and on classical neuropsychological tests. Unlike other physiological manipulations used to improve neglect, this improvement lasted for at least two hours after prism removal and thus could be useful in rehabilitation programmes. The positive effect found for both sensorimotor and more cognitive spatial functions suggests that they share or depend on a common level of space representation linked to multisensory integration. | 65,877 |
0 | Hyperbaric oxygen treatment and bisphosphonate-induced osteonecrosis of the jaw: a case series | MSTS 2018 - Femur Mets and MM | PURPOSE: Bisphosphonate (BP)-associated osteonecrosis of the jaw (ONJ) is an emerging problem with few therapeutic options. Our pilot study of BP-ONJ investigated a possible role for hyperbaric oxygen (HBO(2)) therapy.
PATIENTS AND METHODS: A total of 16 patients, ranging in age from 43 to 78 years, with BP-ONJ were treated with adjunctive HBO(2) between July 2003 and April 2006. Staging was based on the size and number of oral lesions. Clinical response after treatment and at distant follow-up; the odds of remission, stabilization, or relapse; and time to failure analysis were calculated.
RESULTS: The median time on BP therapy before appearance of ONJ symptoms was 18 months, and that from symptom onset to HBO(2) therapy was 12 months. Fourteen of 16 patients (87.5%) improved in stage. The size and number of ONJ lesions were decreased after HBO(2) therapy (P < .001 and P = .008, respectively; Wilcoxon signed-rank test). Immediately after HBO(2) therapy, 7 of 16 patients (44%) were in remission and 8 (50%) had stabilized; however, stabilization without remission was sustained in only 2 patients. At follow-up, 10 of the patients (62.5%) were still in remission or had stabilized. The 7 patients who continued on BP treatment during HBO(2) therapy had a shorter time to failure (8.5 months; 95% confidence interval [CI] = 7.1 to 9.8) than those who discontinued the drug (20.1 months; 95% CI = 17.5 to 23.9; P = .006 by the log-rank test). Clinical response was not associated with cancer type or malignancy remission status.
CONCLUSIONS: Adjunctive HBO(2) therapy may benefit patients with BP-ONJ; however, the outcome is improved with cessation of BP administration. | 78,432 |
0 | Incidence and costs of hip fractures vs strokes and acute myocardial infarction in Italy: comparative analysis based on national hospitalization records | HipFx Supplemental Cost Analysis | OBJECTIVES: As osteoporotic fractures are becoming a major health care problem in countries characterized by an increasing number of older adults, in this study we aimed to compare the incidence and costs of hip fragility fractures in Italian elderly people versus those of major cardiovascular diseases (strokes and acute myocardial infarctions [AMI]) occurring in the whole adult population. METHODS: We analyzed hospitalization records maintained at the national level by the Italian Ministry of Health for the diagnosis of hip fractures (ICD-9-CM codes 820-821), AMI (code 410), hemorrhagic (codes 430, 431, 432) and ischemic strokes (codes 433-434), and TIA (code 435) between 2001-2005. Cost analyses were based on diagnosis-related groups. RESULTS: The incidence of hip fractures in elderly people has increased (+12.9% between 2001 and 2005), as well as that of AMI (+20.2%) and strokes (hemorrhagic: +9.6%; ischemic: +14.7) occurring in the whole adult population; conversely, hospitalization due to TIA decreased by a rate of 13.6% between 2001 and 2005. In 2005, the hospital costs across the national health care system that were associated with hip fragility fractures in the elderly were comparable to those of strokes (both hemorrhagic and ischemic), which occurred in the whole Italian adult population. Moreover, these costs were higher than those generated by AMI and TIA. Rehabilitation costs following strokes reached about 3 billion Euros in 2005, but rehabilitative costs of hip fractures and AMI were comparable (about 530 million Euros in 2005). CONCLUSION: The burden of hip fragility fractures in Italy is comparable to that of AMI and strokes | 51,580 |
0 | A randomized double-blind clinical trial of the effect of chondroitin sulfate and glucosamine hydrochloride on temporomandibular joint disorders: a pilot study | OAK 3 - Non-arthroplasty tx of OAK | Previous studies have shown chondroitin sulfate and glucosamine hydrochloride have beneficial effects on symptoms of osteoarthritis of the knee. Our aim was to study the effect of a daily dose of 1500 mg of glucosamine hydrochloride (GH) and 1200 mg of chondroitin sulfate (CS) taken for twelve weeks on subjects diagnosed with capsulitis, disk displacement, disk dislocation, or painful osteoarthritis of the temporomandibular joint (TMJ). Fortyâ?five subjects were enrolled in the study and were randomly assigned to either an active medication group or a placebo group. Eleven subjects were lost from the study for various reasons, resulting in fourteen subjects remaining in the active medication group and twenty subjects remaining in the placebo group. Subjects taking CSâ?GH had improvements in their pain as measured by one index of the McGill Pain Questionnaire, in TMJ tenderness, in TMJ sounds, and in the number of daily overâ?theâ?counter medications needed. Subjects taking the placebo medication had improvements in their pains as measured by the visual analog scale and by four indices of the McGill Pain Questionnaire. Additional studies are required to evaluate the clinical effectiveness of CSâ?GH and to determine the exact mechanism by which CSâ?GH affects the articular cartilage of synovial joints. | 107,020 |
1 | Ten years' experience with unilateral conjunctival mullerectomy in the Asian eyelid | Upper Eyelid and Brow Surgery | BACKGROUND: The purpose of this study was to report 10 years of experience with unilateral conjunctival mullerectomy in the Asian eyelid. METHODS: Medical records of patients with unilateral ptosis who underwent conjunctival mullerectomy performed by a single surgeon from January of 2001 to December of 2011 were reviewed. The following factors were investigated: preoperative marginal reflex distance-1 of the ptotic and contralateral normal eyelids, levator function, and preoperative marginal reflex distance-1 after instillation of 2.5% phenylephrine of the ptotic eye. Main outcome measures were the surgical success rate of conjunctival mullerectomy, comparison of preoperative factors according to surgical results, and the results of univariate and multiple logistic regression analyses to identify the factors associated with undercorrection of conjunctival mullerectomy. RESULTS: Of a total of 64 eyes (64 patients), 53 eyes (82.8 percent) showed surgical success, two eyes (3.1 percent) showed overcorrection, and nine eyes (14.1 percent) showed undercorrection. The mean preoperative marginal reflex distance-1 difference between both eyes was 2.20 mm in the undercorrection group and 1.40 mm in the surgical success group (p = 0.001). The percentage of patients in whom the phenylephrine test did not raise the lid up to the height of the nonptotic eyelid was 88.9 percent (eight of nine eyes) in the undercorrection group, and 28.3 percent (15 of 53 eyes) and 0 percent (zero of two eyes) in the surgical success and overcorrection groups, respectively (p = 0.001). Multiple logistic regression analysis showed that patients in whom the phenylephrine test did not raise the lid up to the height of the nonptotic eyelid were associated with an increased risk of undercorrection after conjunctival mullerectomy (OR, 10.740; 95 percent confidence interval, 1.098 to 15.431; p = 0.041). We observed 0.18 +/- 0.08-mm lid elevation per 1 mm of conjunctival mullerectomy. CONCLUSIONS: Conjunctival mullerectomy can be successfully performed to correct unilateral ptosis in the Asian eyelid in 82.8 percent of patients. Patients with greater degrees of preoperative ptosis and those in whom the phenylephrine test did not raise the lid up to the height of the nonptotic eyelid have a higher possibility of undercorrection. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. | 68,522 |
0 | Treatment of ipsilateral fractures of the femoral neck and shaft | Management of Hip Fractures in the Elderly | We studied 43 patients with ipsilateral femoral shaft and femoral neck fractures who had dynamic hip screw fixation alone or in combination with dynamic compression plate. All patients except two were diagnosed early; 37 patients had other associated injuries. There were 41 males and two females. The follow-up ranged from eight months to four years (mean 2-1/2 years). Six patients were lost to follow-up. Fracture of the neck of the femur healed in all 37 patients. Four patients had delayed union and two patients developed nonunion of the shaft of the femur. The aim of this paper is to show our experience and results using one technique for the treatment of such fractures | 1,296 |
0 | Vitamin C to prevent complex regional pain syndrome in patients with distal radius fractures: A meta-analysis of randomized controlled trials | Distal Radius Fractures | Objective: To determine whether vitamin C is effective in preventing complex regional pain syndrome (CRPS) in patients with distal radius fractures. Data Sources: MEDLINE (1946 to present), EMBASE (1974 to present), and The Cochrane Library (no date limit) were systematically searched up to September 6, 2014, using MeSH and EMTREE headings with free text combinations. Study Selection: Randomized trials comparing vitamin C against placebo were included. No exclusions were made during the selection of eligible trials on the basis of patient age, sex, fracture severity, or fracture treatment. Data Extraction: Two reviewers independently screened articles, extracted data, and applied the Cochrane Risk of Bias tool. Evidence was graded using the Grading of Recommendations Assessment, Development, and Evaluation approach. Data Synthesis: Heterogeneity was quantified using the Ï? 2 test and the I 2 statistic. Outcome data were combined with a random effects model. Results: Across 3 trials (n 890) of patients with distal radius fractures, vitamin C did not reduce the risk for CRPS (risk ratio 0.45; 95% confidence interval, 0.18-1.13; I 2 70%). This result was confirmed in sensitivity analyses to test the importance of missing data because of losses to follow-up under varying assumptions. Heterogeneity was explained by diagnostic criteria, but not regimen of vitamin C or fracture treatment. Conclusions: The evidence for vitamin C to prevent CRPS in patients with distal radius fractures fails to demonstrate a significant benefit. The overall quality of the evidence is low, and these results should be interpreted in the context of clinical expertise and patient preferences. | 117,112 |
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