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0 | Impact of large-volume liposuction on serum lipids in orientals: a pilot study | Panniculectomy & Abdominoplasty CPG | Recent advances in liposuction techniques now make it possible to remove considerable amounts of subcutaneous adipose tissue. However, the metabolic consequences of this procedure are not well documented. The aim of this study was to identify the effects from the surgical removal of subcutaneous fat on the body weights and serum lipids of patients who have undergone large-volume liposuction. In this study, eleven consecutive patients with a minimum aspirate volume of 5,000 ml were evaluated, and their serum lipids were measured at a postoperative 2-month follow-up assessment. Tumescent fluid was infiltrated using the superwet technique. The liposuction device used was a Liposlim power-assisted liposuction system. The amount of solution infiltrated and the volume of aspirate were measured. Pre- and postoperative serum lipids, body weights, and body mass indices were compared. Statistical analysis was performed on lipid profile changes and aspirate volumes using Spearman's correlations. The average volumes of infiltrate and aspirate were 7,241 and 6,790 ml, respectively. Mean body weight decreased from 64.5 +/- 18.8 to 59.9 s +/- 17.8 kg (p < 0.01). The change in body weight per 1 l of aspirate volume was 0.67 +/- 0.10 kg/l. The mean body mass index dropped from 23.8 +/- 4.4 to 22.0 +/- 4.2 kg/m(2) (p < 0.01), and the mean total serum cholesterol levels from 168.2 +/- 23.6 to 162.9 +/- 26.5 mg/dl, an average of 3.2%. The mean low-density lipoprotein (LDL) decreased from 94.3 +/- 20.5 to 89.5 +/- 19.0 mg/dl, a 5.1% drop, and the mean high-density lipoprotein (HDL) decreased from 55.8 +/- 9.5 to 53.7 +/- 10.7 mg/dl, a 3,8% drop. The mean HDL/LDL proportion increased from 62.6 +/- 20.9% to 63.5 +/- 22.4%, averaging 1.4%. However, no significant correlation was found between the aspirated volume of fat and lipid profile change. In conclusion, over a 2-month period, large-volume liposuction reduced weight and total cholesterol level and increased the HDL/LDL ratio. The authors hope to discover whether the therapeutic impact of liposuction is long-lasting, and to determine whether it reduces the morbidity and mortality associated with obesity. |
0 | Physiotherapy management of knee osteoarthritis in Nigeriaâ??A survey of self-reported treatment preferences | OAK 3 - Non-arthroplasty tx of OAK | Background knee osteoarthritis (OA) is a prevalent condition. Little is known about whether treatments provided by physiotherapists to patients with knee OA in Nigeria follow recommended clinical practice guidelines. Objective The aims of this study were to investigate Nigerian physiotherapistsâ?? treatment preferences for knee osteoarthritis (OA) and to evaluate if their preferences were in line with contemporary clinical practice guidelines and recommendations. Methods A cross-sectional survey of 267 physiotherapists from various health institutions in Nigeria were surveyed, using a structured questionnaire incorporating a clinical vignette on knee OA. Results Based on the clinical vignette, the majority of the respondents (68.2%) recommended review of x-rays as part of the diagnostic process for knee OA. Thermotherapy was the most utilized modality (86.1%), followed by therapeutic exercise (81.3%). Only 11.1% of the physiotherapists used therapeutic exercise alone. Manual therapy in conjunction with other modalities was the choice for 18% of the physiotherapists. Only 49.1% of the physiotherapists reported including advice on weight control and up to 39% reported bed rest as part of the treatment approach. Conclusion There was a poor consensus among the physiotherapists in Nigeria on how knee OA is managed compared with contemporary clinical guidelines and recommendations which emphasized application of core modalities, such as therapeutic exercises, patientsâ?? education, and weight control over passive modalities. Some areas of practice are in line with contemporary guidelines, while some were in conflict with evidence-based practice. |
0 | Arthroscopic treatment of the young degenerative shoulder joint ; is there a role for interpositioning arthroplasty ? | Glenohumeral Joint OA | We evaluate our experience with arthroscopic interpositioning arthroplasty as a treatment of the young degenerative shoulder joint. Between 2007 and 2009 ten patients were treated with either a dermal allograft or a meniscal allograft. In seven patients the graft failed and within 13 months these were revised to a total shoulder arthroplasty. Three patients are still satisfied after 7 to 8 years follow-up. Biologic resurfacing of the glenoid may have a role in the management of glenohumeral arthritis in the young and active patient, but the optimal graft and pathology still need to be defined. |
0 | Solid organ transplant patients experience high rates of infection and other complications after total knee arthroplasty | PJI DX Updated Search | Survival after solid organ transplants in the United States is increasing, and there is a need to understand the complications in knee arthroplasty patients who underwent organ transplantation. A retrospective study was conducted from 1993-2008 on 19 patients (23 knee arthroplasties) with previous successful solid organ transplants. Eleven knee arthroplasties were performed after renal transplantation, and 12 after nonrenal solid organ transplant (seven liver, four heart, one lung). Complications occurred in 9/23 patients (39.1%) and infections occurred in 4/23 patients (17.3%). Of the infected knees, two had MRSA, one had MSSA, and one Escherichia coli. Noninfectious complications (5/24, 21.7%) include aseptic loosening, quadriceps rupture, femoral fracture, hemarthrosis, and arthrofibrosis. All patients with complications were on immunosuppressant medications at the time of arthroplasty. There was a significantly higher rate of infection in the renal group compared to the non-renal group (P = 0.022). There was also a higher overall complication rate in the renal group however this did not reach significance |
0 | Perforation of the small intestine caused by fixation plate penetration into the abdomen | Management of Hip Fractures in the Elderly | The authors report a case of intestinal loop penetration and peritonitis caused by penetration of the tip of the fixation into the abdominal cavity after internal fixation of an unstable intertrochanteric fracture. Complete regression of acute infection was achieved by suturing the intestinal wound, removing the internal fixation device and administering systemic and local antibiotic therapy |
0 | Vacuum phenomenon: prevalence and appearance in the knee with 3 T magnetic resonance imaging | AMP (Acute Meniscal Pathology) | OBJECTIVES: To determine the prevalence of vacuum phenomenon (VP) in the knee on magnetic resonance (MR) images, describe the imaging features that characterize VP, and assess how often VP mimics pathological knee lesions.
MATERIALS AND METHODS: Consecutive knee MR studies performed on a 3 T MR system over a 9-month period were retrospectively reviewed by one radiologist who then selected studies with findings potentially indicating VP. Three experienced musculoskeletal radiologists reviewed these cases in consensus to confirm the presence of VP and to assess the shape, size, and signal of VP; the presence of magnetic susceptibility artifacts; and the ability of MR sequences to show VP.
RESULTS: A total of 914 consecutive exams from 875 patients (524 men; mean age, 35 years) were reviewed. Vacuum phenomenon was found in 12 patients (prevalence 1.3%). In six (50%) patients, VP mimicked a meniscal tear, with four cases simulating a torn medial discoid meniscus. The VP signal was not easily differentiated from meniscal signal on most sequences in most cases (9/12). Gradient-recalled echo (GRE) localizer images proved most definitive, with 3D SPACE images the next most effective. Fast spin echo (FSE) images were only occasionally able to differentiate VP from meniscus.
CONCLUSION: Rarely recognized on MR, VP can mimic meniscal pathology, potentially leading to inappropriate surgery. Because differentiation of VP from the meniscus is challenging on FSE at 3 T, radiologists should become familiar with the appearance of VP and review GRE localizer or 3D images carefully to avoid misinterpretation. |
0 | A new technique in the treatment of distal radius fractures: The Micronail® | Distal Radius Fractures | Objective: In 2006, an intramedullar titanium osteosynthesis for the stabilization of distal radius fractures was introduced in The Netherlands: the Micronail®. The Micronail® can be used in approximately 30% of distal radius fracture treatments. This article presents the introduction of this new treatment, and first clinical results. Methods: In the first year after introduction of the Micronail® in our clinic, 10 patients have been treated with 11 Micronails® (eight 23-A2 radius fractures and three distal 22-A3 forearm fractures). Our patients were mainly woman (n=9) and had a mean age of 81 years (range 69-88 years). After re-alignment of the fracture, the Micronail® was placed into the medulla through a small incision over the styloid process of the radius. By using a guidance system, three locking buttress screws were placed in the distal radial fragment and two locking bolts were placed in the proximal radius. Postoperative treatment consisted of a splint for 5 days, after which full loadcarrying exercises can be started. Results: After 6 weeks, six patients had a full range of motion. Two patients were still in a cast because of secondary dislocation and CTS, respectively. One patient had a cast because of newly sustained trauma, which resulted in a peri-osteosynthetic fracture. Pain was not recorded in these patients. All fractures healed without major loss of alignment. Patients experienced good to excellent results on an analog scale showing the wrist function. At 4 months, all patients had a good range of motion in the operated wrist; the difference between the two wrists was a maximum of 10°. Conclusion: The first results of Micronail® are promising. It has the advantages of other operative techniques (minimally invasive, stable, intramedullar) without their known disadvantages. Short immobilization is sufficient, after which full load-carrying exercises are indicated. © 2011 Turkish Association of Orthopaedics and Traumatology. |
0 | Treatment of femoral neck fractures in young adults | Management of Hip Fractures in the Elderly | Femoral neck fractures in physiologically young adults, which often result from high-energy trauma, are less common than intracapsular femoral neck fractures in elderly patients. They are associated with higher incidences of femoral head osteonecrosis and nonunion. Understanding the multiple factors that play a significant role in preventing these complications will contribute to a good outcome. Although achieving an anatomic reduction and stable internal fixation are imperative, other treatment variables, such as time to surgery, the role of capsulotomy, and the method of fixation remain debatable. Open reduction and internal fixation through a Watson-Jones exposure is the recommended approach. Definitive fixation can be accomplished with three cannulated or noncannulated cancellous screws. Capsulotomy in femoral neck fractures remains a controversial issue, and the practice varies by institution, region, and country. The timing of the open reduction and internal fixation is controversial. Until conclusive data are available through prospective, controlled studies, performing a capsulotomy followed by open reduction and internal fixation on an urgent basis is recommended. The goals of treating femoral neck fractures should include early diagnosis, early surgery, anatomic reduction, capsular decompression, and stable internal fixation |
0 | Skeletal and Uterotrophic Effects of Endoxifen in Female Rats | Reduction Mammoplasty for Female Breast Hypertrophy | Endoxifen, the primary active metabolite of tamoxifen, is currently being investigated as a novel endocrine therapy for the treatment of breast cancer. Tamoxifen is a selective estrogen receptor modulator that elicits potent anti-breast cancer effects. However, long-term use of tamoxifen also induces bone loss in premenopausal women and is associated with an increased risk of endometrial cancer in postmenopausal women. For these reasons, we have used a rat model system to comprehensively characterize the impact of endoxifen on the skeleton and uterus. Our results demonstrate that endoxifen elicits beneficial effects on bone in ovary-intact rats and protects against bone loss following ovariectomy. Endoxifen is also shown to reduce bone turnover in both ovary-intact and ovariectomized rats at the cellular and biochemical levels. With regard to the uterus, endoxifen decreased uterine weight but maintained luminal epithelial cell height in ovariectomized animals. Within luminal epithelial cells, endoxifen resulted in differential effects on the expression levels of estrogen receptors alpha and beta as well as multiple other genes previously implicated in regulating epithelial cell proliferation and hypertrophy. These studies analyze the impact of extended endoxifen exposure on both bone and uterus using a Food and Drug Administration-recommended animal model. Although endoxifen is a more potent breast cancer agent than tamoxifen, the results of the present study demonstrate that endoxifen does not induce bone loss in ovary-intact rats and that it elicits partial agonistic effects on the uterus and skeleton in ovariectomized animals. |
0 | An algorithm recommendation for the management of knee osteoarthritis in Europe and internationally: A report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) | Surgical Management of Osteoarthritis of the Knee CPG | Objectives: Existing practice guidelines for osteoarthritis (OA) analyze the evidence behind each proposed treatment but do not prioritize the interventions in a given sequence. The objective was to develop a treatment algorithm recommendation that is easier to interpret for the prescribing physician based on the available evidence and that is applicable in Europe and internationally. The knee was used as the model OA joint. Methods: |
0 | Effect of single or combined treatment of naproxen, acetaminophen and omega- 3 on Knee osteoarthritis | OAK 3 - Non-arthroplasty tx of OAK | INTERVENTION: Intervention 1: The first group receive acetaminophen(1000milligram(mg),q8h) for 6 weeks. Intervention 2: The second group receive naproxen(500 mg,q12h) for 6 weeks. Intervention 3: The third group receive naproxen(500 mg,q12h) and Omegaâ?3(1000 mg,q8h) for 6 weeks. Intervention 4: The fourth group receive acetaminophen(1000 mg,q8h) and Omegaâ?3(1000 mg,q8h) for 6 weeks. Intervention 5: The fifth group receive acetaminophen(1000 mg,q8h) and naproxen(500 mg,q12h) for 6 weeks. Intervention 6: The sixth group receive acetaminophen(1000 mg,q8h) ,naproxen(500 mg,q12h) and omegaâ?3(1000 mg,q8h)for 6 weeks. The first group receive acetaminophen(1000milligram(mg),q8h) for 6 weeks. The fifth group receive acetaminophen(1000 mg,q8h) and naproxen(500 mg,q12h) for 6 weeks. The fourth group receive acetaminophen(1000 mg,q8h) and Omegaâ?3(1000 mg,q8h) for 6 weeks. The second group receive naproxen(500 mg,q12h) for 6 weeks. The sixth group receive acetaminophen(1000 mg,q8h) ,naproxen(500 mg,q12h) and omegaâ?3(1000 mg,q8h)for 6 weeks. The third group receive naproxen(500 mg,q12h) and Omegaâ?3(1000 mg,q8h) for 6 weeks. Treatment â? Drugs CONDITION: Gonarthrosis [arthrosis of knee],Primary gonarthrosis, bilateral Knee osteoarthritis. ; Gonarthrosis [arthrosis of knee],Primary gonarthrosis, bilateral PRIMARY OUTCOME: Joint stiffness. Timepoint: Before treatment. Method of measurement: WOMAC. Pain. Timepoint: Before starting of intervention. Method of measurement: Visual analogue scale. Pain. Timepoint: Before treatment. Method of measurement: WOMAC. Physical functions. Timepoint: Before treatment. Method of measurement: WOMAC. SECONDARY OUTCOME: Joint stiffness. Timepoint: After end of treatment. Method of measurement: WOMAC. Pain. Timepoint: After end of treatment. Method of measurement: Visual analogue scale. Pain. Timepoint: After end of intervention(6 weeks after start of intervention). Method of measurement: Visual analogue scale. Physical functions. Timepoint: After end of treatment. Method of measurement: WOMAC. INCLUSION CRITERIA: Inclusion criteria include idiopathic knee osteoarthritis in 45â?65 years persons old with mild to moderate knee pain. Exclusion criteria include rheumatic arthritis, septic arthritis, previous joint trauma, acute joint trauma, old fractures of joint, joint anomalies, alcohol abuse, hepatic insufficiency, heparin use, steroid use during 2 months ago, steroid or hyalgan injection into the joint during 9 months ago, taking oral steroid in 8 days ago, gastrointestinal bleeding, renal insufficiency, pregnancy or lactation woman, hypersensitivity to remember drugs, severe respiratory insufficiency and knee prosthesis. |
0 | Clinical Outcomes of Ready-Made J-Shaped Nail Fixation for Unstable Metacarpal Fractures | DoD SSI (Surgical Site Infections) | <b>Background:</b> The purpose of this study was to report the clinical outcomes of ready-made J-shaped intramedullary nail fixation for unstable metacarpal fractures. |
0 | Anterior thigh compartment syndrome after prone positioning for lumbosacral fixation | DOD - Acute Comp Syndrome CPG | We report a case of a patient who developed anterior thigh compartment syndrome after being positioned prone for instrumented lumbar spine surgery. Although rare, clinicians should be aware that compartment syndrome is a possible complication of spinal surgery. © 2012 Springer-Verlag. |
0 | The effects of rivaroxaban on the complications of surgery after total hip or knee replacement: results from the RECORD programme | PJI DX Updated Search | Post-operative complications after total hip or knee replacement can delay recovery, prolong hospitalisation, increase rates of re-admission and, in the most severe cases, lead to long-term disability or even death. In this analysis of pooled data from four large, randomised, phase III clinical trials that compared the oral, direct Factor Xa inhibitor rivaroxaban with subcutaneous enoxaparin for the prevention of venous thromboembolism after total hip or knee replacement (n = 12,729), the incidence of complications, including bleeding and adverse events related to surgery (such as wound infection, wound dehiscence and haemarthrosis) are reported. Interventions and procedures relating to surgery are also compared between the groups. Bleeding events, including excessive wound haematoma and surgical-site bleeding, occurred at similar rates in the rivaroxaban and enoxaparin groups. Over the total study duration, adverse surgical events occurred at a similar rate in the rivaroxaban group compared with the enoxaparin group after total knee replacement (2.26% vs. 2.69%, respectively) and total hip replacement (1.48% vs. 1.65%, respectively). Blood loss, wound drainage and transfusion requirements were also similar between the two groups. This analysis shows that the incidence of adverse surgical events with rivaroxaban was similar to enoxaparin |
0 | Reliability of measuring long-standing lower extremity radiographs | Surgical Management of Osteoarthritis of the Knee CPG | The mechanical axis of the lower extremity was measured using preoperative long-standing radiographs in 56 patients undergoing total knee arthroplasty with the Stryker Navigation System (Stryker, Kalamazoo, Mich). Each radiograph was measured by four physicians, three times, in random order, and at delayed intervals. Measurements from each physician produced intraclass correlation coefficients of 0.9872, 0.9973, 0.9958, and 0.9839. An intraclass correlation coefficient of 0.9844 was noted between each of the raters. Pre- and postoperative axial alignments were determined with Stryker Navigation. Preoperatively, each rater overestimated deformity approximately 1 degrees (P>.05); however, postoperatively each rater underestimated the degree of deformity by approximately 1 degrees (P>.05). Measuring long-standing lower extremity radiographs provides significant inter- and intrarater reliability in determining lower extremity alignment |
0 | Oral ulcers: clinical aspects. A tool for dermatologists. Part I. Acute ulcers | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | Oral ulcers are generally painful lesions that are related to various conditions developing within the oral cavity. They can be classified as acute or chronic according to their presentation and progression. Acute oral ulcers are be associated with conditions such as trauma, recurrent aphthous stomatitis, Behcet's disease, bacterial and viral infections, allergic reactions or adverse drug reactions. Chronic oral ulcers are associated with conditions such as oral lichen planus, pemphigus vulgaris, mucosal pemphigoid, lupus erythematosus, mycosis and some bacterial and parasitic diseases. The correct differential diagnosis is necessary to establish the appropriate treatment, taking into account all the possible causes of ulcers in the oral cavity. In the first part of this two-part review, acute oral ulcers are reviewed |
0 | The efficacy of early initiated, supervised, progressive resistance training compared to unsupervised, home-based exercise after unicompartmental knee arthroplasty: a single-blinded randomized controlled trial | OAK 3 - Non-arthroplasty tx of OAK | OBJECTIVE: To examine if supervised progressive resistance training was superior to home-based exercise in rehabilitation after unicompartmental knee arthroplasty. DESIGN: Single blinded, randomized clinical trial. SETTING: Surgery, progressive resistance training and testing was carried out at Aarhus University Hospital and home-based exercise was carried out in the home of the patient. SUBJECTS: Fifty five patients were randomized to either progressive resistance training or home-based exercise. INTERVENTION: Patients were randomized to either progressive resistance training (home based exercise five days/week and progressive resistance training two days/week) or control group (home based exercise seven days/week). MAIN MEASURES: Preoperative assessment, 10-week (primary endpoint) and one-year follow-up were performed for leg extension power, spatiotemporal gait parameters and knee injury and osteoarthritis outcome score (KOOS). RESULTS: Forty patients (73%) completed 1-year follow-up. Patients in the progressive resistance training group participated in average 11 of 16 training sessions. Leg extension power increased from baseline to 10-week follow-up in progressive resistance training group (progressive resistance training: 0.28 W/kg, P= 0.01, control group: 0.01 W/kg, P=0.93) with no between-group difference. Walking speed and KOOS scores increased from baseline to 10-week follow-up in both groups with no between-group difference (six minutes walk test P=0.63, KOOS P>0.29). CONCLUSIONS: Progressive resistance training two days/week combined with home based exercise five days/week was not superior to home based exercise seven days/week in improving leg extension power of the operated leg. |
0 | Recovery time and patient satisfaction in ambulatory knee arthroscopy: Prospective study comparing three anaesthetic methods | Surgical Management of Osteoarthritis of the Knee CPG | The aim of this study was to compare recovery time and satisfaction of patients operated under two anaesthetic techniques. A randomised-controlled trial that enrolled ASA I-II patients submitted to ambulatory knee arthroscopy was designed. Patients included were randomly assigned to one of the three study groups: general intravenous anaesthesia (TIVA), spinal anaesthesia with lidocaine (LIDO), and spinal anaesthesia with prilocaine (PRILO). Spinal groups did not receive supplementary sedation. Major outcome measures considered were both the time to discharge from the post-anaesthesia care unit (PACU) and from the day-case surgical unit (DSU), the incidence of adverse events, postoperative need for analgesics and patients satisfaction. One hundred and twenty patients were enrolled. Mean time from the patients comes into operating room to discharge from |
0 | Ischaemic monomelic neuropathy (IMN) following vascular access surgery for haemodialysis: An under-recognized complication in non-diabetics | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | Ischaemic monomelic neuropathy (IMN) is an infrequently recognized type of neuropathy, produced after acute arterial occlusion or reduced blood flow to an extremity. In the upper limb, it usually occurs after vascular access surgery for haemodialysis. IMN has been reported largely in diabetics with peripheral neuropathy and atherosclerotic vascular disease. We report a case of IMN following arteriovenous (AV) fistula formation in a patient with advanced chronic renal failure, who did not have diabetes mellitus and symptoms of peripheral neuropathy or features of atherosclerotic vascular disease. Symptoms improved immediately after the distal revascularization and interval ligation procedure to the AV fistula. (copyright) 2012 The Author 2012. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved |
1 | Treatment of isolated diaphyseal fractures of the radius with an intramedullary nail in adults | Distal Radius Fractures | BACKGROUND: The goal of the radius diaphysis fractures in surgical treatment is restoration of bone length, rotation correction and to secure fixation that allows early mobilization. The purpose of this study is evaluating the results of intramedullary (IM) radius nail for the treatment of isolated adult diaphyseal fractures of the radius.
MATERIALS AND METHODS: We retrospectively reviewed adults with isolated fractures of the radius, who were treated with closed or mini open reduction with a IM radius nail between May 2008 and November 2011 and who were followed for a least 1 year. Patients with a Galeazzi fracture, a pathological fracture, or patients with nonunion after previous surgeries were excluded. All patients were allowed full range of motion without any external support. Primary outcomes were Grace and Eversmann rating, Disabilities of the Arm, Shoulder and Hand (DASH) scores.
RESULTS: Twenty-three enrolled patients (mean age 34 years; 17 men) had 23 isolated radius fractures. Mean time to fracture union was 12 weeks (range 10-13 weeks) for radius fractures. No patient had nonunion, deep infections, or radioulnar synostosis. Follow-up ranged from 12 to 42 months. Grace and Eversmann ratings of 21 patients were excellent or good, and 2 patients were medium. Mean DASH score was 4.2 points (range 0-13.3).
CONCLUSIONS: Our experience indicates that this new IM radius nail may be considered as an alternative to plate osteosynthesis for fractures of the radius diaphysis in adults. IM nailing of radius fractures provides reliable bony union and excellent postoperative clinical results in adults. |
0 | Economic return from the women's health initiative estrogen plus progestin clinical trial : A modeling study | HipFx Supplemental Cost Analysis | Background: The findings of the Women's Health Initiative (WHI) estrogen plus progestin (E+P) trial led to a substantial reduction in use of combined hormone therapy (cHT) among postmenopausal women in the United States. The economic effect of this shift has not been evaluated relative to the trial's $260 million cost (2012 U.S. dollars). Objective: To estimate the economic return from the WHI E+P trial. Design: Decision model to simulate health outcomes for a "WHI scenario" with observed cHT use and a "no-WHI scenario" with cHT use extrapolated from the pretrial period. Data Sources: Primary analyses of WHI outcomes, peer-reviewed literature, and government sources. Target Population: Postmenopausal women in the United States, aged 50 to 79 years, who did not have a hysterectomy. Time Horizon: 2003 to 2012. Perspective: Payer. Intervention: Combined hormone therapy. Outcome Measures: Disease incidence, expenditure, qualityadjusted life-years, and net economic return. Results of Base-Case Analysis: The WHI scenario resulted in 4.3 million fewer cHT users, 126 000 fewer breast cancer cases, 76 000 fewer cardiovascular disease cases, 263 000 more fractures, 145 000 more quality-adjusted life-years, and expenditure savings of $35.2 billion. The corresponding net economic return of the trial was $37.1 billion ($140 per dollar invested in the trial) at a willingness-to-pay level of $100 000 per quality-adjusted life-year. Results of Sensitivity Analysis: The 95% CI for the net economic return of the trial was $23.1 to $51.2 billion. Limitation: No evaluation of indirect costs or outcomes beyond 2012. Conclusion: The WHI E+P trial made high-value use of public funds with a substantial return on investment. These results can contribute to discussions about the role of public funding for large, prospective trials with high potential for public health effects. Primary Funding Source: National Heart, Lung, and Blood Institute. Copyright (copyright) 2014 American College of Physicians. All Rights Reserved |
0 | The threshold of bone mineral density for vertebral fractures in female patients with primary hyperparathyroidism | Distal Radius Fractures | BACKGROUND AND OBJECTIVE: Primary hyperparathyroidism (pHPT) is one of the causal diseases that induce secondary osteoporosis. Although patients with pHPT have reduced bone mineral density (BMD) especially at the cortical bone, there have been controversies about risk of fracture. Moreover, no reports have been available about the threshold of BMD for fractures in pHPT patients.
METHODS: BMD values were measured by dual-energy x-ray absorptiometry at lumbar spine, femoral neck and distal one third of radius. Various indices were compared in 116 female pHPT patients and 716 control subjects. Moreover, we analyzed relationship between the cut-off values of BMD and the prevalence of vertebral fractures in pHPT and control subjects.
RESULTS: The prevalence of subjects with vertebral fractures was lower in pHPT patients, compared with that of control subjects. Age and body height were significantly higher and lower in pHPT women with vertebral fractures, respectively. Lumbar spine BMD was significantly lower in pHPT women with vertebral fractures, presumably due to their increased age. There were no differences in femoral neck and radius BMD or in bone metabolic indices between pHPT women with and without vertebral fractures. On the other hand, age-matched BMD was not significantly different between both groups at any measured site. Cut-off values of BMD at lumbar spine and femoral neck were lower in postmenopausal pHPT patients, compared with those of the postmenopausal control group. Moreover, cut-off values of BMD at radius was much lower in postmenopausal pHPT patients, compared with those of the postmenopausal control group (pHPT vs control (g/cm(2)): 0.670 vs 0.706 at lumbar spine; 0.549 vs 0.570 at femoral; 0.394 vs 0.474 at radius). Sensitivity and specificity of vertebral fractures was lower in pHPT patients, compared with those in control group.
CONCLUSIONS: The present cross-sectional study demonstrated that thresholds of BMD for vertebral fractures were lower especially at radial bone in female patients with pHPT, compared with those in the control group. |
0 | A biomechanical comparison of two methods of fixation of fractures of the forearm | Distal Radius Fractures | In this study two different types of forearm internal fracture fixations were compared: limited-contact dynamic compression (DC) plates and fluted intramedullary (IM) rods. Eight matched pairs of intact forearms, consisting of the distal part of the humerus, elbow joint, radius, ulna, interosseus membrane, wrist joint, and metacarpals, were randomly separated into two groups. Each was placed into a custom-designed apparatus and subjected to medial bending, supination, pronation, axial compression, and distraction loading. Loads were applied by a materials testing system, and angular displacements were measured by inclinometers. The procedure consisted of first testing specimens intact, then retesting after osteotomizing and fixing the radius with either a plate or rod in half of the group and retesting after osteotomizing and fixing the ulna in the other half. Testing was continued by osteotomizing and remaining intact bone to create a two-bone fracture, fixing them, and retesting after creating a 5-mm gap at the osteotomy sites. These tests showed that the intact ulna contributes more to forearm stability in bending and torsion than does the radius. Therefore, if the radius is fractured but the ulna remains intact, IM rodding will produce constructs with greater stiffnesses, particularly in torsion, than if the ulna is fractured and the radius is intact. In the case of a two-bone fracture, implantation of rods will result in a construct with significantly less stiffness in torsion, as well as distraction and compression (in the case of a fracture gap), than if the fractures were plated.(ABSTRACT TRUNCATED AT 250 WORDS) |
0 | Vicarious resilience in sexual assault and domestic violence advocates | DoD PRF (Psychosocial RF) | OBJECTIVE: There is little research related to sexual assault and domestic violence advocates' experiences, with the bulk of the literature focused on stressors and systemic barriers that negatively impact efforts to assist survivors. However, advocates participating in these studies have also emphasized the positive impact they experience consequent to their work. This study explores the positive impact.
METHOD: Vicarious resilience, personal trauma experiences, peer relational quality, and perceived organizational support in advocates (n = 222) are examined. Also, overlap among the conceptual components of vicarious resilience is explored.
RESULTS: The first set of multiple regressions showed that personal trauma experiences and peer relational health predicted compassion satisfaction and vicarious posttraumatic growth, with organizational support predicting only compassion satisfaction. The second set of multiple regressions showed that (a) there was significant shared variance between vicarious posttraumatic growth and compassion satisfaction; (b) after accounting for vicarious posttraumatic growth, organizational support accounted for significant variance in compassion satisfaction; and (c) after accounting for compassion satisfaction, peer relational health accounted for significant variance in vicarious posttraumatic growth.
CONCLUSIONS: Results suggest that it may be more meaningful to conceptualize advocates' personal growth related to their work through the lens of a multidimensional construct such as vicarious resilience. Organizational strategies promoting vicarious resilience (e.g., shared organizational power, training components) are offered, and the value to trauma-informed care of fostering advocates' vicarious resilience is discussed. (PsycINFO Database Record |
0 | Salvage of recurrence after failed surgical treatment of hallux valgus | PJI DX Updated Search | Recurrence of the deformity is unfortunately a common occurrence following surgical treatment of hallux valgus. The underlying reason for recurrence is multifactorial and includes surgeon's factor, patient's factor, and deformity components that were not addressed at the index procedure. Salvage of recurrence can be challenging for both the patient and the surgeon. Successful treatment requires understanding the underlying reason for the failure of initial treatment and correcting bony alignment, restoring the joint congruity, and balancing soft tissues. We present an algorithmic approach to revision hallux valgus surgery. é 2011 Springer-Verlag |
0 | Bone disease in Myeloma: The claws of CRAB | MSTS 2018 - Femur Mets and MM | A dynamic approach to use bisphosphonates according to biomarkers of bone metabolism is presented in the Z-MARK study by Raje and colleagues. This is a major step forward toward a rational approach to bisphosphonate usage. |
0 | Strain development in carpal scaphoid for various wrist positions: A cadaveric study using strain gauges | Distal Radius Fractures | In order to investigate the ideal position in which the wrist should be immobilized during scaphoid fracture, treatment the strains which are developed in the carpal scaphoid for various wrist positions has been recorded in cadaveric wrists, using strain gauges. The data obtained shows that during radial deviation with neutral or slight palmar flexion of the wrist the waist of the scaphoid tends to compress because of the development of strong compressive strains, while the strain development parallel to the fracture site that tends to shift the scaphoid waist is minimum. This position seems to be the best for stable scaphoid fracture immobilization. Copyright (C) 2000 Elsevier Science Ltd. |
0 | Cathepsin B Expression and the Correlation with Clinical Aspects of Oral Squamous Cell Carcinoma | MSTS 2018 - Femur Mets and MM | BACKGROUND: Cathepsin B (CTSB), a member of the cathepsin family, is a cysteine protease that is widely distributed in the lysosomes of cells in various tissues. It is overexpressed in several human cancers and may be related to tumorigenesis. The main purpose of this study was to analyze CTSB expression in oral squamous cell carcinoma (OSCC) and its correlation with patient prognosis.
METHODOLOGY/PRINCIPAL FINDINGS: Tissue microarrays were used to detect CTSB expression in 280 patients and to examine the association between CTSB expression and clinicopathological parameters. In addition, the metastatic effects of the CTSB knockdown on two oral cancer cell lines were investigated by transwell migration assay. Cytoplasmic CTSB expression was detected in 34.6% (97/280) of patients. CTSB expression was correlated with positive lymph node metastasis (p = 0.007) and higher tumor grade (p = 0.008) but not with tumor size and distant metastasis. In addition, multivariate analysis using a Cox proportional hazards model revealed a higher hazard ratio, demonstrating that CTSB expression was an independent unfavorable prognostic factor in buccal mucosa carcinoma patients. Furthermore, the Kaplan-Meier curve revealed that buccal mucosa OSCC patients with positive CTSB expression had significantly shorter overall survival. Moreover, treatment with the CTSB siRNA exerted an inhibitory effect on migration in OC2 and CAL27 oral cancer cells.
CONCLUSIONS: We conclude that CTSB expression may be useful for determining OSCC prognosis, particularly for patients with lymph node metastasis, and may function as a biomarker of the survival of OSCC patients in Taiwan. |
0 | Second somatosensory area (SII) plays a significant role in selective somatosensory attention | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | In order to explore human cortical areas involved in active attention toward a somatosensory modality, somatosensory evoked cortical magnetic fields were recorded in ten healthy adults with a 122-channel whole-head magnetometer while the subjects performed the selective attention task. Two kinds of stimulus modality, somatosensory and auditory, were presented independently in the same session. For the somatosensory modality, a randomized sequence of strong (P=0.45) and weak (P=0.05) electric stimuli was delivered to the right median nerve at the wrist. For the auditory modality, a randomized sequence of 900-Hz (P=0.45) and 950-Hz (P=0.05) tones was delivered to both ears. Subjects were requested to pay attention to the specified stimulus modality (either somatosensory or auditory) and to count the number of rare stimuli of the attended modality (weak stimuli in the somatosensory or 950-Hz tone in the auditory modality). A total of 12 sessions were performed for each subject, among which the order of attended modality was changed alternately and counterbalanced among subjects. In the data analysis, somatosensory evoked fields for frequent stimuli (strong electric stimuli) were compared between the two conditions; attend somatosensory condition (ATS) and attend auditory condition (non-attend somatosensory condition; NATS). In six out of the ten subjects, somatosensory evoked fields showed attention-related change. The magnitude of the estimated generator source in SII, but not in SI, significantly increased from NATS to ATS while keeping the same locations. Moreover, a simulation study using the estimated sources in SII in NATS supported the enhancement of the activity in the SII rather than participation of additional sources in the selective attention task. These results suggest that the SII plays a main role in selective somatosensory attention. (copyright) 2002 Elsevier Science B.V. All rights reserved |
0 | In vivo high-resolution MR imaging of the carpal tunnel at 8.0 tesla | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | OBJECTIVE: To determine the feasibility of acquiring in vivo images of the human carpal tunnel at 8 tesla (T). DESIGN: The wrist of an asymptomatic volunteer was imaged with an 8 T /80 cm magnet. The subject was imaged prone with the arm over the head and the wrist placed in neutral position in a custom-built dedicated shielded wrist coil. Axial two-dimensional gradient-echo (GRE) images of the wrist were acquired. RESULTS: Image contrast and resolution at 8 T are excellent. The infrastructure of the median nerve, particularly the interfascicular epineurium and individual fascicles, is better visualized at 8 T than at 1.5 T. The flexor tendons are well delineated from each other and the surrounding soft tissues, and tertiary tendon fiber bundles are resolved. The boundaries of the carpal tunnel are better defined at 8 T. CONCLUSION: We have obtained the first high-quality in vivo images of the human carpal tunnel at 8 T. The 8 T images demonstrated better contrast and resolution than those obtained at 1.5 T |
0 | Construct validity of Comprehensive High-Level Activity Mobility Predictor (CHAMP) for male servicemembers with traumatic lowerlimb loss | DoD LSA (Limb Salvage vs Amputation) | This study examined the convergent construct validity of a new performance-based assessment instrument called the Comprehensive High-Level Activity Mobility Predictor (CHAMP) as a measure of high-level mobility in servicemembers (SMs) with traumatic lower-limb loss (LLL). The study was completed by 118 SMs. Convergent construct validity of the CHAMP was established using the 6-minute walk test (6MWT) as a measure of overall mobility and physical function and the Amputee Mobility Predictor (AMP) as a measure of basic prosthetic mobility. The known group methods construct validity examined disparities in high-level mobility capability among SMs with different levels of LLL. The CHAMP score demonstrated a strong positive relationship between 6MWT distance (r = 0.80, p < 0.001) and AMP score (r = 0.87, p < 0.001), respectively. In addition, the CHAMP can discriminate between different levels of LLL. Study findings support the CHAMP as a valid performance-based assessment instrument of high-level mobility for SMs with traumatic LLL. |
0 | Carpal tunnel syndrome in pregnancy - you need to ask! | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | INTRODUCTION: Carpal tunnel syndrome (CTS) is a common pregnancy complication. However, it is often overlooked by medical practitioners and patients alike. This study aimed to describe CTS in relation to pregnancy and assess how significant the disease was among pregnant women. METHODS: In a prospective cross-sectional study, 333 respondents were randomly selected from among pregnant women attending the primary care maternal health clinic in a university hospital. CTS was diagnosed clinically based on patient history and physical examination. The severity of CTS was assessed using the Boston Carpal Tunnel Questionnaire. Symptomatic respondents were asked whether they had mentioned their problems to doctors and received appropriate treatment. RESULTS: 82 (24.6%) pregnant women presented with symptoms of CTS, a majority of whom were ethnic Malays (Malay 87.8%; non-Malay 12.2%). The risk for developing CTS during the third trimester of pregnancy was found to be two-fold among Malay women compared to patients of other ethnicities (odds ratio 2.262; 95% confidence interval 1.10-4.46; p = 0.024). The commonest complaint was daytime numbness (76.8%). The severity of CTS among patients was predominantly mild (80.5%), and the symptoms were severe enough to affect hand function in approximately one-third (34.1%) of the group. However, only 25.6% of symptomatic patients mentioned their problems to their doctors, and of these, 9.5% received treatment. CONCLUSION: CTS is prevalent in the third trimester of pregnancy, especially among Malay women, in whom the risk of developing the syndrome is two-fold. Yet, this troublesome complication of pregnancy appears to be under-recognised, with most patients not being treated appropriately |
0 | Morphological analysis of knee synovial membrane biopsies from a randomized controlled clinical study comparing the effects of sodium hyaluronate (Hyalgan) and methylprednisolone acetate (Depomedrol) in osteoarthritis | OAK 3 - Non-arthroplasty tx of OAK | OBJECTIVE: The study was part of a randomized openâ?label clinical trial designed to evaluate the effects of intraâ?articular injections of hyaluronan (Hyalgan) (HY) in osteoarthritis (OA) of the human knee. Data were compared with those obtained after treatment with methylprednisolone acetate (Depomedrol) (MP). METHODS: Synovial membranes from patients with OA of the knee, primary or secondary to a traumatic event and classified according to the American College of Rheumatology criteria, were examined by arthroscopy and by light and electron microscopy before and 6 months after local injection of HY (2 ml of 500â?730 000 MW hyaluronan, 10 mg/ml in saline, one injection per week for 5 weeks) or MP (1 ml of methylprednisolone acetate, 40 mg/ml, one injection per week for 3 weeks). RESULTS: Arthroscopy revealed a significant decrease in inflammatory score after both treatments. Histology showed that HY treatment was effective (P< or =0.05) in reducing the number and aggregation of lining synoviocytes, as well as the number and calibre of the vessels. MP treatment significantly reduced the number of mast cells in primary OA. Both treatments tended to decrease the number of hypertrophic and to increase the number of fibroblastâ?like lining cells, to decrease the numbers of macrophages, lymphocytes, mast cells and adipocytes, and to decrease oedema, especially in primary OA, and to increase the number of fibroblasts and the amount of collagen. These phenomena were evident throughout the thickness of the synovial tissue. CONCLUSION: At least in the medium term, both HY and MP modified a number of structural variables of the synovial membrane of the osteoarthritic human knee towards the appearance of that of normal synovium. The effect was more evident in primary OA than in OA secondary to a traumatic event. This is the first evidence that local hyaluronan injections modify the structural organization of the human knee synovium in OA. |
0 | A cross-sectional study of risk factors for musculoskeletal symptoms in the workplace using data from the General Social Survey (GSS) | DoD PRF (Psychosocial RF) | OBJECTIVE: Assessments of potential risk factors for musculoskeletal disorders (MSDs) from large, national study populations using personal interviews are critical to our understanding of exposure-response relationships. To address this need, we analyzed two outcome measures-self-reported back pain and upper extremity pain-from the quality of work life (QWL) module of the General Social Survey (GSS). We investigated several individual, psychosocial, and physical factors for their relationship to these outcome measures. METHODS: The study population included US adults, noninstitutionalized, English-speaking, aged 18 years or older, and employed at least part time (�20 hr/wk). Final sample size was 1484 workers. RESULTS: Variables of physical exposure significantly increased the risk of both low back pain and upper extremity pain. Multiple injuries and some psychosocial factors were associated with MSDs, and there was an additive effect on risk of MSDs with exposure to both physical exposure and work stress. CONCLUSIONS: A relationship between physical loads and musculoskeletal disorders was indicated by the results, which will enable creating a database for tracking reports of MSDs in the US working population. ©2007The American College of Occupational and Environmental Medicine. |
1 | Platelet-Rich Plasma Compared With Other Common Injection Therapies in the Treatment of Chronic Lateral Epicondylitis | PRPs for Lateral Epicondylitis/Elbow Tendinopathies | CLINICAL SCENARIO: Lateral epicondylitis (LE) is a relatively common pathology capable of producing chronic debilitation in a variety of patients. A newer treatment for orthopedic conditions is platelet-rich plasma (PrP) local injection.
FOCUSED CLINICAL QUESTION: Is PrP a more appropriate injection therapy for LE than other common injections such as corticosteroid or whole blood?
SUMMARY OF KEY FINDINGS: Four studies were included: 1 randomized controlled trial (RCT), 2 double-blind RCTs, and 1 cohort study. Two studies involved comparisons of PrP injection to corticosteroid injection. One of the studies involved a 2-y follow-up while another involved a 1-y follow-up. Another study involved the comparison of PrP injection with whole-blood injection with a 6-mo follow-up. The final study included a PrP-injection group and control group. The 2 studies involving PrP vs. corticosteroid injections with 2-y and 1-y follow-ups both favored PrP over corticosteroid injection in terms of pain reduction and function increases. The third study favored PrP injections over whole-blood injections at 6 mo regarding pain reduction. All studies demonstrated significant improvements with PrP over comparison injections or no injection. Clinical Bottom Line: PrP injections provide more favorable pain and function outcomes than whole blood and corticosteroid injections for 1-2 y after injection.
STRENGTH OF RECOMMENDATION: Consistent findings from RCTs suggest level 1b evidence in support of PrP injection as a treatment for LE. |
0 | Evaluation of patients with thoracic outlet syndrome | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | This prospective study evaluated 50 patients with thoracic outlet syndrome. Detailed history and pain scale evaluation preceded physical examination, which included provocative tests (positional and compressive) and sensory evaluation (baseline and postprovocative vibration thresholds and two-point discrimination). Only one patient had a positive nerve conduction study/electromyograph at the brachial plexus level. Thirty-two percent of the patients had a compressive anatomic abnormality as seen on a computed tomography scan. Ninety-four percent had positive provocative position and compression test results. Two-point discrimination was normal in 98%. Clinical assessment of thoracic outlet syndrome is best achieved by reproduction of symptoms with compression and positional provocative testing. Results of the majority of tests (nerve conduction studies/electromyographs, x-ray films, sensory tests) will be normal. Measurements of changes in sensory thresholds during provocation of symptoms may be useful |
0 | Meniscal repair enhancement techniques | AMP (Acute Meniscal Pathology) | Although other methods of meniscus repair enhancement are being investigated (e.g., growth factors, synthetic matrices, stem cells), the results are too preliminary to warrant speculation about their potential for clinical use. Repair of the white-white meniscal tear remains an enigma. Although repair enhancement techniques, such as fibrin clot and synovial abrasion, have been shown to improve the healing rates in certain red-white meniscal lesions, their use in the repair of white-white tears has been limited and must be considered investigational. |
0 | Acupuncture: What Does the Most Reliable Evidence Tell Us? | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | Many trials of acupuncture and numerous systematic reviews have recently become available. Their conclusions are far from uniform. In an attempt to find the most reliable type of evidence, this article provides an overview of Cochrane reviews of acupuncture. Such reviews were studied, their details extracted, and they were categorized as: reviews with a negative conclusion (no evidence that acupuncture is effective); reviews that were inconclusive; and reviews with a positive or tentatively positive conclusion. Thirty-two reviews were found, covering a wide range of conditions. Twenty-five of them failed to demonstrate the effectiveness of acupuncture. Five reviews arrived at positive or tentatively positive conclusions and two were inconclusive. The conditions that are most solidly backed up by evidence are chemotherapy-induced nausea/vomiting, postoperative nausea/vomiting, and idiopathic headache. It is concluded that Cochrane reviews of acupuncture do not suggest that this treatment is effective for a wide range of conditions. (copyright) 2009 U.S. Cancer Pain Relief Committee |
0 | Magnetic resonance imaging evidence of meniscal extrusion in medial meniscus posterior root tear | AMP (Acute Meniscal Pathology) | PURPOSE: The purpose of this study was to evaluate the relation between meniscal extrusion on magnetic resonance imaging (MRI) and tearing of the posterior root of the medial meniscus, as well as to understand the relation between meniscal extrusion and chondral lesions.
METHODS: From January 2007 to December 2008, 387 consecutive cases of medial meniscal tears were treated arthroscopically. Of these cases, 248 (64.1%) with MRI were reviewed. Arthroscopic findings were reviewed for the type of tear and medial compartment cartilage lesion. Root tear was defined as a radial tear in the posterior horn of the medial meniscus near the tibial spine (i.e., within 5 mm of the root attachment). An MRI scan of the knee was used to evaluate the presence and extent of meniscal extrusion. Meniscal extrusion of 3 mm or greater was considered pathologic. Arthroscopic findings were compared with respect to the extent of meniscal extrusion.
RESULTS: There were 98 male patients and 150 female patients. The mean age was 53.5 years (range, 15 to 81 years). The results showed 127 cases (51.2%) in which the medial meniscus had meniscal extrusion of 3 mm or greater. Posterior root tears were found in 66 (26.6%) of the 248 knees. The mean meniscal extrusion in patients with root tear was 3.8 +/- 1.4 mm, whereas the mean extrusion of those who had no root tear was 2.7 +/- 1.3 mm. We found an association between pathologic meniscal extrusion and root tear (P < .001). Meniscal extrusion showed a low positive predictive value (39%) and specificity (58%) with regard to the meniscal root tear. Meniscal extrusion was also significantly correlated with severity of chondral lesions (P < .001).
CONCLUSIONS: Considerable extrusion (>=3 mm) can be associated with tearing of the medial meniscus root and chondral lesion of the medial femoral condyle.
LEVEL OF EVIDENCE: Level IV, therapeutic case series. |
0 | Risk factors for revision surgery after humeral head replacement: 1,431 shoulders over 3 decades | MSTS 2022 - Metastatic Disease of the Humerus | Hypothesis: To assess the long-term risk of revision surgery and its predictors after humeral head replacement (HHR). Methods: We used prospectively collected data from the Mayo Clinic Total Joint Registry and other institutional electronic databases. Revision-free survival for HHR at 5, 10, and 20 years was calculated by use of Kaplan-Meier survival analysis. We used univariate and multivariate-adjusted Cox regression analyses to examine the association of age, gender, body mass index (BMI), comorbidity assessed by Deyo-Charlson index, American Society of Anesthesiologists class, implant fixation (cemented vs uncemented), and underlying diagnosis with the risk of revision surgery. Hazard ratios with 95% confidence intervals (CIs) and P values are presented. Results: During the study period (1976-2008), 1,359 patients underwent 1,431 shoulder HHRs. The mean age was 63 years, 63% of patients were female, the mean BMI was 28 kg/m2, and 60% of implants were cemented. During the follow-up, 114 HHRs were revised. At 5, 10, and 20 years, the shoulder implant survival rate was 93.6% (95% CI, 92.1%-95%), 90% (95% CI, 88%-92%), and 85% (95% CI, 81.8%-88.4%), respectively. In multivariate-adjusted analyses, older age was associated with a lower hazard of revision, with a hazard ratio of 0.97 (95% CI, 0.96-0.99; P < .001), and higher BMI was associated with a higher hazard ratio of 1.04 (95% CI, 1.01-1.08; P = .02). Conclusions: Long-term survival of HHR at 20 years was excellent. Obesity and younger age are risk factors for a higher revision rate after HHR. Further studies should investigate the biologic rationale for these important associations. Surgeons can discuss these differences in revision risk with patients, especially young obese patients. © 2012. |
0 | The Effect of Early Weight Bearing on Migration Pattern of the Uncemented CLS Stem in Total Hip Arthroplasty | Surgical Management of Osteoarthritis of the Knee CPG | Forty-two patients (younger than 65 years) with osteoarthritis were operated on with an uncemented CLS stem and randomized to early unrestricted weight bearing combined with intensive physiotherapy or to partial weight bearing combined with self-training. Radiostereometric analysis showed 1.2 (+0.11 to -6.76) mm subsidence of the stem at 24 months in both groups. There was no significant difference in the migration pattern between the unrestricted and partial weight bearing groups. Actual loading on the operated leg, measured with the F-scan system, did not influence the migration of the stem. There was a strong correlation between the average subsidence at 3 and 24 months (r = 0.96). Early full weight bearing and active rehabilitation can be used for the uncemented CLS stem without increased risk of early loosening. (copyright) 2007 Elsevier Inc. All rights reserved |
0 | Modest utility of quantitative measures in (18)F-fluorodeoxyglucose positron emission tomography scanning for the diagnosis of aortic prosthetic graft infection | PJI DX Updated Search | BACKGROUND: The clinical dilemma in suspected aortic graft infection (AGI) is how to noninvasively obtain a reliable proof of infection. In addition to confirming the presence of infection, obtaining information regarding the extent of infection to select a proper strategy for reoperation is also necessary. Therefore, developing a more reliable noninvasive physiologic approach to detect infected prostheses is required. (18)F-fluorodeoxyglucose positron emission tomography scanning ((18)F-FDG PET) has been suggested to have a pivotal role in the detection of AGI. In this study, we assessed the contribution of two (semi) quantitative parameters-maximal standardized uptake value (SUVmax) and tissue-to-background ratio (TBR)-and of two visual parameters-fluorodeoxyglucose (FDG) distribution patterns and visual grading scale-in the final confirmation of the diagnosis of AGI. METHODS: Patients with a central aortic prosthetic graft and symptoms clinically suggestive of AGI were gathered from a prospectively maintained database. Included were those who underwent (18)F-FDG PET scanning combined with computed tomography angiography and in whom periprosthetic samples were taken at some stage in the diagnostic process. AGI was considered proven in case of a positive culture and compared with a group with negative cultures. Positive predictive values (PPVs) and negative predictive values (NPVs) were calculated. Receiver operating characteristics curves were used to assess the ability of SUVmax and TBR to identify the presence and absence of AGI (ie, accuracy). RESULTS: In 37 of 77 patients with suspected AGI, (18)FDG-PET and perigraft material for culturing was obtained. The tissue culture was positive in 21 of these 37 patients (56.7%). Mean +/- standard deviation SUVmax for proven infection was 8.1 +/- 3.7 (range, 3.6-18.5) and TBR was 5.9 +/- 2.7 (range, 1.7-13.0). The area under the curve for SUVmax was 0.78 (95% confidence interval, 0.63-0.93). A cutoff value of 8 yielded a PPV of 80% and a NPV of 54%. The area under the curve for TBR was 0.70 (95% confidence interval, 0.52-0.87). A cutoff value of 6 yielded a PPV of 73% and NPV of 52%. The PPVs for the visual grading scale and (18)F-FDG distribution patterns were 75% and 61%, respectively; the NPVs were 77% and 67%, respectively. CONCLUSIONS: Our study, performed in a small sample of patients suspected of AGI, showed that the diagnostic abilities of quantitative and visual (18)F-FDG PET parameters are modest |
0 | Time trends of age-adjusted incidence rates of first hip fractures: a register-based study among older people in Viborg County, Denmark, 1987-1997 | Management of Hip Fractures in the Elderly | INTRODUCTION: A retrospective cohort study was performed to investigate if incidence rates of first hip fractures are changing in a Danish county. Study material was obtained from an excerpt from a computerized national health register and covers the period 1987-1997. METHODS: First hip fractures were identified through a search 10 years back from the date of admission. To assess the 20-year trend, 1978 data were included. The study period saw inclusion of 3,036 first (1987-1997) and 122 first and recurrent (1978) hip fracture patients aged 50 years and older. Data were analyzed using weighted regression analysis. RESULTS: Age-adjusted first hip fracture incidence rates increased significantly (P<0.001) for women, men, and pertrochanteric fractures. The rate of increase was 18 [95% confidence interval (CI), 12-25], 8 (95% CI, 4-12), and 10 (95% CI, 7-12) per 100,000 per year for women, men, and pertrochanteric fractures, respectively. The age-adjusted rate for both genders combined was 425 per 100,000 in 1997 (95% CI, 380-470). The incidence of cervical fractures was stable. If the rates of 1978 were included in the analysis, the cervical hip fractures also increased (P<0.001). The weighted average of female-male ratio was a stable 2.6 (95% CI, 2.4-2.8). Cervical-pertrochanteric ratio dropped to 1.2:1 (P<0.001). Mean age at admission rose from 78.9 to 80.8 years. CONCLUSION: In conclusion, the results provided support for an increasing incidence of first hip fractures, even when aging of the population was accounted for |
0 | Front line treatment of elderly multiple myeloma in the era of novel agents | MSTS 2018 - Femur Mets and MM | Melphalan combined with prednisone (MP) has long been the historical treatment of reference for a large proportion of elderly myeloma (MM) patients ineligible for autologous stem cell transplantation, and is still the backbone of new regimens that include the new era of novel agents. Melphalan-prednisone-thalidomide (MPT) and melphalan-prednisone-bortezomib (Velcade®, MPV), proved superior to MP, currently appear to be the treatments of choice for this population. In the near future melphalan-prednisone-lenalidomide (Revlimid®, MPR) will also provide a third therapeutic option (MPT, MPV, and MPR), in elderly multiple myeloma, eventually. These options could lead to more personalized treatment approaches, based on patient comorbidities, as the three novel agents have somewhat different toxicity profiles. Dexamethasone-based regimen is another option and questions regarding the relative efficacy of melphalan-based versus low-dose dexamethasone-based regimens will require randomized phase III trials. More intensive approaches with new drug combinations or with the incorporation of polyethylene glycolated (PEGylated) liposomal doxorubicin will also require additional studies. Additionally, the important issue of maintenance treatment needs to be further investigated. These new and emerging therapies offer multiple effective treatment options for MM patients and greatly enhanced treatment strategies for clinicians. © 2009 Venon et al, publisher and licensee Dove Medical Press Ltd. |
0 | Physicians measure up. A study of 13 surgical procedures | AMP (Acute Meniscal Pathology) | The Colorado Foundation for Medical Care Professional Standards Review Organization performed a six-month study in the latter half of 1978 to determine if the following surgical procedures were performed in accordance with the appropriate indications: primary appendectomy, cataract surgery, cholecystectomy, coronary arteriography, uterine dilation and curettage, surgical repair of hiatal hernia, abdominal hysterectomy, vaginal hysterectomy, lumbar disk excision, meniscectomy, tonsillectomy, adenoidectomy, and tonsillectomy and adenoidectomy. Data were collected concurrently by nurse reviewers on 4,850 hospitalized Medicare and Medicaid patients in Colorado hospitals. Cases that did not meet explicit indications were referred to physician reviewers for final determination. The 4,728 cases (97%) either met indications for these procedures or were justified by physician review. The conclusion from the study was that Colorado physicians are performing these procedures appropriately. |
0 | Fear of falling in patients with hip fractures: prevalence and related psychological factors | Management of Hip Fractures in the Elderly | OBJECTIVE: To determine the prevalence of fear of falling (FoF) in patients after a hip fracture, to investigate the relation with time after fracture, and to assess associations between FoF and other psychological factors. DESIGN: Cross-sectional study performed between September 2010 and March 2011 in elderly patients after a hip fracture. SETTING: Ten postacute geriatric rehabilitation wards in Dutch nursing homes. PARTICIPANTS: A total of 100 patients aged >/=65 years with a hip fracture admitted to a geriatric rehabilitation ward. MEASUREMENTS: FoF and related concepts such as falls-related self-efficacy, depression, and anxiety were measured by means of self-assessment instruments. RESULTS: Of all patients, 36% had a little FoF and 27% had quite a bit or very much FoF. Scores on the Falls Efficacy Scale-International were 30.6 in the first 4 weeks after hip fracture, 35.6 in the second 4 weeks, and 29.4 in the period >/=8 weeks after fracture. In these 3 periods, the prevalence rates of FoF were 62%, 68%, and 59%, respectively. Significant correlations were found between FoF and anxiety (P < .001), and self-efficacy (P < .001). CONCLUSION: In these patients with a hip fracture, FoF is common and is correlated with anxiety and falls-related self-efficacy. During rehabilitation, FoF is greatest in the second 4 weeks after hip fracture. More studies are needed to explore the determinants of FoF and develop interventions to reduce FoF and improve outcome after rehabilitation |
0 | Assessment of chondrogenic differentiation potential of autologous activated peripheral blood stem cells on human early osteoarthritic cancellous tibial bone scaffold | OAK 3 - Non-arthroplasty tx of OAK | INTRODUCTION: Current therapeutic regimens in osteoarthritis (OA) address mainly pain but not the slow progressive degradation of the extracellular matrix (ECM) and the loss of a chondrogenic phenotype in articular cartilage. In the present study, using an early OA cancellous bone scaffold, we aimed to uncover evidence of the successful hyaline cartilage regenerative capacity of autologous human granulocyte colony-stimulating factor (hG-CSF)-activated peripheral blood stem cells (AAPBSC) with growth factor addition.
MATERIALS AND METHODS: AAPBSC were harvested in ten patients (median age 58 years, 8 females), and flow cytometry was performed for cell surface markers. Arthroscopically obtained cancellous bone scaffold specimens were seeded with AAPBSC. In Group 1, the scaffold was seeded with AAPBSC only, in Group 2, AAPBSC plus hyaluronic acid (HA), and in Group 3, AAPBSC plus HA, hG-CSF, and double-centrifuged platelet-rich plasma (PRP). The specimens were analyzed for cell attachment and proliferation by the fluorometric quantification of cellular DNA assay and scanning electron microscopy. Chondrogenic gene expression was determined by reverse transcriptase-polymerase chain reaction (RT-PCR) of Sox9, collagen type II (COL-2), and aggrecan. Histological sections of scaffold constructs for cartilaginous matrix formation were stained with toluidine blue (proteoglycan) and safranin O (sGAG) after 3 weeks.
RESULTS: AAPBSC displayed especially high levels of CD29 and CD44 surface markers, as well as CD90, and CD105, while only a small proportion expressed CD34. Almost half of the seeded cells attached on the bone scaffolds in all three groups (not statistically significant), whereas the means of cell proliferation on day 7 compared to day 1 were statistically significant difference with the order of increase as group 3 > group 2 > group 1. RT-PCR showed statistically significant sequential increases in Sox9, COL-2, and Aggrecan all being highest in group 3. Histological analysis demonstrated cells in the cancellous bone scaffold with a round morphology, and ECM was positively stained by toluidine blue and safranin O indicating increased proteoglycan and glycosaminoglycan content, respectively, in the newly formed cartilage matrix.
CONCLUSIONS: AAPBSC initiated chondrocyte differentiation on an autologous cancellous bone scaffold, and the addition of PRP and hG-CSF further stimulated cell proliferation toward a chondrocyte phenotype with potentiated Sox9 transcription resulting in sequential COL-2 and aggrecan mRNA increases that ultimately resulted in histologically confirmed increased proteoglycan and glucosaminoglycan content in newly formed hyaline cartilage. |
0 | Assessment and management of periodontal infections: a medical-surgical approach | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | Over the last 30 years, significant advances have been achieved in elucidating the etiology, pathogenesis, and treatment of periodontal diseases. A new paradigm has emerged that includes the initiation of disease by specific bacteria within a biofilm that stimulate an immunoinflammatory host response, resulting in host tissue destruction. Disease modifiers, which may be of genetic, environmental, or acquired origin, have been recognized as major determinants of disease severity and progression. Current treatment protocols include an assessment of risk factors to identify an individual's degree of susceptibility and therapeutic responsiveness. Basic and clinical research has resulted in the development of several strategies to identify specific bacteria and host-derived markers associated with disease progression. Preventive and therapeutic antimicrobial therapies, which use various delivery systems, have been devised to target drug placement to the infection site. More recently, host modulatory therapies have been created that inhibit disease progression through the reduction of inflammatory mediators. Finally, biological mediators, including growth and differentiation factors, have been used to enhance an individual's healing potential to achieve periodontal and bone regeneration. A combined medical-surgical approach is indicated for these new methods of diagnosis, prevention, and treatment of periodontal diseases, which will allow for earlier treatment interventions and improved patient outcomes |
0 | Assessment of the risk of systemic fat mobilization and fat embolism as a consequence of liposuction: ex vivo study | Panniculectomy & Abdominoplasty CPG | BACKGROUND: Adverse consequences of liposuction, including those associated with fat embolism, have been reported in the literature. Fat embolism syndrome after liposuction may be underestimated because of the unspecific nature of the symptoms. The aim of this study was to determine whether there is a generic risk of the generation of intravascular fat emboli as a consequence of liposuction. METHODS: An animal study was conducted in which liposuction was performed on 10 Sprague-Dawley rats. The procedure was conducted with the animals under general anesthesia for 60 minutes, in a similar manner to that practiced clinically. Three blood samples were taken from each animal through a central line (one before liposuction and two at 30 and 60 minutes into liposuction) and examined for the presence of fat particles. The animals were then euthanized and the lungs and brain were removed for histological examination. In the control group, liposuction was not performed, but similar blood and histological samples were taken. RESULTS: In the study group, stained fat particles were seen in all blood samples taken during liposuction but not in those taken before liposuction. The difference between the 30- and 60-minute samples and the preliposuction control ones was statistically significant (p < 0.001 minimum). The differences between the 30-minute and 60-minute samples were also statistically significant (p = 0.017), demonstrating that fat mobilization during liposuction is a cumulative process. Nothing of significance was seen in the blood samples of the control group. Lipid deposits were seen in the lungs of all study group animals but not in the control group. With one possible exception, no lipid deposits were confirmed in brain specimens. CONCLUSIONS: The authors' experiments have demonstrated a significant risk of systemic fat mobilization and fat embolism after liposuction in the animal model. Further clinical investigation is required to evaluate the real clinical risk of this procedure from this perspective. |
0 | Subchondroplasty for Bone Marrow Lesions in the Arthritic Knee Results in Pain Relief and Improvement in Function | BMAC (Bone Marrow Aspirate Concentrate) | Subchondroplasty is a relatively new joint preserving procedure, which involves the localized injection of calcium pyrophosphate bone substitute into the bone marrow lesion. The advent of magnetic resonance imaging (MRI) has greatly facilitated the identification of these bone marrow lesions. We investigated the clinical efficacy of subchondroplasty in the treatment of symptomatic bone marrow lesions in the knee, including knees with preexisting osteoarthritis. This study comprised of 12 patients whose knees were evaluated with standard radiographs and MRI to identify and localize the bone marrow lesions. They then underwent subchondroplasty under intraoperative radiographic guidance. Preoperative and postoperative visual analog scale (VAS) pain scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and Knee Injury and Arthritis Outcome Scores (KOOS) were obtained. VAS scores improved significantly from 7.5 +/- 1.8 before surgery to 5.2 +/- 2.7 after surgery. This further improved to 2.1 +/- 2.4 at the one-year follow-up. KOOS scores improved significantly from 38.5 +/- 17.0 before surgery to 73.2 +/- 19.0 at the one-year follow-up. WOMAC scores improved significantly from 47.8 +/- 20.5 before surgery to 14.3 +/- 13.2 at the one-year follow-up. Subchondroplasty offers an effective way to treat subchondral bone marrow lesions in the arthritic knee, resulting in improvement in symptoms and early return to activity. Long-term studies are required to evaluate if these benefits can last. This is a Level II study. |
0 | Is lateral pin fixation for displaced supracondylar fractures of the humerus better than crossed pins in children? | DOD - Acute Comp Syndrome CPG | Background: Closed reduction and percutaneous pin fixation is considered standard management for displaced supracondylar fractures of the humerus in children. However, controversy exists regarding whether to use an isolated lateral entry or a crossed medial and lateral pinning technique. Questions/purposes: We performed a meta-analysis of randomized controlled trials (RCTs) to compare (1) the risk of iatrogenic ulnar nerve injury caused by pin fixation, (2) the quality of fracture reduction in terms of the radiographic outcomes, and (3) function in terms of criteria of Flynn et al. and elbow ROM, and other surgical complications caused by pin fixation. Methods: We searched PubMed, Embase, the Cochrane Library, and other unpublished studies without language restriction. Seven RCTs involving 521 patients were included. Two authors independently assessed the methodologic quality of the included studies with use of the Detsky score. The median Detsky quality score of the included trials was 15.7 points. Dichotomous variables were presented as risk ratios (RRs) or risk difference with 95% confidence intervals (CIs) and continuous data were measured as mean differences with 95% CI. Statistical heterogeneity between studies was formally tested with standard chi-square test and I 2 statistic. For the primary objective, a funnel plot of the primary end point and Egger's test were performed to detect publication bias. Results: The pooled RR suggested that iatrogenic ulnar nerve injury was higher with the crossed pinning technique than with the lateral entry technique (RR, 0.30; 95% CI, 0.10-0.89). No publication bias was further detected. There were no statistical differences in radiographic outcomes, function, and other surgical complications. No significant heterogeneity was found in these pooled results. Conclusions: We conclude that the crossed pinning fixation is more at risk for iatrogenic ulnar nerve injury than the lateral pinning technique. Therefore, we recommend the lateral pinning technique for supracondylar fractures of the humerus in children. Level of Evidence: Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. © 2013 The Association of Bone and Joint Surgeons®. |
1 | The development of a population-based automated screening procedure for PTSD in acutely injured hospitalized trauma survivors | DoD PRF (Psychosocial RF) | Objective: This investigation aimed to advance posttraumatic stress disorder (PTSD) risk prediction among hospitalized injury survivors by developing a population-based automated screening tool derived from data elements available in the electronic medical record (EMR). Method: Potential EMR-derived PTSD risk factors with the greatest predictive utilities were identified for 878 randomly selected injured trauma survivors. Risk factors were assessed using logistic regression, sensitivity, specificity, predictive values and receiver operator characteristic (ROC) curve analyses. Results: Ten EMR data elements contributed to the optimal PTSD risk prediction model including International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) PTSD diagnosis, other ICD-9-CM psychiatric diagnosis, other ICD-9-CM substance use diagnosis or positive blood alcohol on admission, tobacco use, female gender, non-White ethnicity, uninsured, public or veteran insurance status, E-code identified intentional injury, intensive care unit admission and EMR documentation of any prior trauma center visits. The 10-item automated screen demonstrated good area under the ROC curve (0.72), sensitivity (0.71) and specificity (0.66). Conclusions: Automated EMR screening can be used to efficiently and accurately triage injury survivors at risk for the development of PTSD. Automated EMR procedures could be combined with stepped care protocols to optimize the sustainable implementation of PTSD screening and intervention at trauma centers nationwide. (PsycINFO Database Record (c) 2018 APA, all rights reserved) |
1 | The pathophysiology of venous thromboembolism: implications with compression garments | Panniculectomy & Abdominoplasty CPG | The highest risk of venous thromboembolism lies with abdominoplasty and liposuction and deaths increase when combined with other procedures. The objective of this study was to evaluate physiologic changes in the deep venous system with compression-garments and asses whether there is a correlation between these procedures, rectus plication, and garments. Part 1 of this article is a retrospective review of all office surgical incidents that resulted in an abdominoplasty and/or liposuction death in the state of Florida over the past 8 years. Part 2 is a clinical study, evaluating the effect compression garments have on the pathophysiology of venous thromboembolism. Duplex ultrasounds were performed with and without garments to evaluate venous changes. Literature was reviewed related to intraabdominal pressure and high-tension abdominal closures and surgeons were polled about their use of rectus plication and garments/binders. In 8 years, 13 patients died related to abdominoplasty, liposuction, or the combination of the 2. In 100% of subjects, ultrasounds showed a decrease in venous flow, proximal vessel dilation, and loss of normal biphasic flow within the popliteal vein. Multiple publications have reported an increased morbidity and mortality related to liposuction and abdominoplasty procedures. The most frequent cause of death with these types of procedures was thromboembolism, and we discuss possible reasons for this increased rate. The exact cause of deep venous thrombosis in these procedures remains unknown, but postoperative garments may affect the physiology of venous flow, and may be involved in the formation of deep venous thrombosis and should be considered along with other patient safety procedures. |
0 | Unicondylar fractures of the distal humerus: an operative approach | The Treatment of Pediatric Supracondylar Humerus Fractures AUC | This paper retrospectively reviews a series of 22 unicondylar fractures of the distal end of the humerus that were treated by open reduction and internal fixation over a 10 year period. The fracture patterns were classified according to the system of Muller et al. A strict rating scale was developed that incorporated subjective data, objective elbow motion, and the functional status of the involved elbow. At an average follow-up of 5.9 years (range 2.3 to 12.3 years), 12 elbows were rated as excellent, 6 as good, and 4 as fair. Complications included extensive posttraumatic arthritis in four patients, a nonunion in one, and a transient radial nerve palsy in one |
0 | Liver disease and mortality among patients with hip fracture: A population-based cohort study | Hip Fx in the Elderly 2019 | Purpose: The aim of this study was to examine the prognostic impact of liver disease on mortality following hip fracture (HF). Patients and methods: This nationwide cohort study, based on prospectively collected data retrieved from Danish registries, included all patients diagnosed with incident HF in Denmark during 1996â??2013. Patients were classified based on the coexisting liver disease at the time of HF, ie, no liver disease, noncirrhotic liver disease, and liver cirrhosis. We computed 30-day and 31â??365-day mortality risks. To compare patients with and without liver disease, we computed mortality adjusted hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) using Cox regression controlled for potential confounders. Results: Among 152,180 HF patients, 2,552 (1.7%) patients had noncirrhotic liver disease and 1,866 (1.2%) patients had liver cirrhosis. Thirty-day mortality was 9.4% among patients with noncirrhotic liver disease, 12.6% among patients with liver cirrhosis patients, and 9.7% among patients without liver disease. Compared to patients without liver disease, crude and adjusted HRs within 30 days following HF were, respectively, 0.96 (95% CI: 0.85â??1.10) and 1.24 (95% CI: 1.09â??1.41) for patients with noncirrhotic liver disease and 1.30 (95% CI: 1.14â??1.48) and 2.25 (95% CI: 1.96â??2.59) for those with liver cirrhosis. Among patients who survived 30 days post-HF, the 31â??365-day mortality was 18.5% among patients with noncirrhotic liver disease, 26.4% among patients with liver cirrhosis, and 19.4% among patients without liver disease. Corresponding crude and adjusted HRs were, respectively, 0.95 (95% CI: 0.86â??1.04) and 1.08 (95% CI: 0.99â??1.20) for patients with noncirrhotic liver disease and 1.40 (95% CI: 1.27â??1.54) and 1.91 (95% CI: 1.72â??2.12) for those with liver cirrhosis. Conclusion: Liver disease patients, especially those with liver cirrhosis, had increased 30-day mortality and 31â??365-day mortality following HF, compared to patients without liver disease. |
0 | Intramedullary osteosynthesis of complex proximal femoral fractures with the Targon PF nail | DoD SSI (Surgical Site Infections) | We evaluated the performance of the Targon PF nailing system in the treatment of complex proximal femoral fractures with a retrospective analysis of prospectively collected data for 94 patients with a complex proximal femoral fracture (subtrochanteric fracture or fracture with reversed fracture line pattern) treated with a Targon PF nail. There were no intra-operative femoral fractures. Late complications requiring reoperation were one femoral fracture and one fracture around the nail secondary to tumour. Seven nails had to be dynamised and a further six 'self-dynamised' at the site of the distal locking screw. One patient required revision of the distal locking. Only one other patient required secondary surgery for a wound haematoma. There were no cases of implant cut-out or non-union. The Targon PF nail represents a progressive development in the design of intramedullary nails for proximal femoral fractures and the results compare favourably with other intramedullary systems used to treat complex proximal femoral fractures. © 2007 Elsevier Ltd. All rights reserved. |
0 | Percutaneous Transphyseal Intramedullary Kirschner Wire Pinning: A Safe and Effective Procedure for Treatment of Displaced Diaphyseal Forearm Fracture in Children | Distal Radius Fractures | Percutaneous transphyseal intramedullary Kirschner wire (K-wire) fixation was performed for diaphyseal fracture of the forearm in 84 children. In 60 patients (71%) closed reduction was performed, while in the remaining 24 (29%) closed reduction was supplemented with a mini-open reduction. The K-wire was inserted transphyseally through the radial styloid or the Lister tubercle for the radius, and through the tip of the olecranon for the ulna. With an average follow-up of 70 months and a minimum follow-up of 2 years, all the patients reviewed were found to have good functional results; none had nonunion, deep infection, or premature physeal closure. Moreover, initial preoperative translation of the fracture of more than 100% displacement was found to be associated with a significantly higher chance of requiring a mini-open reduction. The authors concluded that percutaneous transphyseal intramedullary K-wire pining for forearm diaphyseal fracture in children is a convenient, effective, and safe operation, without any deleterious effects on subsequent growth of the distal radius. |
0 | Cost-effectiveness of fracture prevention in men who receive androgen deprivation therapy for localized prostate cancer | HipFx Supplemental Cost Analysis | BACKGROUND: Androgen deprivation therapy (ADT) increases the risk for fractures in patients with prostate cancer. OBJECTIVE: To assess the cost-effectiveness of measuring bone mineral density (BMD) before initiating ADT followed by alendronate therapy in men with localized prostate cancer. DESIGN: Markov state-transition model simulating the progression of prostate cancer and the incidence of hip fracture. DATA SOURCES: Published literature. TARGET POPULATION: A hypothetical cohort of men aged 70 years with locally advanced or high-risk localized prostate cancer starting a 2-year course of ADT after radiation therapy. TIME HORIZON: Lifetime. PERSPECTIVE: Societal. INTERVENTION: No BMD test or alendronate therapy, a BMD test followed by selective alendronate therapy for patients with osteoporosis, or universal alendronate therapy without a BMD test. OUTCOME MEASURES: Incremental cost-effectiveness ratio (ICER), measured by cost per quality-adjusted life-year (QALY) gained. RESULTS OF BASE-CASE ANALYSIS: The ICERs for the strategy of a BMD test and selective alendronate therapy for patients with osteoporosis and universal alendronate therapy without a BMD test were $66,800 per QALY gained and $178,700 per QALY gained, respectively. RESULTS OF SENSITIVITY ANALYSES: The ICER for universal alendronate therapy without a BMD test decreased to $100,000 per QALY gained, assuming older age, a history of fractures, lower mean BMD before ADT, or a lower cost of alendronate. LIMITATIONS: No evidence shows that alendronate reduces actual fracture rates in patients with prostate cancer who receive ADT. The model predicted fracture rates by using data on the surrogate BMD end point. CONCLUSION: In patients starting adjuvant ADT for locally advanced or high-risk localized prostate cancer, a BMD test followed by selective alendronate for those with osteoporosis is a cost-effective use of resources. Routine use of alendronate without a BMD test is justifiable in patients at higher risk for hip fractures |
0 | Arthroscopic inside-out repair of complete radial tears of the meniscus with a fibrin clot | AMP (Acute Meniscal Pathology) | PURPOSE: To report on the results of 12 complete radial tears of the meniscus treated using arthroscopic inside-out repair with fibrin clots, the results showed good meniscal healing and excellent clinical outcomes.
METHODS: From 2007 to 2009, 12 patients with complete radial tears of the meniscus were treated by arthroscopic inside-out repair with fibrin clots. In all patients, the International Knee Documentation Committee (IKDC) subjective knee form and Lysholm score were determined pre- and post-operatively. We performed magnetic resonance imaging (MRI) and if indicated, we performed a second-look arthroscopic examination.
RESULTS: At a mean of 30 +/- 4 postoperative months, the Lysholm score and IKDC subjective knee score had improved from 65 +/- 6 and 57 +/- 7 to 94 +/- 3 and 92 +/- 3, respectively. Eleven of 12 cases showed complete healing on follow-up MRI. Six of 7 patients undergoing a second-look arthroscopic examination had healed completely.
CONCLUSION: This study shows successful meniscal repairs using fibrin clots in complete radial tears. This surgical procedure appears to be a good treatment method for complete radial tear of the meniscus.
LEVEL OF EVIDENCE: Case series, level IV. |
0 | Three-dimensional analysis of the proximal anterior femoral flare and torsion. Anatomic bases for metaphyseally fixed short stems design | Hip Fx in the Elderly 2019 | PURPOSE: The use of femoral stems with a short metaphyseal fixation may lead to fractures or subsidence. Such failures may be related to a mismatch between the torsions or the sagittal flares of the stem and the femur. The goal of our study was to perform a 3D analysis of the proximal metaphyseal femur anatomy with a special focus on the anterior proximal flare and torsion. Such data may help to detect the outlier patients for whom a short metaphyseal fixation should be avoided.
METHODS: A prospective study included 80 consecutive patients who underwent a primary cementless THA with a 3D CT-scan based pre-operative planning. A femoral frame was determined in order to analyse the proximal metaphyseal torsion and flares of the femur.
RESULTS: The mean metaphyseal torsion was 21.6degree +/- 7degree at 5 mm above the lesser trochanter (LT) and 34.7degree +/- 8.8 at 15 mm under LT generating a differential torsion of 13degree around the LT. The mean flare index was 4.3 +/- 0.9 medially, 3.7 +/- 0.8 laterally, 2 +/- 0.6 anteriorly and 3.1 +/- 0.6 posteriorly. The anterior flare was the only flare significantly correlated to the bone density, to the age and to the femoral off-set: the higher the anterior flare index, the younger the patient, the higher the bone density and the higher the femoral offset. The anterior flare was not significantly correlated to the femoral anteversion, the metaphyseal torsion and the coronal neck-shaft angle.
CONCLUSION: The proximal femoral metaphysis presents a highly variable anterior flare and torsion that may explain a mismatch between the femur and the femoral stem, consequently generating a risk of subsidence or fracture when using shortly fixed stems.
LEVEL OF EVIDENCE: Level IV. |
0 | Results of geometric arthroplasty for rheumatoid and osteoarthritis of the knee | Surgical Management of Osteoarthritis of the Knee CPG | The Geometric Total Knee Arthroplasty was one of the earliest unconstrained knee arthroplasties available for the replacement of knees severely affected by destructive arthritis. This paper presents the results of Geometric knee arthroplasty performed by surgeons of the Alfred Hospital, Melbourne, during the years 1973 to 1977, this being the initial five years experience with this procedure. One hundred and fifty arthroplasty operations were performed in 106 patients, 78 for osteoarthritis and 72 for rheumatoid arthritis, with the average time from operation to review being four years. The Geometric arthroplasty was used in 147 of these operations. Assessment was based on a modification of the British Orthopaedic Association Knee Function Assessment Chart (1978) and 137 knees were available for review. Eighty nine percent of patients suffering osteoarthritis, and 79% of patients with rheumatoid arthritis were satisfied or enthusiastic with their prosthesis. Nineteen percent of rheumatoid patients and 4% of osteoarthritic patients considered the result of their operation disappointing. In both groups, the operated knee constituted minimal persisting disability to the patient when reviewed. Seventeen knees (11.3%) were assessed as unsatisfactory, of which 7 (4.6%) were due to infection, and 5 (3.3%) were due to loosening. Revision procedures were performed in 7 knees (5%), for instability or loosening. Improvements in arthroplasty design have resulted in alternative prostheses now being chosen by most surgeons for knee replacement, and the long term results of these newer prostheses must be evaluated with those results obtained using the original geometric prosthesis |
0 | The transtibial versus the anteromedial portal technique in the arthroscopic bone-patellar tendon-bone anterior cruciate ligament reconstruction | SR for PM on OA of All Extremities | The transtibial (TT) drilling of the femoral tunnel in the bone-patellar tendon-bone (BPTB) anterior cruciate ligament (ACL) reconstruction was found to place the tunnel non-anatomically. The use of the anteromedial portal (AMP) for the femoral drilling would provide the surgeon with more freedom to anatomically place the tunnel in the real femoral ACL footprint. The purpose of this study was to compare the clinical outcomes of BPTB ACL reconstruction using the AMP or the TT technique for the femoral tunnel drilling. A Medline search was not able to identify any study directly comparing the clinical outcomes of the AMP and the TT techniques. The literature search identified experimental and quasi-experimental studies published from 1966 to March 2009 where at least one group underwent arthroscopic autologous BPTB ACL reconstructions using either the AMP or the TT technique for the femoral tunnel drilling. Overall IKDC, Lysholm score, activity level, range of motion, single-leg hoop test, Lachman test, Pivot shift sign test, KT-1000 arthrometer measurements, and radiographic assessments were indirectly compared between the two groups (AMP versus TT). Twenty-one studies, involving a total of 859 patients (257 in the AMP and 602 in the TT group), were included in this analysis. The AMP group demonstrated significantly earlier return to run and significantly greater range of motion, Lachman test values, and KT-1000 arthrometer measurements in the 1-2-year follow-up, although no differences were found for both the 3-5 and the 6-10-year follow-ups for any of these parameters. In contrast, the TT group demonstrated significantly higher activity level for the 3-5 and 6-10-year follow-up. The use of the AMP elicited greater knee stability and range of motion values, and earlier return to run compared to the TT technique. These results may indicate a potential benefit of the AMP over the TT technique. However, as the benefits of the AMP were not obtained in the mid and long-term follow-ups, overall there is no definitive evidence at this point to conclude that one technique is superior to the other. Randomized controlled trials directly comparing the use of both techniques with long-term follow-ups will help clarify which one, if any, provides best clinical outcomes |
0 | Subintimal Ki-67 as a synovial tissue biomarker for inflammatory arthropathies | AMP (Acute Meniscal Pathology) | OBJECTIVES: Ki-67 is expressed in the nuclei of dividing cells and can be used to assess proliferation of synovial inflammatory and stromal cells. We evaluated subintimal Ki-67+ cell density as a tissue biomarker for inflammatory arthropathies and compared it to subintimal CD68, a synovial biomarker of RA.
METHODS: Subintimal Ki-67+ and CD68+ cell densities were measured immunohistochemically in synovial specimens obtained from patients with rheumatoid arthritis (RA; n = 19), osteoarthritis (OA; n = 18), "non-inflammatory" orthopaedic arthropathies (avascular necrosis, meniscus injury, femur fracture; n = 16), chronic septic arthritis (n = 9), and histologically normal synovium (n = 10).
RESULTS: were correlated with a histological synovitis score. Utilising the areas under receiver operating characteristic curves (AUCs), we compared the abilities of Ki-67 and CD68 to differentiate among these arthropathies.
CONCLUSIONS: Subintimal Ki-67 was overexpressed in inflammatory arthropathies, distinguished among differentially inflamed arthropathies, and correlated positively with the histological severity of synovitis. It may prove useful in synovial tissue classification and as a synovial marker of disease activity in clinical trials when biopsies are available. |
0 | Fat transplantation for treatment of the senescent face | Panniculectomy & Abdominoplasty CPG | For more than a century, clinicians have attempted to utilize fat for the treatment of tissue deficiencies and contour abnormalities. Autologous fat transplantation for soft tissue augmentation has become increasingly popular in recent years. This has occurred as a result of the present authors' comprehension that the aging face is not simply as a result of gravity-induced ptosis, but also as a result of volume loss secondary to the atrophy of tissues. The popularity of tumescent liposuction has brought renewed interest and accessibility of fat for transplantation. Newer techniques and approaches to augmentation have provided more predictable and reproducible results. Fat augmentation has become an effective, safe, and reliable method for restoring volume and correcting the atrophy that accompanies senescence. In this review, the present authors describe their approach and technique of fat transplantation for the aging face. Copyright © Blackwell Publishing, Inc., 2006. |
0 | What Are the Risk Factors for Dislocation of Hip Bipolar Hemiarthroplasty Through the Anterolateral Approach? A Nested Case-control Study | Hip Fx in the Elderly 2019 | BACKGROUND: Hip dislocation after treatment of a femoral neck fracture with a hemiarthroplasty remains an important problem in the treatment of hip fractures, but the associations between patient factors and surgical factors, and how these factors contribute to dislocation in patients who have undergone bipolar hemiarthroplasty through an anterolateral approach for femoral neck fracture currently are only poorly characterized.
QUESTIONS/PURPOSES: We evaluated patients with bipolar hemiarthroplasty dislocation after surgery for femoral neck fracture treated through an anterolateral approach and asked: (1) What are the frequency, characteristics, and risk factors of bipolar hemiarthroplasty dislocations? (2) What are the frequency, characteristics, and risk factors of bipolar hemiarthroplasty dissociations?
METHODS: A review of hospital records for patients who underwent bipolar hip hemiarthroplasty for femoral neck fracture at one hospital between July 2004 and August 2014 was conducted. During that time, 1428 patients were admitted with a diagnosis of femoral neck fracture; 508 of these patients underwent bipolar hip hemiarthroplasty, of whom 61 died and 23 were lost to followup during the first year, leaving 424 (83%) available for analysis. The remainder of the patients during that time were treated with internal fixation (512), unipoloar hip arthroplasty (17), or THA (391). For each patient with dislocation, we selected five control patients from the cohort according to sex, age (+/- 3 years), and year of entry in the study to eliminate some confounding factors. We recorded patient characteristics regarding demographics, medical comorbidities, Katz score, American Society of Anesthesiologists score, Mini-Mental State Examination (MMSE) score, and anesthesia type. Medical comorbidities included diabetes, chronic pulmonary disease, heart disease, neuromuscular diseases, and dementia. Univariate analyses were used to search for possible risk factors. Conditional logistic regression analyses on dislocation or dissociation were performed to estimate hazard rates (HRs) and corresponding 95% CIs with covariates of a probability less than 0.1 in univariate analysis.
RESULTS: In this cohort, there were 26 dislocations including four that were also dissociations. The proportion of patients experiencing a dislocation was 6% (26 of 424). The mean interval from surgery to dislocation was 56 weeks (range, 0-433 weeks), and 18 dislocations (69%) occurred within 3 months after surgery. Three variables were independently associated with an increased risk of hip dislocation: dementia (HR, 3.51; 95% CI, 1.19-10.38; p = 0.02), discrepancy of offset (HR, 1.72; 95% CI, 1.15-2.58; p = 0.008), and lower MMSE score (HR, 0.93; 95% CI, 0.88-0.98; p = 0.007). The proportion of patients experiencing a dissociation was 0.9% (four of 424). The result of conditional logistic regression for dissociation showed that cup size smaller than 43 mm was the risk factor (HR = 513.05). However, there was no statistical difference with the probability equaling 0.47.
CONCLUSIONS: After the anterolateral approach for treatment of femoral neck fracture using bipolar hemiarthroplasty, 6% of hips dislocated and 0.9% experienced dissociation. Cognitive dysfunction and discrepancy of offset were independent risk factors associated with an increased risk of prosthetic dislocation. The small cup without a safety ring may be the risk factor of dissociation. Discrepancy of offset should be avoided during the operation by performing an accurate femoral osteotomy and choosing an adequate femoral stem neck length. For patients with cognitive dysfunction and a small cup, suturing the joint capsule during the operation and reinforcing protective measures after surgery might reduce the occurrence of dislocation and dissociation, however a study addressing this is necessary to confirm this.
LEVEL OF EVIDENCE: Level III, therapeutic study. |
0 | Donor site morbidity with reamer-irrigator-aspirator (RIA) use for autogenous bone graft harvesting in a single centre 204 case series | DoD SSI (Surgical Site Infections) | Donor site morbidity and complication rate using the reamer-irrigator-aspirator (RIA) system for intramedullary, non-structural autogenous bone graft harvesting were investigated in a retrospective chart and radiographic review at a University affiliated Level-1 Trauma Centre. 204 RIA procedures in 184 patients were performed between 1/1/2007 and 12/31/2010. RIA-indication was bone graft harvesting in 201 (98.5%), and intramedullary irrigation and debridement in 3 (1.5%) cases. Donor sites were: femur - antegrade 175, retrograde 4, tibia - antegrade 7, retrograde 18. Sixteen patients had undergone two RIA procedures, two had undergone three procedures, all using different donor sites. In 4 cases, same bone harvesting was done twice. Mean volume of bone graft harvested was 47 +/- 22ml (20-85 ml). The complication rate was 1.96% (N=4). Operative revisions included 2 retrograde femoral nails for supracondylar femur fractures 6 and 41 days postoperatively (antegrade femoral RIA), 1 trochanteric entry femoral nail (subtrochanteric fracture) 17 days postoperatively (retrograde femoral RIA) and 1 prophylactic stabilization with a trochanteric entry femoral nail for intraoperative posterior femoral cortex penetration without fracture. In our centre, the RIA technique has a low donor site morbidity and has been successfully implemented for harvesting large volumes of nonstructural autogenous bone graft. |
1 | Arthroscopic repair of rotator cuff tears using absorbable anchors with a single-row technique | Optimizing the Management of Full-Thickness Rotator Cuff Tears | PURPOSE: To review outcomes of arthroscopic repair of rotator cuff tears using absorbable anchors with a single-row technique. METHODS: 66 patients underwent arthroscopic repair for rotator cuff tears using absorbable anchors with a single-row technique. 51 of them aged 37 to 73 (mean, 57) years had been followed up for a mean of 29 (range, 20-37) months. The extent of the tear was classified as large, medium or small. Functional outcome was assessed using the Constant score. Constant scores and re-tear rates in 3 patient groups (classified by patient age and tear size) were compared. RESULTS: Among the 66 patients, there were 24 large, 29 medium and 13 small cuff tears, and a total of 48, 37, and 18 anchors were used, respectively. Among the 51 patients, the median Constant score improved significantly after arthroscopy (30 vs. 73, p<0.0001). Six shoulders had complete re-tears; their median Constant score was 48 and their adjusted Constant score was 65%. Complete re-tears occurred more often in patients aged >60 years than in those aged 50 to 59 years and <50 years (4/15 vs. 1/22 vs. 1/14), and more often in patients with large tears than in those with medium and small tears (4/24 vs. 2/29 vs. 0/13). CONCLUSION: Arthroscopic repair of rotator cuff tears using absorbable anchors with a single-row technique is reliable in patients aged <60 years with small or medium tears |
0 | A high ratio of dietary animal to vegetable protein increases the rate of bone loss and the risk of fracture in postmenopausal women. Study of Osteoporotic Fractures Research Group | Management of Hip Fractures in the Elderly | BACKGROUND: Different sources of dietary protein may have different effects on bone metabolism. Animal foods provide predominantly acid precursors, whereas protein in vegetable foods is accompanied by base precursors not found in animal foods. Imbalance between dietary acid and base precursors leads to a chronic net dietary acid load that may have adverse consequences on bone. OBJECTIVE: We wanted to test the hypothesis that a high dietary ratio of animal to vegetable foods, quantified by protein content, increases bone loss and the risk of fracture. DESIGN: This was a prospective cohort study with a mean (+/-SD) of 7.0+/-1.5 y of follow-up of 1035 community-dwelling white women aged >65 y. Protein intake was measured by using a food-frequency questionnaire and bone mineral density was measured by dual-energy X-ray absorptiometry. RESULTS: Bone mineral density was not significantly associated with the ratio of animal to vegetable protein intake. Women with a high ratio had a higher rate of bone loss at the femoral neck than did those with a low ratio (P = 0.02) and a greater risk of hip fracture (relative risk = 3.7, P = 0.04). These associations were unaffected by adjustment for age, weight, estrogen use, tobacco use, exercise, total calcium intake, and total protein intake. CONCLUSIONS: Elderly women with a high dietary ratio of animal to vegetable protein intake have more rapid femoral neck bone loss and a greater risk of hip fracture than do those with a low ratio. This suggests that an increase in vegetable protein intake and a decrease in animal protein intake may decrease bone loss and the risk of hip fracture. This possibility should be confirmed in other prospective studies and tested in a randomized trial |
0 | Anomalous muscle belly to the index finger | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | An unusual variation of flexor digitorum superficialis was observed during the cadaver dissection. The flexor digitorum superficialis (FDS) had a normal origin and insertion, except to the index finger, where a muscle belly replaced the tendon of FDS. The unusual muscle belly originated as a continuation of FDS tendon in the carpal tunnel and inserted normally into the middle phalanx. A branch of the median nerve innervated the anomalous muscle belly. The anomalous muscle belly described here should be considered in the aetiology of carpal tunnel syndrome. (copyright) 2006 Elsevier GmbH. All rights reserved |
0 | Trauma related to falls from trees treated in a specialized trauma centre in Burkina-Fasoâ??one hundred and six cases treated in one year | Distal Radius Fractures | Purpose: Falls from trees related traumas are rarely reported in literature. They are public health problems in developing countries where their frequency is still important. The aim of the study is to describe falls from trees related trauma patterns and to present preventative measures. Methods: An annual ongoing prospective study was held in our trauma emergency department (ED) about all the patients who sustained an injury after a recent fall from tree. A questionnaire related to the patient and to the trauma was established. The data were encoded and analysed by a statistical software. Results: One hundred six patients who sustained a fall from tree trauma, out of a total of 139, were studied. Most patients were under 15 years old (76.4 %); they were injured in fruits season (33 %) after a fall from a fruit tree (mango trees, Shea trees, Néré, etc.) and were received late (86 %). Injuries were polymorphic from traumatic brain injuries (51.8 %) and spine injuries (13.2 %) to thoraco-abdominal (21.6 %) and limbs injuries (46.2 %). Three housewives were pregnant at the time of the trauma with secondary abortions. Patients were managed medically (33.9 %), surgically (19.8 %) or by casting (34.9 %) with good outcome in 59 cases. Twelve patients refused medical care and two died. Conclusion: Education programs must focus on picking fruits and leaves in order to make them safe and prevent injuries related to these traditional or professional activities. |
0 | Does the application of tape influence quadriceps sensorimotor function in knee osteoarthritis? | OAK 3 - Non-arthroplasty tx of OAK | OBJECTIVES: Using additional data from two previously reported studies, the aim was to determine the effects of immediate and shortâ?term continuous (3 weeks) application of knee tape on quadriceps sensorimotor function in individuals with symptomatic knee osteoarthritis (OA). METHODS: A withinâ?subjects study (n = 18) and a randomized controlled trial (n = 87) were performed using community volunteers. Therapeutic tape (patellar realignment and softâ?tissue unloading) was compared with control (placebo) tape and no tape. Outcome measures included knee joint position sense, isometric quadriceps strength and electromyographic quadriceps onset during stair descent. RESULTS: Application of therapeutic tape worsened joint position sense (variable error) at a knee angle of 40 degrees (P < 0.01), but did not immediately alter any other sensorimotor parameter. Even after 3 weeks of wearing tape continuously, sensorimotor function was not altered. Furthermore, no differential effect of tape was noted when participants were dichotomized into those with poor and good sensorimotor scores at baseline. CONCLUSIONS: Neither immediate application nor continuous use of tape (for 3 weeks) appears to influence sensorimotor function in people with knee OA. Alterations in sensorimotor function cannot explain the painâ?relieving effects of therapeutic tape observed in this population. |
0 | The efficacy of 48-week oral ibandronate treatment in postmenopausal osteoporosis when taken 30 versus 60 minutes before breakfast | Management of Hip Fractures in the Elderly | Since effective prevention and treatment of osteoporosis demands a high degree of long-term compliance, optimization of the dosing regimen in terms of efficacy and convenience of drug intake is a critical issue of oral bisphosphonate treatment. The purpose of the present study was to investigate whether the efficacy of the treatment with oral ibandronate, 2.5 mg daily, can be maintained if changing the postdose fast from 60 to 30 min. This was a 48-week, multicenter, open-label, randomized, parallel-group noninferiority study. Subjects were postmenopausal women 55-80 years old with lumbar spine (L1-L4) bone mineral density (BMD) corresponding to a T score < or =2.5. Women were randomly assigned to take 2.5 mg ibandronate exactly 30 or 60 min before breakfast. Lumbar spine and proximal femur (trochanter, femoral neck, total hip) BMD were measured by dual energy X-ray absorptiometry; serum osteocalcin and creatinine-corrected urinary C-telopeptide of type I collagen (u-CTX/Cr) excretion were measured by ELISA. After 48 weeks of treatment, the relative increase in lumbar spine BMD from baseline in the 30-min fast group was lower than that in the 60-min fast group (3.07% versus 4.95%, one-sided 97.5% CI = -2.89%) such that the prespecified noninferiority criteria were not met. The mean relative increases in BMD at the trochanter (3.04% versus 4.36%), femoral neck (1.82% versus 2.19%), and total hip (2.35% versus 3.21%) in the 30-min fast group were also lower than those in the 60-min fast group. Less suppression of the markers of bone turnover (u-CTX/Cr, -48.5% vs -61.8%; serum osteocalcin, -34.8% vs 43.8%) was observed in the 30-min compared with the 60-min group. In conclusion, if reducing the postdose fasting interval, dose-increase compensation would likely to be required to maintain efficacy of oral ibandronate treatment. Another potential solution for improving the convenience with bisphosphonate treatment is expected from weekly or monthly dosing regimens currently under clinical investigations |
0 | Twenty years with the 'ball' personal technique for breast reduction | Reduction Mammoplasty for Female Breast Hypertrophy | The authors present their personal technique for breast reduction. They call it the 'Ball' technique because of the shape that the breast acquires when it is remodeled. Their philosophy is to achieve a new breast and cover it with two layers, the internal one dermal and the external one cutaneous, without detaching the submamary fold. The fundamentals of the technique are: with the patient in the sitting position and the arms adducted, the incisions are marked utilizing a Wise pattern. Complete the de-epithelization within the boundaries of the pattern. Wide dissection and detachment of the cutaneous flap from the mammary gland. Glandular resection of the upper quadrants. Remodeling of the breast with an inferiorly based dermis-fat-gland flap, after releasing the lateral aspects. Anchoring of the remodeled gland (wrapped with dermis) to the Pectoralis Major muscle. Redraping of the cutaneous flap around 'the ball'. This technique has been used since January 1979 and for this report, the first 891 cases were reviewed. The good results observed at short and long follow-up intervals, the low incidence of complications, the versatility of the technique as it is applicable to severe ptosis and gigantomastias and some degree of prophylaxis of breast cancer as the upper quadrants are removed, make it a technique to be considered and used. |
0 | Is there still a role for osteoarticular allograft reconstruction in musculoskeletal tumour surgery? | DoD SSI (Surgical Site Infections) | Aims: To assess complications and failure mechanisms of osteoarticular allograft reconstructions for primary bone tumours. Patients and Methods: We retrospectively evaluated 38 patients (28 men, 74%) who were treated at our institution with osteoarticular allograft reconstruction between 1989 and 2010. Median age was 19 years (interquartile range 14 to 32). Median follow-up was 19.5 years (95% confidence interval (CI) 13.0 to 26.1) when 26 patients (68%) were alive. In addition, we systematically searched the literature for clinical studies on osteoarticular allografts, finding 31 studies suitable for analysis. Results of papers that reported on one site exclusively were pooled for comparison. Results: A total of 20 patients (53%) experienced graft failure, including 15 due to mechanical complications (39%) and three (9%) due to infection. In the systematic review, 514 reconstructions were analysed (distal femur, n = 184, 36%; proximal tibia, n = 136, 26%; distal radius, n = 99, 19%; proximal humerus, n = 95, 18%). Overall rates of failure, fracture and infection were 27%, 20%, and 10% respectively. With the distal femur as the reference, fractures were more common in the humerus (odds ratio (OR) 4.1, 95% CI 2.2 to 7.7) and tibia (OR 2.2, 95% CI 1.3 to 4.4); infections occurred more often in the tibia (OR 2.2, 95% CI 1.3 to 4.4) and less often in the radius (OR 0.1, 95% CI 0.0 to 0.8). Conclusion: Osteoarticular allograft reconstructions are associated with high rates of mechanical complications. Although comparative studies with alternative techniques are scarce, the risk of mechanical failure in our opinion does not justify routine employment of osteoarticular allografts for reconstruction of large joints after tumour resection. |
0 | Asymptomatic peripheral vascular disease in total knee arthroplasty: preoperative prevalence and risk factors | OAK 3 - Non-arthroplasty tx of OAK | Background: Although vascular disease is commonly accepted as a risk factor for wound complications and prosthetic joint infections, little is known about the preoperative prevalence of lower-extremity peripheral vascular disease in patients undergoing total knee arthroplasty (TKA). In this study, we investigated the prevalence of asymptomatic vascular disease and its risk factors. Materials and methods: A total of 1,000 knees of 692 patients who underwent primary TKA due to osteoarthritis were preoperatively evaluated by experienced musculoskeletal radiologists using Doppler ultrasonography of the lower extremity vessels. The mean age of the patients was 74.1 years (range 65â??81). Risk factors for development of peripheral vascular disease were investigated. Results: Abnormal findings were identified in 38 knees of 32 patients (4.6Â %); atherosclerotic changes in 31 knees of 25 patients (3.6Â %), deep vein thrombosis (DVT) in two knees, and anomalous vessels in five knees. Three out of 31 knees with atherosclerotic changes showed severe luminal stenosis. Two knees were moderate and 26 knees showed mild changes according to our institutional criteria. Multivariate logistic regression analysis showed that age and diabetes mellitus were positively associated with vascular pathology. Conclusion: The prevalence of incidentally detected peripheral vascular disease was significant. Three of 31 knees had severe arterial stenosis and two knees had DVT. All patients with vascular pathologies had one or more risk factors related to vascular disease. Out of those patients, age was the most important risk factor. Understanding the prevalence of vascular pathology and related risk factors in TKA candidates may be important for successful TKA. Level of Evidence: Level III. |
0 | The effects of a moderate exercise program on knee osteoarthritis in male wistar rats | OAK 3 - Non-arthroplasty tx of OAK | OBJECTIVE(S): Osteoarthritis (OA) or degenerative joint disease is the commonest form of arthritis and can lead to joint pain, decrease in joint's range of motion, loss of function, and ultimately disability. Exercise is considered as one of the non-pharmacological treatments of OA. But the effects of exercise on knee joint cartilage remain ambiguous. The aim of the present study was to investigate the effect of a four-week moderate treadmill exercise on rats' knee osteoarthritis.
MATERIALS AND METHODS: Eighteen male Wistar rats (173 +/- 1 g, 8 weeks old) were randomly divided into three groups (n = 6): Intact control, monosodium iodoacetate (MIA) only (OA), and training. The osteoarthritis model was induced by intra-articular injection of monosodium iodoacetate (MIA). Subjects followed a moderate-intensity exercise program for 28 days. Rats were killed after 28 days and histological assessment was done on their knee joints. One-way ANOVA (P<0.05) and post-hoc Tukey test was used for the statistical analysis.
RESULTS: Histological assessment on 3 measurements of, depth ratio of lesions (P=0.001), total cartilage degeneration width (P=0.001), and significant cartilage degeneration width (P=0.001), demonstrated that moderate exercise for 4 weeks could surprisingly almost treat OA symptoms of rats' knee joints.
CONCLUSION: The findings of the present study indicate that a moderate treadmill exercise program exert a beneficial influence on rats' knee osteoarthritis. |
0 | Evaluation of the usefulness of intrathecal bupivacaine infusion for analgesia after hip and knee arthroplasty | AAHKS (8) Anesthetic Infiltration | Spinal anaesthesia in 47 ASA I-III patients was induced with 0.5% bupivacaine 2 ml via a 28-gauge spinal catheter (L3-4 interspace) and 0.5-ml increments were given if needed before or during hip or knee arthroplasty. Intrathecal 24-h infusions consisted of 0.5% bupivacaine 0.4 ml h-1 (2 mg h-1) (n = 12), 0.5% bupivacaine 0.2 ml h-1 (1 mg h-1) (n = 12) or saline (n = 11) (12 exclusions). Patients received oxycodone 0.1-0.14 mg kg-1 i.m. for rescue analgesia. Infusion of bupivacaine 2 mg h-1 provided significantly better postoperative analgesia (19 oxycodone doses per group in 24 h) compared with bupivacaine 1 mg h-1 (36 doses of oxycodone per group) and saline (52 doses per group) (P < 0.05). Five patients in the bupivacaine 2-mg h-1 group and none in the other groups had measurable sensory block 24 h after the infusion was started. Three patients in the bupivacaine 2-mg h-1 group, two with concomitant arterial hypotension, and one patient in the bupivacaine 1-mg h-1 group experienced an increase in block on the ward. The incidence of nausea and vomiting was similar in all groups. Although an effective analgesic, intrathecal infusion of bupivacaine 2 mg h-1 cannot be recommended for routine pain relief because of the risk of increasing spinal block. Technical problems (19%) also reduced the overall efficacy of the continuous intrathecal analgesic regimen. |
0 | Anterior reconstructive spinal surgery with Zielke instrumentation for metastatic malignancies of the spine | MSTS 2018 - Femur Mets and MM | From March 1984 to April 1996, 60 consecutive patients with spinal metastasis underwent palliative surgery by anterior corpectomy and Zielke instrumentation. Their ages ranged from 21 to 76 years (mean 54 years). Thirty-two patients had metastasis to the thoracic spine, 20 to the lumbar spine, and 8 had both thoracic and lumbar metastases. The primary malignancies were lung cancer in 12 patients, colorectal cancer in 10, hepatoma in 9, thyroid cancer in 7, breast cancer in 3, and cancers of the stomach, kidney, nasopharynx, long bones, skin, and cervix in 1 patient each. A primary carcinoma was never identified in 13 patients. In the present series, 4 patients died within 1 month, and 56 patients were followed-up. All maintained spinal stability postoperatively. Forty of 52 patients with severe pain obtained significant symptomatic relief for 3 months or more, and 33 of the 46 paralyzed patients gained neural improvement. Sphincter dysfunction became better in 10 patients, and none became worse. We conclude that anterior corpectomy to decompress neural encroachment with instrumental reconstruction to stabilize the collapsed spine is a good adjunctive treatment in these highly selected patients. |
1 | Diagnosis and treatment of cuff tear arthropathy | Glenohumeral Joint OA | Rotator cuff tears account for a significant majority of shoulder pain presentations. Without diagnosis and management, advanced cuff tears may progress to cuff tear arthropathy, a degenerative arthritis condition of the shoulder. This article discusses the causes and management of cuff tear arthropathy, including definitive treatment with reverse shoulder arthroplasty. |
0 | Sonography of tendons | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | Musculoskeletal ultrasonography (MSUS) has been refined by improved examination techniques and higher frequency transducer technology. Sonography is the modality of choice in the screening of tendon disorders. The accuracy in diagnosing tendon lesions has improved with better understanding of the sonographic anatomy and the pathophysiology of tendons. The sonographic appearance of tears, tendon dislocations, tendinitis, tenosynovitis, insertion tendinopathy, ganglion cysts, and bursitis is described. Normal variants that mimic tendon disease are shown. The tendons of the shoulder, elbow, wrist, hand, knee, ankle, and foot are considered |
0 | Mono- and Combined Therapy of Metastasizing Breast Carcinoma 4T1 with Zoledronic Acid and Doxorubicin | MSTS 2018 - Femur Mets and MM | The efficiency of monotherapy with zoledronic acid (Resorba), doxorubicin, and their combination was studied on the model of metastasizing breast carcinoma in BALB/c mice. Doxorubicin monotherapy was accompanied by a significant increase in median survival up to 57 days (vs. 34 and 35 days in control groups); 27% animals survived for 90 days (duration of the study). Bioluminescence area of the primary tumor significantly decreased on days 21 and 28; the total number of visceral metastases also decreased according to magnetic-resonance imaging data. Resorba monotherapy produced no general toxic effect, the median survival increased to 64 days, and 90-day survival was 33%. Imaging techniques (magnetic-resonance imaging, microtomography, bioluminescent analysis) showed that Resorba delayed the development of the primary tumor (regression of luminescence area on days 21 and 28, regression of standardized bioluminescence intensity on day 28) and significantly reduced the number of visceral metastases in comparison with the control. Combination therapy was less effective than monotherapy with the same medications. Median survival was 55 days, 90-day survival was 13%, but magnetic-resonance imaging and bioluminescence analysis after combination therapy also showed delayed growth of the primary tumor and reduced number of visceral metastases. Microtomography revealed bone metastases in ~30% animals of the control group; in experimental groups, no bone metastases were found. The experiment with periosteal (distal epiphysis of the femur) injection of 4T1-Luc2 tumor cells demonstrated pronounced selective effectiveness of Resorba in relation to bone metastases. Monotherapy with Resorba can prevent the development of not only bone, but also visceral metastases of breast cancer. |
1 | Incidence and risk factors of injuries and their impact on academic success: A prospective study in PETE students | DoD PRF (Psychosocial RF) | Injuries can have a major impact on the physical performance and academic career of physical education teacher education (PETE) students. To investigate the injury problem, risk factors, and the impact of injuries on academic success, 252 PETE students were followed during their first semester. Risk factor analysis was conducted by means of logistic regression analysis with a differentiation for upper body, lower body, acute, overuse, and severe injuries. An incidence of 1.26 injuries/student/semester was found. Most injuries involved the lower body (61%), were new injuries (76%), occurred acutely (66%), and were sustained during curricular gymnastics (25%) or extracurricular soccer (28%). Significant risk factors for lower body acute injuries were age (OR = 2.14; P = .01), previous injury (OR = 2.23; P = .01), and an injury at the start of the year (OR = 2.56; P = .02). For lower body overuse injuries, gender (OR = 2.85; P = .02) and the interval shuttle run test score (OR = 2.44; P = .04) were significant risk factors. Previous injury (OR = 2.59; P = .04) and injury at the start of the year (upper body: OR = 4.57; P = .02; lower body: OR = 3.75; P r = .20; P = .02) and success in theoretical courses (r = .24; P = < .01). No association was found between time loss and academic success for sport courses. (PsycINFO Database Record (c) 2018 APA, all rights reserved) |
0 | Management of Periprosthetic Femur Fractures | PJI DX Updated Search | Total joint replacement (TJR) is among the most clinically successful reconstructive surgeries in orthopaedics. The incidence of periprosthetic femur fractures has increased for many reasons, including longer duration of in situ use of the TJRs, more active lifestyle, wear debris and associated osteolysis, and trauma. Moreover, the fracture may occur with the increasing volume of revision TJRs. These fractures pose a significant technical challenge to the surgeon. This review focuses on periprosthetic femur fractures around a total hip replacement. We have elected to emphasize the following issues:. â¢intraoperative calcar fractures from broaching and insertion of the stem during total hip replacementâ¢postoperative fractures as classified by the Vancouver systemâ¢management and clinical outcome of treatment of these fractures |
1 | The outcome at 15 years of endoscopic anterior cruciate ligament reconstruction using hamstring tendon autograft for 'isolated' anterior cruciate ligament rupture | Anterior Cruciate Ligament Injuries CPG | The purpose of this study was to report the outcome of 'isolated' anterior cruciate ligament (ACL) ruptures treated with anatomical endoscopic reconstruction using hamstring tendon autograft at a mean of 15 years (14.25 to 16.9). A total of 100 consecutive men and 100 consecutive women with 'isolated' ACL rupture underwent four-strand hamstring tendon reconstruction with anteromedial portal femoral tunnel drilling and interference screw fixation by a single surgeon. Details were recorded pre-operatively and at one, two, seven and 15 years post-operatively. Outcomes included clinical examination, subjective and objective scoring systems, and radiological assessment. At 15 years only eight of 118 patients (7%) had moderate or severe osteo-arthritic changes (International Knee Documentation Committee Grades C and D), and 79 of 152 patients (52%) still performed very strenuous activities. Overall graft survival at 15 years was 83% (1.1% failure per year). Patients aged < 18 years at the time of surgery and patients with > 2 mm of laxity at one year had a threefold increase in the risk of suffering a rupture of the graft (p = 0.002 and p = 0.001, respectively). There was no increase in laxity of the graft over time. ACL reconstructive surgery in patients with an 'isolated' rupture using this technique shows good results 15 years post-operatively with respect to ligamentous stability, objective and subjective outcomes, and does not appear to cause osteoarthritis |
0 | Identification of hip fracture patients from radiographs using fourier analysis of the trabecular structure: A cross-sectional study | Management of Hip Fractures in the Elderly | Background: This study presents an analysis of trabecular bone structure in standard radiographs using Fourier transforms and principal components analysis (PCA) to identify contributions to hip fracture risk. Methods: Radiographs were obtained from 26 hip fracture patients and 24 controls. They were digitised and five regions of interest (ROI) were identified from the femoral head and neck for analysis. The power spectrum was obtained from the Fourier transform of each region and three profiles were produced; a circular profile and profiles parallel and perpendicular to the preferred orientation of the trabeculae. PCA was used to generate a score from each profile, which we hypothesised could be used to discriminate between the fracture and control groups. The fractal dimension was also calculated for comparison. The area under the receiver operating characteristic curve (A(z)) discriminating the hip fracture cases from controls was calculated for each analysis. Results: Texture analysis of standard radiographs using the fast Fourier transform yielded variables that were significantly associated with fracture and not significantly correlated with age, body mass index or femoral neck bone mineral density. The anisotropy of the trabecular structure was important; both the perpendicular and circular profiles were significantly better than the parallel-profile (P < 0.05). No significant differences resulted from using the various ROI within the proximal femur. For the best three groupings of profile (circular, parallel or perpendicular), method (PCA or fractal) and ROI (A(z) = 0.84 - 0.93), there were no significant correlations with femoral neck bone mineral density, age, or body mass index. PCA analysis was found to perform better than fractal analysis (P = 0.019). Conclusions: Both PCA and fractal analysis of the FFT data could discriminate successfully between the fracture and control groups, although PCA was significantly stronger than fractal dimension. This method appears to provide a powerful tool for the assessment of bone structure in vivo with advantages over standard fractal methods. (copyright) 2004 Gregory et al; licensee BioMed Central Ltd |
0 | The trauma and acute care surgeon in the COVID-19 pandemic era | Coronavirus Disease 2019 (COVID-19) | The World Health Organization recognized in March 2020 the existence of a pandemic for the new coronavirus that appeared in China, in late 2019, and whose disease was named COVID-19. In this context, the SBAIT (Brazilian Society of Integrated Care for Traumatized Patients) conducted a survey with 219 trauma and emergency surgeons regarding the availability of personal protective equipment (PPE) and the role of the surgeon in this pandemic by means of an electronic survey. It was observed that surgeons have been acting under inadequate conditions, with a lack of basic supplies as well as more specific equipment such as N95 masks and facial shields for the care of potential victims who may be contaminated. The latter increases the risk of contamination of professionals, resulting in potential losses in the working teams. Immediate measures must be taken to guarantee access to safety equipment throughout the country, since all trauma victims and/or patients with emergency surgical conditions must be treated as potential carriers of COVID-19. |
0 | The geometric osteotomy: joint preservation in juxta-articular surface bone neoplasms | MSTS 2022 - Metastatic Disease of the Humerus | Purpose . To present the oncologic and functional results of a consecutive series of patients treated by geometric osteotomy and allograft reconstruction for juxta-articular surface bone neoplasms.Patients. Twelve consecutive patients (mean age 28 years) underwent excision of benign aggressive or malignant juxta-articular surface bone neoplasms. In each case, only part of the circumference of the bone was excised, and the joint surface was preserved and kept in continuity with the remainder of the bone. The defects were filled with allograft or autograff, and internally fixed as appropriate. Methods . Patients were eligible for the study if they had a histologically proven, primary tumour of bone adjacent to a joint such that the turnout could be completely excised with a partial cortical resection and preservation of the joint. The database at the University Musculoskeletal Oncology Unit was used to identify all cases. Patient demographics and oncologic results were recorded. Functional assessment was performed using the Musculoskeletal Tumor Society rating scale and the Toronto Extremity Salvage Score. Results . Nine tumours were about the knee and three were in the proximal humerus. Negative margins were achieved in all cases. No patient had metastatic disease at a mean follow-up of 56.5 months. There was one local recurrence and this was managed by conversion to a Van Nes rotationplasty. Functional results were excellent in the proximal humeral cases and in cases about the knee where the stabilizing ligaments were preserved. Cases with post-operative knee instability were less successful but none the less were well controlled with bracing.Discussion. This technique offers an alternative to joint excision and prosthetic replacement in a group of young patients. |
0 | Over One-Third of Patients With Multiligament Knee Injuries and an Intact Anterior Cruciate Ligament Demonstrate Medial Meniscal Ramp Lesions on Magnetic Resonance Imaging | AMP (Acute Meniscal Pathology) | PURPOSE: To determine the incidence of ramp lesions and posteromedial tibial plateau (PMTP) bone bruising on magnetic resonance imaging (MRI) in patients with multiligament knee injuries (MLKIs) and an intact anterior cruciate ligament (ACL).
METHODS: A retrospective review of consecutive patients surgically treated for MLKIs at 2 level I trauma centers between January 2001 and March 2021 was performed. Only MLKIs with an intact ACL that received MRI scans within 90 days of the injury were included. All MLKIs were diagnosed on MRI and confirmed with operative reports. Two musculoskeletal radiologists retrospectively rereviewed preoperative MRIs for evidence of medial meniscus ramp lesions (MMRLs) and PMTP bone bruises using previously established classification systems. Intraclass correlation coefficients were used to calculate the reliability between the radiologists. The incidence of MMRLs and PMTP bone bruises was quantified using descriptive statistics.
RESULTS: A total of 221 MLKIs were identified, of which 32 (14.5%) had an intact ACL (87.5% male; mean age of 29.9 +/- 8.6 years) and were included. The most common MLKI pattern was combined injury to the posterior cruciate ligament and posterolateral corner (n = 27, 84.4%). PMTP bone bruises were observed in 12 of 32 (37.5%) patients. Similarly, MMRLs were diagnosed in 12 of 32 (37.5%) patients. A total of 8 of 12 (66.7%) patients with MMRLs demonstrated evidence PMTP bone bruising.
CONCLUSIONS: Over one-third of MLKI patients with an intact ACL were diagnosed with MMRLs on MRI in this series. PMTP bone bruising was observed in 66.7% of patients with MMRLs, suggesting that increased vigilance for identifying MMRLs at the time of ligament reconstruction should be practiced in patients with this bone bruising pattern.
LEVEL OF EVIDENCE: Level IV, retrospective case series. |
1 | MR imaging based strategies in limb salvage surgery for osteosarcoma of the distal femur | MSTS 2018 - Femur Mets and MM | Objective. To analyse to what extent MR imaging based decisions were correct in determining the surgical procedure in patients with osteosarcoma of the distal femur. Design. We compared the findings on MR imaging that determined the surgical strategy with the actual surgical findings or histopathological specimen. We assessed to what extent MR images could be used to determine the surgical procedure in patients with osteosarcoma. Patients. Between 1985 and 1992, 34 patients with an osteosarcoma were treated. Two patients had a low-grade osteosarcoma. Thirty-two patients with a high-grade osteosarcoma of the distal femur (17 stage IIB, 15 stage III) were included in this study. Surgical options consisted of either limb salvage surgery or ablative surgery, which included the Van Nes-Borggreve rotationplasty. Limb salvage surgery consisted of extra-articular or transarticular resection, followed by reconstruction. Surgery was planned depending on the local extent of the tumour as depicted on the MR studies, coupled with data from the biopsy, age, patient compliance and histological grade. Follow-up was available in all patients. Nine of 17 patients graded as IIB were alive with an average follow-up of 68 months (range 46-109 months), of whom one has metastases. No local recurrence was encountered. Results. If no tumour involvement on MR imaging was found and this was used as a determining factor, this proved to be correct at subsequent analysis. We found that in eight of 11 cases, when MR images suggested a close relationship between tumour and nerve, an oncologically safe plane could be achieved during surgery. In three, a free plane could not be accomplished, as confirmed at histopathological examination. Hence, when nerve involvement was equivocal on MR imaging we found it valuable to reassess nerve involvement during surgery and reconsider limb salvage surgery. When the decisive factor was the vascular involvement and tumour extension was read as equivocal, it was possible to obtain a oncologically safe plane in six of 13 cases. When comprehensive tumour involvement of any structure was noted pre-operatively, it proved to be correct at histopathological examination, except for one case of assumed vascular involvement that proved to be free. Conclusions. If no tumour involvement of a structure was found on MR imaging and this was used as a determining factor, this proved to be correct. When nerve involvement was equivocal on MR imaging we found it valuable to reassess nerve involvement during surgery and reconsider limb salvage surgery. Extensive tumour involvement of any structure, as shown by MR imaging, could be used correctly as a decisive argument in planning a surgical procedure. |
1 | Long-term effectiveness of steroid injections and splinting in mild and moderate carpal tunnel syndrome | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | To evaluate the long-term efficacy of non-surgical treatment methods for mild and moderate carpal tunnel syndrome, 120 patients with clinical symptoms and electrophysiologic evidence were included in a prospective, randomized and blinded trial: 60 patients were instructed to wear splints every night, 30 received injections of betamethasone 4 cm proximal to the carpal tunnel, and 30 received injections distal to the carpal tunnel. After approximately 1 year (mean, 11 months; range, 9-14), 108 patients were available for final evaluation. We assessed clinical symptom severity and performed detailed electrophysiologic examinations before and after treatment. Splinting provided symptomatic relief and improved sensory and motor nerve conduction velocities at the long-term follow-up when the splints were worn almost every night. Proximal and distal injections of steroids were ineffective on the basis of both clinical symptoms and electrophysiologic findings |
0 | The malignant clone and the bone-marrow environment | MSTS 2018 - Femur Mets and MM | Multiple myeloma (MM) is characterized by the clonal expansion of monoclonal immunoglobulin-secreting plasma cells within the bone marrow (BM). It has become clear that the intimate reciprocal relationship between the tumor cell clone and the niches of the BM microenvironment plays a pivotal pathophysiologic role in MM. We and others have identified several new molecular targets and derived novel therapies which induce cytotoxicity against MM cells in the BM milieu, including thalidomide, bortezomib, and lenalidomide. Importantly, these agents induce tumor-cell death, as well as inhibit MM-cell-BM-stromal-cell (BMSC) adhesion and related tumor-cell growth, survival, and migration. Moreover, they block both constitutive and MM-cell binding-induced growth factor and cytokine secretion in BMSCs. Further, they also block tumor angiogenesis and can augment anti-MM immunity. Although all three of these agents are now FDA-approved to treat MM, patients inevitably relapse, and further improvements remain urgently needed. Here we review our current knowledge of the MM cell clone, as well as the impact of the BM microenvironment on tumor-cell growth, survival, migration and drug resistance. Delineating the mechanisms and sequelae of the reciprocal relationship between the MM cell clone, distinct BM extracellular matrix proteins, and accessory cell compartments may provide the basis for new effective therapeutic strategies to re-establish BM homeostasis and thereby improve MM patient outcome. © 2007 Elsevier Ltd. All rights reserved. |
0 | Reorientational proximal femoral osteotomies for arthrogrypotic hip contractures | Pediatric Diaphyseal Femur Fractures 2020 Review | Background: Severe hip contractures in arthrogrypsosis are multiplanar, which can preclude or can greatly complicate sitting and ambulation. The reorientational osteotomy at the intertrochanteric level preserves preoperative hip motion but moves it to a more functional domain. We retrospectively compared preoperative and postoperative hip motion and evaluated the ambulatory abilities of patients who underwent the procedure. Methods: Since 2008, 65 patients with arthrogryposis had 119 reorientational proximal femoral osteotomies with a minimum follow-up of 2 years. The mean patient age at the time of the surgical procedure was 48 months. An intertrochanteric wedge osteotomy aligned the femoral shaft with the body axis, leaving the hip joint in its preexisting position. A cannulated hip blade plate was used for fixation. Hip motions were recorded preoperatively, at implant removal, and at the time of the latest follow-up, as was ambulatory ability. Results: Eighty-one hips had a mean flexion contracture of 52 preoperatively, which improved by 35; 84 hips with a mean preoperative adduction of 220 improved by 42; 101 hips with a mean preoperative internal rotation of 216 improved by 35 (p < 0.0001 for all). The flexion-extension total arc of motion for the 119 hips improved by 13 (p < 0.0001). Only 11 of 94 hips that preoperatively flexed â?¥90 did not do so postoperatively, but none of the patients reported seating difficulties and one of the patients had already regained hip flexion of â?¥90 by a soft-tissue release. At a mean follow-up of 40 months, 36 patients were independently ambulatory and 20 patients were walker-dependent. Conclusions: Children with arthrogryposis often have the potential for ambulation if the limb positioning can be optimized. The reorientational hip osteotomy corrects the hip contractures by altering the range of motion but not the total arc of motion. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. |
0 | Fatigue contributes to the strength training stimulus | The Treatment of Pediatric Supracondylar Humerus Fractures AUC | To investigate the role of fatigue in strength training, strength increases produced by a training protocol in which subjects rested between contractions were compared with those produced when subjects did not rest. Forty-two healthy subjects were randomly allocated to either a no-rest group, a rest group, or a control group. Subjects in the two training groups trained their elbow flexor muscles by lifting a 6RM weight 6-10 times on 3 d each week for 6 wk. Subjects in the no-rest group performed repeated lifts without resting, whereas subjects in the rest group rested for 30 s between lifts. Both training groups performed the same number of lifts at the same relative intensity. The control group did not train. Subjects who trained without rests experienced significantly greater mean increases in dynamic strength (56.3% +/- 6.8% (SD)) than subjects who trained with rests (41.2% +/- 6.6%), and both training groups experienced significantly greater mean increases in dynamic strength than the control group (19.7% +/- 6.6%). It was concluded that greater short-term strength increases are achieved when subjects are required to lift training weights without resting. These findings suggest that processes associated with fatigue contribute to the strength training stimulus |
1 | Total hip replacement in congenital dislocation and dysplasia of the hip | Developmental Dysplasia of the Hip CPG | The results of thirty-one total hip replacements in twenty-four patients with either severe congenital dysplasia or dislocation, after an average follow-up of four years, were excellent in eleven, good in sixteen, fair in one, and poor in one. The operative technique included superolateral bone grafts to increase the acetabular coverage in six hips. Twenty-seven hips required smaller and straighter femoral components than normal. The incidence of major complications was 19 per cent |
0 | Diagnosis of acute maxillofacial infections: the role of computerized tomography | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | Most acute maxillofacial infections are diagnosed by conventional dental and maxillofacial radiographic techniques. Computed tomography has greatly improved our ability to evaluate infections of the maxillofacial region that originate or extend into the contiguous soft tissues and paranasal sinuses. Four cases in which computed tomography facilitated diagnosis and treatment of advanced infections of the maxillofacial region are presented. In one case an underlying neoplasm was identified |
0 | Distal humerus fractures nonunion with elbow stiffness in working adults: Can triple tension band technique and Lambda Plate(®) be a standby solution? | Pediatric Supracondylar Humerus Fracture 2020 Review | BACKGROUND: Distal humerus fracture nonunion and associated elbow stiffness are two intermingled orthopaedic challenges for working adults. This prospective study aimed to evaluate the short-term results of the triple tension band and Lambda plate in managing both problems. METHODS: The study included fourteen cases. The mean age was 35.7 ± 8.5 years (range 25-49). Eight cases were males. Initial management was conservative in three cases. Three cases had a history of infected nonunion. Eight cases had initially OTA type C injuries and six cases had type A injuries. All cases had olecranon osteotomy, triple tension band, Lambda plating, and autogenous bone grafting. Five cases had ulnar nerve anterior transposition. Evaluation of the cases was objectively via Mayo Elbow Performance (MEP) score and subjectively through Disabilities of the Arm, Shoulder and Hand (DASH) score. RESULTS: The average follow-up period was 23.7 ± 5.3 months. All cases had a solid bony union in a mean of 16.4 ± 2.1 weeks and the final range of motion averaged 100 ± 19.6°. MEP and DASH scores had significant improvement at the final follow-up periods (P = 0.001). Cases with transposed ulnar nerve had significantly less MEP scores (P = 0.028) and more DASH scores (P = 0.013). CONCLUSIONS: The prescribed technique could be a good alternative to the known traditional methods with the advantages of: good exposure for arthrolysis; rigid and stable internal fixation even with low bone quality or small-sized distal fragments; and secure early rehabilitation. |
0 | Geometric mismatch of the gamma nail to the Chinese femur | Management of Hip Fractures in the Elderly | The geometric mismatch of the femoral component of the Gamma nail to the Chinese femora resulted in intraoperative complications. To provide scientific data for modification of the implant, 28 pairs of normal Chinese femora were studied with the 3-dimensional reconstruction from the computed tomography scan data. Measurements were taken from the reconstituted drawings, and the anthropometric data were applied in the modification of the implant. This study is the first report on the application of Chinese anthropometric data on the design of a trauma implant. It is hoped that a larger scale of the study will provide a more comprehensive data base for wider application to orthopaedic implant design in the future |
0 | Pediatric Sports Medicine Injuries: Common Problems and Solutions | Osteochondritis Dissecans 2020 Review | The treatment of sports injuries in the skeletally immature has a unique set of complications. Growth deformity may occur after anterior cruciate ligament reconstruction; therefore, skeletal age is used to help guide the choice between physeal sparing and transphyseal techniques. Arthrofibrosis after tibial spine fracture fixation can be reduced by initiating immediate range of motion, and should be treated early and cautiously to avoid iatrogenic fracture. Nonunions of medial epicondyle elbow fractures are more common with nonoperative treatment, but seldom lead to clinical problems outside of certain athletes. Risks of OCD fixation are specific to the material of screw used. |
0 | A New Guide for the Arthroscopically Assisted Latarjet Procedure | DoD SSI (Surgical Site Infections) | The Latarjet procedure is a commonly used treatment for recurrent shoulder instability. However, its neurological complication rate has been reported to be as high as 10%. During the Latarjet procedure, the neurovascular structures are relocated inferiorly and medially. I hypothesized that the risk of nerve injury would be reduced by assisting the inferior-medial relocation of the neurovascular structures intraoperatively.
Methods: Seventeen consecutive patients with shoulder instability accompanied by glenoid bone loss were treated with an all-arthroscopic Latarjet procedure assisted by the novel low-profile SaSumata (SS) guide. The SS guide is inserted through a portal made above the coracoid process and is attached to the coracoid process by 2 pre-fix screws (i.e., temporary pre-fixation screws). Unlike previous techniques, the SS guide is not shuttled from 1 portal to the other to redirect the bone graft from the donor site to the recipient site; instead, it remains attached to the graft throughout the procedure. The SS guide brings the coracoid graft along an inferior-medial trajectory, pushing aside the neurovascular structures with the help of a switching stick. Owing to its semicircular pronged head, the SS guide holds the graft until the pre-fix screws are exchanged with permanent screws. All patients were clinically assessed and underwent computed tomography (CT) scans.
Results: This maneuver was performed arthroscopically in 17 patients, with no conversion to open surgery and no neurological injuries. No patient had recurrence of dislocation after follow-up for a minimum of 24 months. The mean Subjective Shoulder Value was 87.5% +/- 11.7%. The mean Rowe score was 88 +/- 15.7. The bone block was optimally positioned between 3 o'clock and 5 o'clock and was flush with the glenoid facet in 16 of the 17 patients. There was 1 fracture of the bone block. The mean operation time after the first 5 patients was 125 +/- 23 minutes.
Conclusions: The SS guide was a useful tool for performing the arthroscopically assisted Latarjet procedure for recurrent anterior shoulder instability, with good functional results.
Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. |
0 | Frailty in Surgical Preoperative Evaluation and Postoperative Recovery | Hip Fx in the Elderly 2019 | Purpose of Review: Major abdominal surgery in the elderly is challenging and complex. Frailty as a clinical entity in the elderly is increasingly recognized as a useful assessment tool to identify at-risk patients. We aim to review recent literature on frailty in surgical preoperative evaluation and postoperative recovery and determine its applications in emergency surgery. Recent Findings: Frailty has been established as an independent predictor of morbidity and mortality in elderly surgical patients. Individualized treatment goals and tailor-made interventions to optimize clinical conditions in frail patients before and after surgery improve outcomes. Sarcopenia is increasingly recognized as a predictor of poor surgical outcome in elderly; its use in emergency surgery is promising. More research into this area is needed. Summary: Frailty is a useful tool to identify at-risk patients for optimization and targeted intervention before major surgery. To meet the complex needs of these patients, an integrated transdisciplinary approach is recommended. |
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