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0 | Adamantinoma | MSTS 2022 - Metastatic Disease of the Humerus | Adamantinoma is one of the rarest low-grade malignant bone tumours, representing less than 1% of them. Fisher in 1913 named this tumour adamantinoma because of its similarity to ameloblastoma of the jaw. It usually arises in the center of long bones, and 97% of all reported cases were in long tubular bones and mainly in the tibial mid shaft (80-85%). Other long bones not uncommonly affected are the humerus, ulna, femur, fibula and radius. Ribs, spine, metatarsal and carpal bones are very rarely affected. The symptoms are not specific but most frequently the patient complains about swelling, redness, pain and sensitivity of the bone where the tumour is located. Young males are more prone to develop adamantinoma than females. The tumour usually spreads to the lungs, the regional lymph nodes, or other bones. Wide tumour excision and limb salvage reconstruction surgery, or an amputation, are the current surgical treatment options. Radiotherapy and chemotherapy have not been shown to be effective modalities of treatment. [References: 58] |
0 | The relationship between HIF-2α and VEGF with radiographic severity in the primary osteoarthritic knee | OAK 3 - Non-arthroplasty tx of OAK | Purpose: The aim of this study was to determine the relationship of hypoxia-inducible factor-2 (HIF-2α) and vascular endothelial growth factor (VEGF) with radiographic severity in primary osteoarthritis (OA) of the knee. Expression of these two factors in cartilage samples from OA knee joints was examined at mRNA and protein levels. Materials and Methods: Knee joints were examined using plain radiographs, and OA severity was assessed using the Kellgren and Lawrence (KL) grading system. Specimens were collected from 29 patients (31 knees) who underwent total knee replacement because of severe medial OA of the knee (KL grades 3 and 4), 16 patients who underwent knee arthroscopy (KL grade 2), and 5 patients with traumatic knees (KL grade 0). HIF-2α and VEGF expression was quantified by real-time polymerase chain reaction and western blotting. Results: Cartilage degeneration correlated with the radiographic severity grade. OA severity, determined using the Mankin scale, correlated positively with the KL grade (r=0.8790, p<0.01), and HIF-2α and VEGF levels with the radiographic severity of knee OA (r=0.7001, p<0.05; r=0.6647, p<0.05). Conclusion: In OA cartilage, HIF-2α and VEGF mRNA and protein levels were significantly and positively correlated. The expression of both factors correlated positively with the KL grade. HIF-2α and VEGF, therefore, may serve as biochemical markers as well as potential therapeutic targets in knee OA. |
1 | Vascular injuries in the state of Pará, Brazil, 2011-2013 and their relation with demographic and clinical variables | DoD LSA (Limb Salvage vs Amputation) | Background: Vascular traumas are associated with high morbidity rates. Objective: To report the characteristics of vascular traumas in the Brazilian state of Pará, in trauma victims treated at the Hospital Metropolitano de Urgência e Emergência (HMUE), from 2011 to 2013. Method: This was a descriptive, cross-sectional, retrospective and quantitative study that analyzed data on sex, age group, geographical origin, time waiting for care, mechanism of trauma, clinical status, anatomic site of injury, prevalence of associated fractures, vascular structures injured, types of vascular injury, principal types of surgery, early postoperative outcomes, level of amputation, number of deaths, length of hospital stay and multidisciplinary care for 264 medical records. Results: The majority of victims were male and the most common age group was from 16 to 30 years. The majority of cases were from towns other than the state capital, accounting for 169 cases (64.02%). The principal mechanism of injury was firearm wounding â?? 110 (41.67%) followed by cold weapon wounds â?? 65 (24.62%) and traffic accidents â?? 42 (15.91%). The segments of the body and the vascular structures most often injured were lower limbs â?? 120 (45.45%) and injuries to the popliteal and femoral arteries and veins. The most common clinical presentation at admission was hemorrhage â?? 154 (58.33%). The most common surgeries were ligatures of veins and arteries. There were 163 (61.74%) hospital discharges and 33 (12.5%) deaths. Conclusions: The greatest prevalence observed was related to traumas caused by urban violence. Victims were most frequently male, of working age and from towns other than the capital of the state of Pará. |
0 | Infrapatellar fat pad from late osteoarthritis patients has an anabolic phenotype | Surgical Management of Osteoarthritis of the Knee CPG | Introduction: Onset and progression of osteoarthritis (OA) are associated with obesity. Since not only knee OA but also hand OA is associated with obesity, systemic metabolic factors next to mechanical factors might influence this process. Recent studies showed that adipose tissue is not only able to secrete adipokines but also cytokines such as IL-1beta and IL-6. In this study, we investigated whether infrapatellar fat pad (IPFP) is able to influence cartilage biology and contribute to the onset of OA. Methods: Explants of Hoffa's fat pad obtained during total knee replacement of 29 OA patients were cultured separately in medium for 24 hours in a concentration of 50 mg/mL resulting in 29 different batches of fat conditioned medium (FCM). Pro-inflammatory (IL-1(beta), IL-6, IL-12) and anti-inflammatory cytokines (IL-10) and growth factors (FGF2 and PAI1) content (Luminex) of the FCM were measured and the presence of CD68+ (macrophages), CD86+ (classically activated macrophages) and CD206+ (alternatively activated macrophages) cells in the explants of IPFP (immunohistochemistry) were determined. Explants of healthy cartilage were cultured in FCM (1:1 with fresh medium) for 48 hours. We evaluated Nitric Oxide (NO) production and glycosaminoglycan (GAG) release by the cartilage, gene expression of MMP1, MMP13, ADAMTS4, ADAMTS5 and COMP in the cartilage. Results: All cytokines were measurable in the 29 batches of FCM. High numbers of CD68+ cells and CD206+ cells were present in the IPFPs, but large variety was seen between the patients. Samples of Hoffa's fat pad with high numbers of CD68+ cells seemed to produce more PAI1 than samples with low numbers of CD68+ cells. When high numbers of CD206+ cells were present, a trend towards high levels of FGF2 was seen in the FCM. No association was found between CD86+ cells and production of cytokines. Culturing cartilage in FCM resulted in lower NO production and GAG release than the control condition. MMP1 gene expression was also lower in response to the FCM, whereas MMP13, ADAMTS4 and ADAMTS5 remained unchanged. COMP gene expression increased in response to FCM. (Figure Presented) Discussion: Medium conditioned by infrapatellar fat pad from late osteoarthritis patients had mainly anabolic effects on cartilage. High numbers of macrophages (CD68+ cells) and alternatively activated macrophages (CD206+ cells) were present in the IPFPs used for making the fat conditioned medium. These cells might have contributed to the production of anti-inflammatory cytokines and growth factors and thus the anabolic/repair effect seen on cartilage |
0 | A Systematic Summary of Systematic Reviews on the Topic of Hip Arthroscopic Surgery | Developmental Dysplasia of the Hip 2020 Review | Background: There is a rapidly growing body of literature on the topic of hip arthroscopic surgery. Purpose: To provide an overall summary of systematic reviews published on the indications, complications, techniques, outcomes, and information related to hip arthroscopic surgery. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of all hip arthroscopic surgeryâ??related systematic reviews published between January 2000 and May 2018 was performed using PubMed, MEDLINE, and the Cochrane Library. Narrative reviews and non-English articles were excluded. Results: A total of 837 articles were found, of which 85 met the inclusion criteria. Included articles were summarized and divided into 6 major categories based on the subject of the review: femoroacetabular impingement (FAI), non-FAI indications, surgical technique, outcomes, complications, and miscellaneous. Conclusion: A summary of systematic reviews on hip arthroscopic surgery can provide surgeons with a single source for the most current synopsis of the available literature. As the prevalence of orthopaedic surgeons performing hip arthroscopic surgery increases, updated evidence-based guidelines must likewise be advanced and understood to ensure optimal patient management. |
0 | Periodontal disease and systemic health--diabetes | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | This article discusses the biologic basis of periodontal disease and diabetes mellitus. Following is a consideration of the possibility of a link between diabetes and periodontal disease. Mounting evidence suggests that there is, indeed, a connection between periodontal disease and diabetes |
0 | Comparison of the analgesic efficacy of preemptive and preventive intraarticular pethidine injection after arthroscopic knee surgrery | Surgical Management of Osteoarthritis of the Knee CPG | Introduction: Postoperative pain relief is an important goal in surgical procedures of the lower extremity (1). Arthroscopic knee surgery (AKS) is one the most common ambulatory surgeries. Several previous studies had been evaluated the efficacy of intra-articular (IA) pethidine as a compound which has anesthetic and opioid agonist properties, on postoperative pain relief in AKS(2,3). The aim of this study was to compare the postoperative analgesic effect of pre & post surgical IA pethidine administration in AKS. Methods: After institution ethics committee approval and patient's informed written consent 75 adult patients (ASAI&II)undergoing AKS with general anesthesia were enrolled in this double blind study.Patients were randomized in three equal groups to receive either 50 mg IA pethidine before surgical incision (preemptive) , after completion of surgery (preventive) and placebo (G1, G2 and G3 respectively). In each patient operated knee joint pain at rest and movement, was evaluated at 1, 2,6,12 and 24 hours after surgery completion using visual analog scale (VAS).Patients received morphine(0.05 mg/kg IM) as postoperative analgesia as requested.Data were analyzed using ANOVA- Repeated measure and T-paired tests. Results: Postoperative pain scores in three groups are shown in table . The time (mean (plus or minus) SD) between completion of operation and patient's request of morphine, morphine consumption (mean (plus or minus) SD) in postoperative 24 hours and the numbers of patients requested analgesic in G1,G2,G3 were: 2(plus or minus) 1.3, 3.3(plus or minus) 1.5 & 5.2 (plus or minus) 1.3 hours p<0.05, 4.4(plus or minus) 2.4, 8.7(plus or minus) 2 & 11.6 (plus or minus) 4.4 mg p<0.05, 11,18 & 21 person p<0.05 respectively. Discussion: This study showed that preemptive intra- articular pethidine injection is more effective than preventive injection for postoperative pain relief in arthroscopic knee surgery (Table presented) |
0 | The effect of capitellar impaction fractures on radiocapitellar stability | Distal Radius Fractures | Purpose To determine the effect of capitellar impaction fractures on radiocapitellar stability in a model that simulated a terrible triad injury. Methods Six cadaveric elbows were dissected free of skin and muscles. Tendons were preserved. The lateral collateral ligament was released and repaired (surgical control). Two sizes of capitellar impaction defects were created. After lateral collateral ligament release and repair, we then sequentially created osseous components of a terrible triad injury (partial radial head resection and coronoid fracture) through an olecranon osteotomy that was fixed with a plate. Radiocapitellar stability was recorded after the creation of each new condition. Results Significantly less force was required for radiocapitellar subluxation after the creation of 20° and 40° capitellar defects compared with the surgical control (intact capitellum). After the addition of a Mason type II radial head defect and then a coronoid defect, stability decreased significantly further. Conclusions Impaction fractures of the distal portion of the capitellum may contribute to a loss of radiocapitellar stability, particularly in an elbow fracture-dislocation. Clinical relevance Because these injuries may be unrecognized, consideration should be given to diagnosing and addressing them. |
0 | What is a food and what is a medicinal product in the European Union? Use of the benchmark dose (BMD) methodology to define a threshold for " pharmacological action" | OAK 3 - Non-arthroplasty tx of OAK | The decision criterion for the demarcation between foods and medicinal products in the EU is the significant " pharmacological action" Based on six examples of substances with ambivalent status, the benchmark dose (BMD) method is evaluated to provide a threshold for pharmacological action. Using significant dose-response models from literature clinical trial data or epidemiology, the BMD values were 63. mg/day for caffeine, 5. g/day for alcohol, 6. mg/day for lovastatin, 769. mg/day for glucosamine sulfate, 151. mg/day for Ginkgo biloba extract, and 0.4. mg/day for melatonin. The examples for caffeine and alcohol validate the approach because intake above BMD clearly exhibits pharmacological action. Nevertheless, due to uncertainties in dose-response modelling as well as the need for additional uncertainty factors to consider differences in sensitivity within the human population, a " borderline range" on the dose-response curve remains. " Pharmacological action" has proven to be not very well suited as binary decision criterion between foods and medicinal product. The European legislator should rethink the definition of medicinal products, as the current situation based on complicated case-by-case decisions on pharmacological action leads to an unregulated market flooded with potentially illegal food supplements. © 2012 Elsevier Inc. |
0 | A multiplanar external fixator assembly for complex proximal humeral fractures: A novel management modality | Hip Fx in the Elderly 2019 | High-velocity trauma is increasing the frequency of proximal humeral fractures in the younger population. Proximal humeral fractures are the second most common upper-extremity fracture and the third most common fracture after hip fractures and distal radial fractures, in patients who are older than 65 years of age. Overall, this injury tends to follow a bimodal age distribution except 2-part fractures, which follow a unimodal distribution in the elderly. Osteoporotic, comminuted, and displaced fractures of upper-end humerus with or without compromised soft tissue were considered as complex fractures. Displaced proximal-end humeral fractures are often unstable and could be associated with injury of the rotator cuff and avascular necrosis of the head of the humerus. Avascular necrosis of the head is found in 12% to 34% cases of 3-part fracture and 41% to 59% cases of 4-part fracture. The reason attributed to this is an increased risk of loss of blood supply to the head of the humerus in 3-part or 4-part fractures. Many modalities of management, including nonoperative management, percutaneous multiple K-wire fixation, fixators, and open reduction and internal fixation by plate/screws have been described for the treatment of these complex proximal humeral fractures. Despite early exercise programs, the problem of shoulder stiffness is associated with a conservative protocol. To overcome this problem, early mobilization of the joint is mandatory, which is not possible with conservative treatment/K-wire fixator before 3 weeks. Open reduction and internal fixation requires soft tissue stripping, which may lead to higher chances of avascular necrosis of the head of the humerus and stiffness of the shoulder. Thus, the above-described complex fracture patterns present extra challenge to practicing orthopedic surgeons. In this report, we aimed to present a multiplanar external fixator assembly with the technique of indirect closed reduction of complex proximal humeral fractures. Copyright © 2012 by Lippincott Williams & Wilkins. |
0 | Revision total hip arthroplasty using an interlocking stem with an allograft-prosthesis composite | PJI DX Updated Search | We report the clinical and radiographic outcomes and complications of revision surgery using a cementless interlocking stem with an allograft-prosthesis composite (APC). This study included 11 patients with an average follow-up of 73 years. Of the 11 revisions, 1 was aseptic, 7 were septic, and 3 were periprosthetic femoral fractures. The mean Harris hip score improved from 25.6 points before surgery to 74.8 points at final follow-up. Osseous union at the proximal allograft-host bone junction occurred in 10 hips (90.9%) ; the greater trochanter did not unite in 4 of 7 hips (57.1%). Moderate and severe allograft resorption occurred in one hip each. Postoperative complications included 1 deep infection, 2 heterotopic ossifications, and 1 dislocation. Using an interlocking stem with an allograft-prosthesis composite in revision surgery provided acceptable results in the presence of circumferential massive bone deficiency of the proximal femur |
0 | Diagnosis and treatment of erosive rheumatoid arthritis and other forms of joint destruction | Surgical Management of Osteoarthritis of the Knee CPG | Single or multiple destruction of joints arises from many causes, ranging from the acute destructive process (usually monarticular) in septic joint disease, to the chronic, slowly evolving destruction of cartilage and adjacent bone that occurs in osteoarthrosis. Medical treatment of a few of these conditions (including rheumatoid arthritis) is reasonably satisfactory, if it is initiated early. On the other hand, surgical procedures are indicated if physical and X ray examination of the involved joints discloses the presence of a significant destructive process, involving both articular cartilage and bone. Several very satisfactory operative techniques, including synovectomy (in the relatively early phases) and prosthetic joint replacement, have been developed recently. These are especially favorable in destructive disease of the hip, knee, or small joints of the hand. The various differential diagnostic, radiographic, medical, and surgical procedures are discussed in some detail |
0 | Fractures of the hip: does the type of fall really affect the site of fracture? | Management of Hip Fractures in the Elderly | The purpose of this study was to test accepted theories relating the characteristics of a fall to the anatomical site of hip fracture in the elderly. Twisting injuries are said to result in intracapsular fractures and falls directly onto the side are said to result in extracapsular fractures. 618 consecutive patients with a hip fracture were studied prospectively by being questioned with regard to the nature of their fall. After exclusions, 552 patients were left in the study. Of these, 324 patients sustained intracapsular fractures and 228 extracapsular fractures. More intracapsular fractures were associated with a fall onto the affected side than extracapsular fractures and rotation at the hip during the fall had a significant association with extracapsular fractures. In this study 84 per cent of all fractures occurred by falling directly onto the affected side. The clinical significance of this finding is that protective padding on the hip might be beneficial |
1 | Early wound complications of operative treatment of calcaneus fractures: analysis of 190 fractures | DoD SSI (Surgical Site Infections) | OBJECTIVES: The purpose of the present study was to discover any associations between preoperative variables and the occurrence of wound complications in the surgical treatment of calcaneus fractures.
DESIGN: Retrospective review.
SETTING: A Level 1 trauma center.
PATIENTS: One hundred seventy-nine patients, with 190 fractured calcanei, were studied.
INTERVENTION: Each patient underwent open reduction and internal fixation for calcaneus fractures with standard techniques.
MAIN OUTCOME MEASUREMENTS: The age, sex, preexisting medical conditions, social history, and mechanism of injury of each patient were recorded. Note was made of the status of the soft tissue injury, if any. The time from injury to surgical stabilization was recorded, as was the type of incision used, use of preoperative antibiotics, and type of wound closure. The patients' records were reviewed for wound complications. These complications were classified as those that could be treated nonsurgically and those that required surgical management.
RESULTS: Records from July 1992 to July 1998 showed 179 patients who underwent operative stabilization of a calcaneus fracture. Eleven had bilateral fractures, for a total of 190 fractured calcanei. The average age was thirty-five years. Nine patients were diabetics. One hundred eleven of the patients reported current use of cigarettes. Eighteen of the fractures were open. A standard, L-shaped lateral approach to the calcaneus was used in each case. Stabilization was achieved by using standard techniques, with plates and screws. In all cases, a two-layer wound closure was used. Forty-eight patients (25 percent) developed some form of wound complication. Forty (21 percent) of these required surgical treatment. Statistical analysis identified diabetes (p = 0.02; relative risk 3.4), smoking (p = 0.03; relative risk 1.2), and open fractures (p < 0.0001; relative risk 2.8) as risk factors for wound complication. The presence of more than one risk factor increased the relative risk of a wound complication requiring surgery.
CONCLUSION: Smoking, diabetes, and open fractures all increase the risk of wound complication after surgical stabilization of calcaneus fractures. Cumulative risk factors increase the likelihood of wound complications. Patients who have the risk factors identified in this study should be counseled as to the possible complications that may arise after surgery. In patients with multiple risk factors, consideration should be given to nonsurgical management. |
0 | Normal pressure hydrocephalus found after anesthesia - A case report | Surgical Management of Osteoarthritis of the Knee CPG | Normal pressure hydrocephalus (NPH) is characterized by insidious onset and gradual development of the triad of gait disturbance, dementia, and urinary incontinence. Nausea, vomiting, and signs of increased intracranial pressure do not occur. A 71-year-old male patient was scheduled for total knee replacement due to osteoarthritis of right knee joint. No neurological symptoms and signs except mild forgetfulness were detected during physical examination following admission. Due to operational mistakes, the anesthesiologist was informed that the surgery was cancelled just after completion of induction of general anesthesia. The patient was allowed to emerge from anesthesia. Unfortunately, his consciousness became drowsy the next morning. After a series of examinations, he was at last diagnosed as a case of NPH principally by the brain computed tomography scan. So he was scheduled again but this time for vetriculoperitoneal (V-P) shunt. The patient regained consciousness after V-P shunt. From this case, we learned that NPH may remain in concealment in the patients we contacted in our daily practice. A vigilant physician should keep in mind that the presentation of gait disturbance, dementia, and urinary incontinence in a patient may indicate the likelihood of NPH |
0 | Early results with a patient specific interpositional knee device | OAK 3 - Non-arthroplasty tx of OAK | The iForma ConforMIS Interpositional knee device is a recently developed patient specific implant used for the treatment of mild to moderate uni-compartmental osteoarthritis. The benefits over traditional methods of surgical management are: it is less invasive, can be performed as a day procedure and does not limit future options. Bespoke implants are produced from data extracted from MRIs. Twenty-six patients with the iForma ConforMIS interpositional knee implant from November 2007 were retrospectively reviewed. The average age was 54.7 years, The average pre-operative WOMAC score was 37.8 improving to 67.6 post-operatively. Five patients required revision. No dislocations were reported. Our early experience suggests this device is a viable and safe treatment option. However, patient selection plays an important role in the outcome following surgery and long term results should be awaited. |
0 | Fixed versus mobile bearing unicompartmental knee replacement: a meta-analysis | Surgical Management of Osteoarthritis of the Knee CPG | This systematic review compares the clinical, radiological and kinematic outcomes of fixed compared to mobile bearing unicompartmental knee replacements (UKRs). A meta-analysis of pooled mean difference and relative risk data was undertaken following a review of electronic databases. Five studies were identified. Analysis suggested that there was no significant difference in clinical outcome or complication rate between mobile and fixed bearing UKR. However, the evidence reviewed presented with a number of methodological limitations. Areas for further study are recommended |
0 | Seat belt injury to the female breast: review and discussion of its surgical management | Reduction Mammoplasty for Female Breast Hypertrophy | With the use of the three-point lap-diagonal seat belt restraint, there has been a reduction in the number of deaths caused by automobile trauma. However, a new pattern of injury has emerged, the 'seat-belt syndrome', which comprises a constellation of injuries including soft tissue injury to the breast. Given that seat belt legislation is becoming more widespread, it is likely that the incidence and reporting of these injuries will become more common. In this paper, we provide an overview of the varied clinical and radiological presentations, and suggested management of seat belt injury to the female breast. The consequences of such injury can be severe in their functional, psychosocial and aesthetic impact, and thus, using an index case as an example, the previously unreported area of breast reconstruction in a breast deformed as a result of blunt trauma is discussed, highlighting some of its challenges. |
0 | Optimal strategies for the prevention of heterotopic ossification after total hip arthroplasty: A network meta-analysis | AAHKS (8) Anesthetic Infiltration | BACKGROUND: Nonselective nonsteroidal anti-inflammatory drugs (NSAIDs), selective NSAIDs, and radiation are widely used for the prevention of heterotopic ossification (HO) after total hip arthroplasty (THA). Previous studies have suggested that nonselective NSAIDs, selective NSAIDs and radiation can prevent HO after THA, though the results are conflicting. In this network meta-analysis, we aimed to comprehensively analyze the efficacy and safety of three strategies for preventing HO after THA compared to a placebo.
PATIENTS AND METHODS: Relevant studies about nonselective NSAIDs, selective NSAIDs, radiation and controls that were used to prevent HO after THA were collected. Data were extracted independently by two reviewers. Network meta-analysis was applied to assess treatment efficacy and safety. The surface under the cumulative ranking curve (SUCRA) method was used to assess which treatment was ranked the highest. The node-splitting method was used to calculate inconsistency.
RESULTS: Radiation was found to be the most efficient option for preventing overall incidence of HO and Brooker IV, I, II and III HO after THA. Selective NSAIDs were the safest option, and radiation was ranked second for preventing HO after THA, as the treatments were ranked taking discontinuation caused by nongastrointestinal side effects (DNGSE) and the incidence of complications into consideration.
CONCLUSIONS: A network meta-analysis concluded that radiation is the most efficacious method for preventing HO after THA. |
0 | Prevalence of Staphylococcus aureus colonization in orthopaedic surgeons and their patients: a prospective cohort controlled study | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | BACKGROUND: Methicillin-resistant Staphylococcus aureus and methicillin-sensitive Staphylococcus aureus surgical site infections are an increasing health problem in the United States. To date, no study, as far as we know, has evaluated the prevalence of Staphylococcus aureus colonization in orthopaedic surgeons. The purpose of our study was to assess the prevalence of methicillin-resistant Staphylococcus aureus and methicillin-sensitive Staphylococcus aureus colonization in orthopaedic surgery attending surgeons and residents at our institution compared with that in our high-risk patients. METHODS: We performed nasal swab cultures in seventy-four orthopaedic attending surgeons and sixty-one orthopaedic surgery residents at our institution, screening for methicillin-resistant Staphylococcus aureus and methicillin-sensitive Staphylococcus aureus. We compared these results with a prospective database of nasal cultures of patients undergoing joint replacement and spine surgery. RESULTS: A total of 135 physicians were screened. Of those physicians, 1.5% were positive for methicillin-resistant Staphylococcus aureus and 35.7% were positive for methicillin-sensitive Staphylococcus aureus. None of the sixty-one residents were positive for methicillin-resistant Staphylococcus aureus. However, 59% were positive for methicillin-sensitive Staphylococcus aureus. Of the seventy-four attending surgeons, 2.7% were positive for methicillin-resistant Staphylococcus aureus and 23.3%, for methicillin-sensitive Staphylococcus aureus. Previous studies at our institution have demonstrated a 2.17% prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus and an 18% rate of methicillin-sensitive Staphylococcus aureus in high-risk patients. Thus, no difference was found between the prevalence of methicillin-resistant Staphylococcus aureus in residents or attending surgeons and that in the high-risk patients. However, the prevalence of methicillin-sensitive Staphylococcus aureus colonization in the surgeons (35.7%) was significantly higher than that in the high-risk patient group (18%) (p < 0.01). CONCLUSIONS: At a major teaching hospital, a higher prevalence of methicillin-sensitive Staphylococcus aureus colonization was found among attending and resident orthopaedic surgeons compared with a high-risk patient group, but the prevalence of methicillin-resistant Staphylococcus aureus colonization was similar |
0 | Intramuscular pressures with limb compression. Clarification of the pathogenesis of the drug-induced muscle-compartment syndrome | DOD - Acute Comp Syndrome CPG | To study muscle necrosis due to prolonged limb compression, we measured intramuscular pressure by inserting wick catheters into 10 volar forearms and 10 anterior tibial compartments of adult volunteers. We then placed the subjects in positions in which victims of drug overdose are commonly found. Intramuscular pressures in the area of direct compression on hard surfaces ranged from 26 to 240 mm Hg, and averaged 101 mm Hg. Most remarkable was a mean pressure of 180 mm Hg on compression of the forearm by the rib cage. These pressures are sufficient to cause muscle and capillary ischemia and necrosis by local obstruction of the circulation. This local injury by limb compression may produce edema sufficient to start compartment tamponade and consequent muscle-compartment and crush syndromes. |
0 | Rates of change and sensitivity to change in cartilage morphology in healthy knees and in knees with mild, moderate, and end-stage radiographic osteoarthritis: Results from 831 participants from the osteoarthritis initiative | AMP (Acute Meniscal Pathology) | Objective. To study the longitudinal rate of (and sensitivity to) change of knee cartilage thickness across defined stages of radiographic osteoarthritis (OA), specifically healthy knees and knees with end-stage radiographic OA. Methods. One knee of 831 Osteoarthritis Initiative participants was examined: 112 healthy knees, without radiographic OA or risk factors for knee OA, and 719 radiographic OA knees (310 calculated Kellgren/Lawrence [K/L] grade 2, 300 calculated K/L grade 3, and 109 calculated K/L grade 4). Subregional change in thickness was assessed after segmentation of weight-bearing femorotibial cartilage at baseline and 1 year from coronal magnetic resonance imaging (MRI). Regional and ordered values (OVs) of change were compared by baseline radiographic OA status. Results. Healthy knees displayed small changes in plates and subregions (±0.7%; standardized response mean [SRM] ±0.15), with OVs being symmetrically distributed close to zero. In calculated K/L grade 2 knees, changes in cartilage thickness were small (<1%; minimal SRM-0.22) and not significantly different from healthy knees. Knees with calculated K/L grade 3 showed substantial loss of cartilage thickness (up to-2.5%; minimal SRM-0.35), with OV1 changes being significantly (P < 0.05) greater than those in healthy knees. Calculated K/L grade 4 knees displayed the largest rate of loss across radiographic OA grades (up to-3.9%; minimal SRM-0.51), with OV1 changes also significantly (P < 0.05) greater than in healthy knees. Conclusion. MRI-based cartilage thickness showed high rates of loss in knees with moderate and end-stage radiographic OA, and small rates (indistinguishable from healthy knees) in mild radiographic OA. From the perspective of sensitivity to change, end-stage radiographic OA knees need not be excluded from longitudinal studies using MRI cartilage morphology as an end point. © 2011, American College of Rheumatology. |
0 | Septic diseases associated with the hoof complex: abscesses, punctures wounds, and infection of the lateral cartilage | DoD SSI (Surgical Site Infections) | Hoof abscesses are probably the most common cause of acute severe lameness in horses encountered by veterinarians and farriers. Most affected horses show sudden, severe (acute) lameness; the degree of lameness varies from being subtle in the early stages to non-weight bearing. There is still debate between the veterinary and farrier professions as to who should treat a hoof abscess and the best method to resolve the abscess. Puncture wounds to the sole of the foot can introduce bacteria and debris to the solar surface of the distal phalanx and produce a fracture or a septic pedal osteitis. |
0 | Effect of medial soft-tissue releases during posterior-stabilised total knee arthroplasty | Surgical Management of Osteoarthritis of the Knee CPG | PURPOSE: To assess the effect of each step of medial soft-tissue releases on the joint gap angle during posterior-stabilised total knee arthroplasty (TKA). METHODS: 82 women and 9 men (mean age, 72 years) with medial osteoarthritic knees underwent 100 posterior-stabilised TKAs, in which release of superficial fibres of the medial collateral ligament (MCL) were required using the gap control technique. The order of releases was the superficial MCL, the pes anserinus, and then the semi-membranosus. The superficial MCL was released selectively. The effect of each step of medial soft-tissue releases in full extension and in 90 masculine flexion was compared. RESULTS: After all medial soft-tissue releases, the mean joint gap angles decreased from 8.7 masculine to 3.8 masculine varus in flexion and from 4.4 masculine to 1.4 masculine varus in extension. The total effect of medial soft-tissue releases was significantly larger in flexion than in extension (4.9 masculine+/-3.2 masculine vs. 3.0 masculine+/-2.0 masculine, p<0.0001), except for the release of posterior fibres of the superficial MCL. The effect of release of the semi-membranosus in flexion was largest. CONCLUSION: The release effect was significantly greater in flexion than in extension during posterior-stabilised TKA; the joint gap technique may be more reliable in medial osteoarthritic knees with moderate and severe varus instability |
0 | Autogenous aortoiliac/femoral reconstruction from superficial femoral- popliteal veins: Feasibility and durability | DOD - Acute Comp Syndrome CPG | Purpose: Autogenous aortoiliac/femoral reconstruction with superficial femoral-popliteal veins (SFPVs) has been successfully used to treat prosthetic infection and failure, but outcome data are scant. In this prospective, observational study, we hypothesized that (1) replacement of the aortoiliac/femoral system with SFPVs could be performed with perioperative morbidity and mortality rates equal to those of conventional methods; (2) long-term patency rates would be excellent; (3) limb salvage rates would be correspondingly high; (4) aneurysmal degeneration would not occur; and (5) venous morbidity would be minimal. Methods: Since 1990, 41 patients have undergone complete or partial aortoiliac/femoral reconstruction with 63 SFPVs with a mean (± SD) follow-up time of 32 ± 21 months. With the exception of two patients lost to follow up, all have been observed at 6-month intervals with clinical examination and noninvasive tests. Results: There were no immediate operative deaths, but three patients (7.3%) died of multisystem organ failure after 1 month. Forty, nine percent of patients had significant perioperative complications including amputation (5%), compartment syndrome (12.3%), and pulmonary embolism (2.4%). Most patients (85%) had multilevel occlusive disease, and the mean SVS/ISCVS runoff score for the group was 4.9 ± 2.6 (1 = normal, 10 = no runoff). Fifty-eight percent of all distal anastomoses were end-to-end, and in 68% of limbs the profunda femoris artery or superficial femoral artery was the sole runoff vessel. At 5 years, the cumulative secondary patency rate was 100%; primary patency rate, 83%; limb retention rate, 86%; and survival rate, 69%. Four patients had permanent limb edema controlled by compression stockings but none have had venous ulceration. There has been no aneurysmal dilation of SFPV grafts, and mean diameter shown by serial duplex imaging at 6 months (10.8 ± 1.1 mm) was not significantly different from that at 60 months (7.8 ± 1.1 mm). Conclusions: Aortoiliac/femoral reconstruction with SFPVs is a successful and durable option for infection and other complex aortic problems. |
0 | Developing a strategy for the prevention of hip fractures in the elderly due to osteoporosis: the application of economics to the findings from a clinical trial | HipFx Supplemental Cost Analysis | The occurrence of a fracture is the most obvious manifestation of osteoporosis. Preventive measures can reduce the risk of such events. The cost of preventing fractures depends on the cost and effectiveness of the intervention and the cost associated with treating the fractures. This paper aims to develop a framework for commissioners to evaluate new technologies by integrating the evidence on effectiveness with the costs likely to be incurred in providing interventions and the probable benefits generated. The explicit aim is to show how the effectiveness of an intervention designed to prevent hip fractures in the elderly, combined with an analysis of its potential economic impact, can provide an indication of how quality improvements in health-care provision and cost savings may be generated |
0 | The effect of Alendronate on symptoms of knee osteoarthritis | OAK 3 - Non-arthroplasty tx of OAK | INTERVENTION: Alendronate tablet 70mg orally single dose/week (Alnate product of Dr. Abidi Company) for 24 weeks. Intervention 1: Alendronate tablet 70mg orally single dose/week (Alnate product of Dr. Abidi Company) for 24 weeks. Intervention 2: Placebo, one tablet orally per week for 24 weeks. Placebo Placebo, one tablet orally per week for 24 weeks CONDITION: Gonarthrosis Knee osteoarthritis. ; Gonarthrosis PRIMARY OUTCOME: Reduction in symptoms of knee osteoarthritis. Timepoint: Weeks 0, 4, 12, 24. Method of measurement: WOMAC Index. SECONDARY OUTCOME: Joint space narrowing. Timepoint: weeks 0 and 24. Method of measurement: Knee Xâ?ray. INCLUSION CRITERIA: INCLUSION CRITERIA: fulfilling the American College of rheumatology (ACR) criteria of primary knee osteoarthritis, radiologically ascertained grade I or II severity of OA of the knee on the Kellgrenâ?Lawrence scale, having a Western Ontario and McMaster Universities (WOMAC) pain subscale index of at least 2 at baseline (the 5â?point Linkert version of the WOMAC), presence of daily knee pain for at least 6 months preceding the study Exclusion criteria: Presence of secondary osteoarthritis, arthroscopy or surgery of target knee within 6 months prior to study, intraâ?articular treatment of target knee within 6 months prior to study, other chronic inflammatory processes, previous gastrointestinal problems (such as gastroesophageal reflux or esophageal stricture), previous allergic reactions to bisphosphonates, presence of any risk factors for osteoporosis |
0 | Agreement study of radiographic classification of rotator cuff tear arthropathy | Glenohumeral Joint OA | HYPOTHESIS: This study evaluated the intra-rater and inter-rater correlation of 3 commonly used x-ray image classifications and defined the clinical factors most correlated with a surgical recommendation for a hemiarthroplasty or a reverse total shoulder arthroplasty (RSA) for treatment of rotator cuff tear arthropathy (CTA). We hypothesized that specific radiographic criteria and clinical criteria would be most important and consistently used among experienced shoulder surgeons when determining the best surgical option for a particular patient.
METHODS: Four experienced orthopedic surgeons evaluated standard anteroposterior radiographs and the clinical examination of 37 shoulders with CTA. On each reading, they classified the grade of pathology using the Seebauer, Favard, and Hamada classifications. Using radiographic criteria alone, or with the clinical findings, each evaluator determined the recommended prosthetic treatment for each shoulder.
RESULTS: Intra-rater correlations for surgical recommendations using radiographic criteria ranged from 0.39 to 1.0 and improved in 3 of 4 evaluators when the clinical examination was included in the clinical decision. The inter-rater reliability using these same criteria were fair, at 0.32 for radiographic and .35 for radiographic and clinical data. The most significant radiographic factors associated with a surgical decision were the degree of humeral head superior migration and the escape of the humeral head from the coracoacromial arch. Clinical factors most associated with the decision for RSA were advanced age, loss of shoulder elevation, superior humeral head escape, and pseudoparalysis of the shoulder. Radiographic findings had a less significant effect on surgical recommendations when clinical factors were included.
CONCLUSION: Clinical and radiographic criteria are needed for a decision for hemiarthroplasty or RSA in the treatment of CTA. A treatment algorithm based upon radiographic and clinical criteria is proposed. |
0 | Optimal utilization of MSK imaging during COVID-19 pandemic | Coronavirus Disease 2019 (COVID-19) | The COVID-19 pandemic has caused multi-dimensional global crisis in the recent times. There is an increasing necessity of understanding and developing a strategy for optimal utilization of healthcare resources in this time of crisis. Radiology department remains the backbone for diagnosis and for appropriate management of orthopaedic ailments. Amidst COVID-19 pandemic, there is a need to change in imaging algorithm, for various clinical conditions taking care of the exposure risk to patients and healthcare workers and to handle the volume of diagnostic and intervention work. Radiology preparedness is to set the workflow protocols and policies applicable to radiology investigations for different clinical conditions, which will help to attain these objectives. Radiologists are in best position to decide the most appropriate imaging investigation and protocol making it vital to have a frequent Orthopaedic surgeonâ??Radiologist interaction, which is one of the most important steps in patient management pathway. |
0 | Increased skeletal:renal uptake ratio: etiology and characteristics | MSTS 2018 - Femur Mets and MM | Twenty-four patients with increased skeletal:renal uptake ratios of 99mTc-methylene diphosphonate were studied. Increased uptake was central in metastatic prostate carcinoma, peripheral in hematologic disorders, and heterogeneous in Paget disease and fibrous dysplasia. There was no discernible redistribution of skeletal uptake in patients with renal failure. Absence of both renal and bladder activity was not observed in patients with normal renal function. An increased ratio was always abnormal and frequently indicated diffuse bone disease. |
0 | Coronal Malalignment in the Adult Knee | OAK 3 - Non-arthroplasty tx of OAK | Coronal plane deformity in the adult patient is a complex clinical problem. Once the hip, knee, and ankle joint centers lose collinerarity, the knee is exposed to abnormal loads across its tibiofemoral compartments, leading to early degenerative changes. Malalignment can coexist with arthrosis and ligamentous instability. High tibial osteotomy and distal femoral osteotomy have been useful tools to realign the adult knee. They can be performed along with ligament reconstruction and cartilage restoration procedures with high success rates. Despite novel techniques and fixation methods, principles of deformity correction should be followed to maximize clinical outcomes. |
0 | Alendronate produces greater effects than raloxifene on bone density and bone turnover in postmenopausal women with low bone density: Results of | Management of Hip Fractures in the Elderly | Objectives. Alendronate and raloxifene are antiresorptive agents with different mechanisms of action, each used to treat osteoporosis in postmenopausal women. This study was undertaken to compare the efficacy and tolerability of alendronate to raloxifene in postmenopausal women with low-bone density. Design. Randomized, double-masked, double-dummy multicentre international study. Setting. Clinical trial centres in Europe, South America and Asia-Pacific. Subjects. A total of 487 postmenopausal women with low bone density, based on bone mineral density (BMD) of the lumbar spine or hip (T-score (less-than or equal to)-2.0). Interventions. Patients received either alendronate 70 mg once weekly and daily placebo identical to raloxifene or raloxifene 60 mg daily and weekly placebo identical to alendronate for 12 months. Main outcome measures. Evaluations included BMD of the lumbar spine and hip and markers of bone turnover at 6 and 12 months and adverse event reporting. Results. Alendronate demonstrated substantially greater increases in BMD than raloxifene at both lumbar spine and hip sites at 12 months. Lumbar spine BMD increased 4. 8% with alendronate vs. 2.2% with raloxifene (P < 0.001). The increase in total hip BMD was 2.3% with alendronate vs. 0.8% with raloxifene (P < 0.001). Reductions in bone turnover were significantly larger with alendronate than raloxifene. Overall tolerability was similar, however, the proportion of patients reporting vasomotor events was significantly higher with raloxifene (9.5%) than with alendronate (3.7%, P = 0.010). The proportion of patients reporting gastrointestinal events was similar between groups. Conclusion. In postmenopausal women with low bone density, improvements in BMD and markers of bone turnover were substantially greater during treatment with alendronate compared to raloxifene |
0 | Imaging of elbow replacement arthroplasty | PJI DX Updated Search | Elbow replacement arthroplasty has become a standard surgical treatment for a variety of diseases of the elbow. First popularized for the treatment of late-stage rheumatoid arthritis and other debilitating forms of joint disease, the current indications have expanded to include primary treatment of elbow trauma. The most commonly used total elbow replacements are linked semiconstrained chromium-molybdenum alloy or titanium alloy prostheses with polyethylene bearing surfaces. These are inserted after resection of the ulnotrochlear joint and typically cemented in place; the radial head is often sacrificed. Modular metal components or massive osteoarticular allografts may be used when there is extensive bone deficiency. Metal radial head replacements are increasing being used for primary fracture treatment and in posttraumatic elbow reconstructive surgery. Long-term outcomes for total elbow replacement are similar to those of other joints, with 10-year survivals of approximately 90%. Complications specific to elbow implants include infection, aseptic loosening, prosthetic failure, and periprosthetic fracture |
0 | Predictors of survival in patients with bone metastasis of lung cancer | MSTS 2022 - Metastatic Disease of the Humerus | The prognosis of patients with bone metastasis from lung cancer has not been well documented. We assessed the survival rates after bone metastasis and prognostic factors in 118 patients with bone metastases from lung cancer. The cumulative survival rates after bone metastasis from lung cancer were 59.9% at 6 months, 31.6% at 1 year, and 11.3% at 2 years. The mean survival was 9.7 months (median, 7.2 months; range, 0.1-74.5 months). A favorable prognosis was more likely in women and patients with adenocarcinoma, solitary bone metastasis, no metastases to the appendicular bone, no pathologic fractures, performance status 1 or less, use of systemic chemotherapy, and use of an epithelial growth factor receptor inhibitor. Analyses of single and multiple variables indicated better prognoses for patients with adenocarcinoma, no evidence of appendicular bone metastases, and treatment with an epithelial growth factor receptor inhibitor. The mean survival period was longer in a small group treated with an epithelial growth factor receptor inhibitor than in the larger untreated group. The data preliminarily suggest treatment with an epithelial growth factor receptor inhibitor may improve survival after bone metastasis. |
0 | New operative strategy in the treatment of metastasizing medullary carcinoma of the thyroid | MSTS 2018 - Femur Mets and MM | Medullary carcinoma of the thyroid (MTC) is exceptional in that the hormone calcitonin produced by the tumor cells represents a specific and sensitive tumor marker. Careful screening by serial calcitonin determinations following pentagastrin stimulation allows for the early detection of metastatic disease. We have adopted a method of meticulous modified radical neck dissection to eradicate persistent or recurrent MCT in 11 patients treated over a 15-month period. This surgical approach resulted in potentially curative treatment in two patients. Effective tumor reduction was achieved in another seven. Two patients have persistent or progressive disease despite maximum efforts to eradicate malignant tissue. Follow-up is presently incomplete in one patient. Postoperative complications included recurrent nerve paralysis (n = 3), hypoparathyroidism (n = 2), muscular weakness (n = 2) and Horner's syndrome (n = 3). The majority of nervous complications improved spontaneously. It is concluded that the adopted method of meticulous modified radical neck dissection offers the chance of cure to some patients and results in the removal of substantial tumor mass in the majority of others. Postoperative problems are mostly temporary and are deemed acceptable. |
0 | Effect of preoperative deformity on postoperative leg axis in total knee arthroplasty: a prospective randomized study | Surgical Management of Osteoarthritis of the Knee CPG | Computer-assisted surgery-total knee arthroplasty (CAS-TKA) has been suggested to afford greater precision than conventional TKA; however, it is unclear whether this is influenced by preoperative angular deformity. This prospective study was conducted to determine the effect of preoperative angular deformity on the postoperative mechanical axis. Sixty patients underwent stage bilateral TKA; CAS-TKA was performed on one side and conventional TKA on the other side. It was demonstrated that severity of preoperative angular deformity affected the resulting alignment in conventional TKA, but not in CAS-TKA. The mechanical axis of the leg was within 3 degrees of the planned axis in 83% of CAS-TKA but only 32% of conventional TKA cases when the preoperative angular deformity was >12 degrees (P < 0.01). When the preoperative angular deformity was <12 degrees , the mechanical axis of the leg was within 3 degrees of the planned axis in 90% of CAS-TKA but only 69% of conventional TKA (P < 0.025). This study thus concluded that the resulting alignment in conventional TKA is influenced by large preoperative angular deformity. Consistent results in alignment can be achieved with CAS-TKA, though preoperative angular deformity still played a role in predicting the postoperative mechanical axis. CAS-TKA achieves better postoperative alignment than conventional TKA in both severe and mild preoperative angular deformity |
0 | Differences in Health Care Resource Utilization After Surgery for Metastatic Spinal Column Tumors in Patients with a Concurrent Affective Disorder in the United States | MSTS 2022 - Metastatic Disease of the Humerus | Background: Affective disorders, such as depression and anxiety, are exceedingly common among patients with metastatic cancer. The aim of this study was to investigate the relationship between affective disorders and health care resource utilization in patients undergoing surgery for a spinal column metastasis. Methods: A retrospective cohort study was performed using the 2016–2018 National Inpatient Sample database. All adult patients (=18 years) undergoing surgery for a metastatic spinal tumor were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification coding systems. Patients were categorized into 2 cohorts: no affective disorder (No-AD) and affective disorder (AD). Patient demographics, comorbidities, hospital characteristics, intraoperative variables, postoperative adverse events (AEs), length of stay (LOS), discharge disposition, and total cost of hospital admission were assessed. A multivariate logistic regression analysis was used to identify independent predictors of increased cost, nonroutine discharge, and prolonged LOS. Results: Of the 8360 patients identified, 1710 (20.5%) had a diagnosis of AD. Although no difference was observed in the rates of postoperative AEs between the cohorts (P = 0.912), the AD cohort had a significantly longer mean LOS (No-AD, 10.1 ± 8.3 days vs. AD, 11.6 ± 9.8 days; P = 0.012) and greater total cost (No-AD, $53,165 ± 35,512 vs. AD, $59,282 ± 36,917; P = 0.011). No significant differences in nonroutine discharge were observed between the cohorts (P = 0.265). On multivariate regression analysis, having an affective disorder was a significant predictor of increased costs (odds ratio, 1.45; confidence interval, 1.03–2.05; P = 0.034) and nonroutine discharge (odds ratio, 1.40; confidence interval, 1.06–1.85; P = 0.017), but not prolonged LOS (P = 0.067). Conclusions: Our study found that affective disorders were significantly associated with greater hospital expenditures and nonroutine discharge, but not prolonged LOS, for patients undergoing surgery for spinal metastases. |
0 | Surgical treatment for posterior dislocation of hip combined with acetabular fractures using preoperative virtual simulation and three-dimensional printing model-assisted precontoured plate fixation techniques | DoD SSI (Surgical Site Infections) | Background and Purpose. Hip dislocation combined with acetabular fracture remains a challenging condition for orthopedic surgeons. In this study, we utilized a computer-assisted simulation and three-dimensional (3D) printing technology to treat patients with hip dislocation combined with acetabular fracture. We hypothesized that the 3D printing-assisted method would shorten the internal fixation time and surgical time. Methods. We retrospectively reviewed 16 patients diagnosed with traumatic posterior dislocation of hip combined with acetabular fractures and treated with plate fixation from September 2013 to August 2017. Patients were divided into two groups: (1) traditional method and (2) 3D printing groups. In the traditional method group, the plates were contoured during the surgery, whereas in the 3D printing group, the patient's pelvic computed tomography image was transformed to the 3D medical image software for processing preoperatively.The fracture reduction was simulated by the computer. Thereafter, the 1:1 scale 3D printing model was used to design the surgical plan and contour patient-specific plates preoperatively. Results. The internal fixation time was significantly shorter in the 3D printing group than in the traditional method group (-33 min, P<0.05). The mean operative time was shorter than that in the traditional method group (-43 min). However, blood loss and postoperative radiograph results were similar between the groups. The complication rate was lower in the 3D printing group (2/7) than in the traditional method group (5/9). Interpretation. Computer-assisted simulation with 3D printing technology is a more efficientmethod for treating hip dislocation combined with acetabular fractures. |
0 | Mortality after distal radial fractures in the Medicare population | Hip Fx in the Elderly 2019 | The occurrence of a low energy fracture of the distal radius increases the risk for another, more serious fracture, such as a proximal femoral fracture. Early mortality after a proximal femoral fracture has been widely studied, but the association between a distal radial fracture and mortality is unknown. The date of death for all Medicare beneficiaries who sustained an isolated distal radial fracture in 2007 was determined using Medicare Vital Statistics files. The adjusted mortality rate for each age-sex group was calculated and compared with published US mortality tables. Distal radial fractures were not associated with an increased mortality rate. In fact, beneficiaries had a significantly lower mortality rate after distal radial fractures than the general population. This may be related to the injured beneficiaries' involvement in the healthcare system. Mortality rate did not vary significantly based on time from injury. Our results indicate that any mortality is unlikely to be attributable to the distal radial fracture or its treatment. Level of evidence: III. |
0 | Activity and tissue localization of cathepsin D in non small cell lung cancer | MSTS 2018 - Femur Mets and MM | Activity and tissue localization of cathepsin D were examined in tumors deriving from 80 patients with non small cell lung cancer. Activity of the enzyme was higher in sediments and supernatants of tumors than in non invaded lung parenchyma. In all histological types of tumors cathepsin D activity in sediments was three times lower and in lung parenchyma five times lower than in supernatants. The immunohistochemical technique was used for enzyme localization. We observed seemingly the lack of correlation between activity of cathepsin D examined in tumors and immunohistochemical reaction intensity in neoplasm cells. Different numbers of macrophages and quantity of tumor stroma could explain this effect in examined histological types of cancer. Results of our explanations indicates for relations between cathepsin D activity versus histological type and degree of tumor differentiation. We did not observe correlation between cathepsin D activity versus lymph node metastases and clinical stages. |
0 | A comprehensive meta-analysis of association between genetic variants of GDF5 and osteoarthritis of the knee, hip and hand | OAK 3 - Non-arthroplasty tx of OAK | OBJECTIVE: A number of studies have reported an association of GDF5 with osteoarthritis (OA) but have produced some divergent findings and their interpretation may not be straightforward.
METHODS: We investigated the association between GDF5 and OA using meta-analytic techniques, combining all published data up to Nov 2014. 16 independent samples from 11 research teams contributed data on SNP rs143383 (located in the 5'-UTR of GDF5) and knee, hip, and hand OA. The total number of cases and controls for this marker was 7,965 and 12,747 for knee OA, 6,363 and 9,727 for hip OA, and 4,335 and 5,991 for hand OA, respectively. The ORs for each OA phenotype were synthesized using random-effects models or fixed-effects models depending on the test of between-study heterogeneity.
RESULTS: Using a random-effect model, a significant difference was identified between patients with knee OA and controls for the T-allele of rs143383 (Subtotal OR = 1.18, 95 % CI=1.10-1.27, P=1.84 x 10(-6)). For hand OA, a moderate association was also observed (Subtotal OR = 1.09, 95 % CI = 1.02-1.16, P = 0.01) for SNP rs143383 in the combined population. However, non-statistically significant summary OR of hip OA was found in both combined studies (Subtotal OR = 1.22, 95 % CI = 0.97-1.53, P = 0.09) and European studies (Subtotal OR = 1.16, 95 % CI = 0.91-1.48, P = 0.23).
CONCLUSIONS: Our results demonstrate that SNP rs143383 of GDF5 is a compelling risk factor for both knee and hand OA, and provide further support for GDF5 in the etiology of OA. Further efforts to identify functional variants of GDF5 in in vitro and in vivo will be required. |
0 | Review of current understanding of post-traumatic osteoarthritis resulting from sports injuries | Glenohumeral Joint OA | Certain types of joint injuries, common in athletes, are known to have a high association with the development of osteoarthritis (OA). Post-traumatic osteoarthritis (PTOA) is especially debilitating due to its earlier onset than traditional OA, and its predisposition to affect a younger and more active population. Five common athletic injuries have been demonstrated to be risk factors for the development of OA. These include ACL rupture, meniscus tear, glenohumeral instability, patellar dislocation, and ankle instability. Though the mechanisms responsible for the development of PTOA are not entirely clear, certain kinematic, biologic, and mechanical factors have been implicated. In addition, there has been an increased emphasis on development of new methods to detect early OA changes in patients with known risk factors, as early intervention may prevent the development of end-stage OA. New imaging modalities as well as the identification of specific biomarkers may allow earlier detection. Though these developments hold promise, it is not entirely known what steps we can take today to prevent the future development of OA, even with early detection. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:397-405, 2017. |
0 | Impact of high-volume disease in Asian population with newly diagnosed metastatic prostate cancer | MSTS 2022 - Metastatic Disease of the Humerus | Purpose: The purpose of this study is to investigate the clinical oncological outcomes and prognostic factors of high-volume disease (HVD) in the Asian population with metastatic hormone-sensitive prostate cancer. Methods: We retrospectively analyzed 503 patients with newly diagnosed metastatic prostate cancer. Patients were classified as HVD if visceral metastases were present and/or =4 bone lesions with =1 lesion beyond the vertebral bodies and pelvis. Overall survival (OS) and cancer-specific survival were investigated based on the disease burden. The Cox proportional hazards regression model was used to evaluate the prognostic factors. Results: About 50.7% patients were classified as low-volume disease (LVD) and 49.3% were HVD at diagnosis. The medians of OS and cancer-specific survival were 64 and 116 months, respectively, for patients with LVD and 26 and 46 months, respectively, for men with HVD (both P < 0.001). Among patients with HVD, 76.6% had both high-volume bone disease (HBD) (=4 bone metastases) and appendicular bone involvement. There was no significant difference in both OS and cancer-specific survival between patients with visceral metastases and those with HBD combined with appendicular bone involvement. In the multivariable analysis, presence of Gleason score =8, HBD, or HVD may predict poorer OS and cancer-specific survival outcomes (all P < 0.05). Conclusions: Asian patients with high-volume metastatic prostate cancer had a larger proportion of HBD with appendicular bone involvement, who had a comparably poor prognosis to those with visceral metastases. Patients with HBD or HVD had reduced survival outcomes. |
1 | Heparin, low molecular weight heparin and physical methods for preventing deep vein thrombosis and pulmonary embolism following surgery for hip fractures (Cochrane review) [with consumer summary] | Management of Hip Fractures in the Elderly | BACKGROUND: Hip fracture patients have a high risk of thrombo-embolic complications following surgical management. OBJECTIVES: To examine the effects of heparin (unfractionated (U), and low molecular weigh t (LMW) heparins), and physical methods (compression stockings, calf or foot pumps) for prevention of deep venous thrombosis (DVT) and pulmonary embolism after surgery for hip fracture in the elderly. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised register (up to March 2002), MEDLINE (1966 to March 2002), EMBASE (1980 to March 2002), CINAHL (1982 to February week 4 2002), Current Contents (1993 week 26 to 2002 week 12), reference lists of published articles and contacted trialists and other workers in the field. Date of most recent search: March 2002. SELECTION CRITERIA: Randomised and quasi-randomised trials evaluating the use of heparins and physical agents for prevention of DVT and pulmonary embolism in patients undergoing surgery for hip fracture. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed methodological quality and extracted data. Trials were grouped into five categories (heparin versus control, mechanical versus cont rol, LMW heparin versus U heparin, heparin versus mechanical, and miscellaneous) and results pooled where possible. MAIN RESULTS: The 31 included trials involved at least 2958 predominantly female and elderly patients. Overall, trial quality was disappointing. Ten trials involving 826 patients which compared U heparin with control, and five trials of 373 patients which compared LMW heparin with control, showed a reduction in the incidence of lower limb DVT (124/474 (26%) versus 219/519 (42%); relative risk (RR) 0.60; 95% confidence interval (CI) 0.50 to 0.71). There were insufficient data to confirm the efficacy of either agent in the prevention of pulmonary embolism. There was no statistically significant difference in overall mortality (42/356 (12%) versus 38/374 (10%); RR 1.16; 95%CI 0.77 to 1.74). Data were inadequate for all other outcomes including wound complications. There is insufficient evidence from five trials, involving 644 patients, to establish if LMW heparin was su perior to U heparin. Most trials evaluating heparins had methodological defects. Five trials, involving 487 patients, testing mechanical pumping devices were also methodologically flawed, and so pooled results need to be viewed cautiously. Mechanical pumping devices may protect against DVT (16/221 (7%) versus 52/229 (22%); RR 0.31; 95%CI 0.19 to 0.51) and pulmonary embolism. Data were insufficient to establish any effect on the incidence of fatal pulmonary embolism and overall mortality. Problems with skin abrasion and compliance were reported. AUTHORS' CONCLUSIONS: U and LMW heparins protect against lower limb DVT. There is insufficient evidence to confirm either protection against pulmonary embolism or an overall benefit, or to distinguish between various applications of heparin. Foot and calf pumping devices appear to prevent DVT, may protect against pulmonary embolism, and reduce mortality, but compliance remains a problem. Good quality trials of mechanical methods as well as di rect comparisons with heparin and low dose aspirin should be considered |
1 | Use of screening nerve conduction studies for predicting future carpal tunnel syndrome | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | Objective: To determine if an abnormal sensory nerve conduction study consistent with median mononeuropathy in asymptomatic workers was predictive of future complaints of the hand or finger suggestive of carpal tunnel syndrome. Methods: This was a case-control study of over 700 active workers at five different work sites: four sites involved manufacturing workers and one site represented clerical workers. Patients' reports of symptoms of pain, numbness, tingling, or burning in the hand or finger that lasted more than one week or occurred three or more times after the initial screening were investigated. 77 cases were defined as asymptomatic workers with electrodiagnostic findings of median mononeuropathy in either hand based on a comparison of median and ulnar sensory evoked peak latencies. A difference (less-than or equal to) 0.5 ms was defined as abnormal; a normal difference was (less-than or equal to) 0.2 ms. Controls were asymptomatic age, and sex matched workers with normal nerve conduction studies in both hands. Follow up questionnaires were completed 17 (SD 6) months later. Results: The follow up participation rate was 72%. Cases had a 12% risk of developing symptoms during the follow up period compared with 10% in the control group, (chi)(2) = 0.12, P = 0.73. Conclusions: Abnormal median sensory nerve conduction studies in asymptomatic workers were not predictive of future hand or fingers complaints and if used for preplacement screening among active workers this should be done with caution |
1 | Displaced supracondylar fractures of the humerus in children | The Treatment of Pediatric Supracondylar Humerus Fractures AUC | In a 3-year period, 101 children were admitted to hospital with supracondylar fractures of the humerus. Eight-six were examined an average of 3.7 years after the injury. Forty-seven cases were treated with closed reduction and plaster bandage. After an unsuccessful attempt at closed reduction, 39 cases were treated with percutaneous K-wire pinning and plaster. The cases treated with percutaneous pinning thus include the most severe fractures. Nevertheless, the results at follow-up in these cases easily equalled those obtained by closed reduction for the less displaced fractures. They were also comparable with reported results of extension treatment and, in contrast, required only a few days of hospitalisation |
0 | Legal disputes over informed consent for cosmetic procedures: a descriptive study of negligence claims and complaints in Australia | Panniculectomy & Abdominoplasty CPG | BACKGROUND: Plastic surgeons and other doctors who perform cosmetic procedures face relatively high risks of malpractice claims and complaints. In particular, alleged problems with the consent process abound in this area, but little is known about the clinical circumstances of these cases. METHOD: We reviewed 481 malpractice claims and serious health care complaints resolved in Australia between 2002 and 2008 that alleged failures in the informed consent process for cosmetic and other procedures. We identified all "cases" involving cosmetic procedures and reviewed them in-depth. We calculated their frequency, and described the treatments, allegations, and outcomes involved. RESULTS: A total of 16% (77/481) of the legal disputes over informed consent involved cosmetic procedures. In 70% (54/77) of these cases, patients alleged that the doctor failed to disclose risks of a particular complication, in 39% patients claimed that potential lack of benefit was not explained, and in 26% patients allegations centred on the process by which consent was sought. Five treatment types-liposuction, breast augmentation, face/neck lifts, eye/brow lifts, and rhinoplasty/septoplasty-featured in 70% (54/77) of the cases. Scarring (30/77) and the need for reoperation (18/77) were among the most prevalent adverse health outcomes at issue. CONCLUSION: A mix of factors "supercharges" the informed consent process for cosmetic procedures. Doctors who deliver these procedures should take special care to canvas the risks and possible outcomes that matter most to patients. |
0 | Relative risk factors for osteoporotic fracture: a pilot study of the MEDOS questionnaire | Management of Hip Fractures in the Elderly | This study tested selected elements of a questionnaire devised to detect risk factors for osteoporosis in a large case-control study of hip fracture. The questions were applied to two separate studies. The first utilised a hospital sample of postmenopausal women with established vertebral osteoporosis, and responses were compared to woman with primary osteoarthritis. In a second study, the questionnaire was applied to apparently healthy women participating in a study of bone density. Significant differences between patients with osteoporosis and osteoarthritis were observed in body mass index, the prevalence of appendicular fractures, the degree of immobilisation, the age of menarche, exposure to sunlight and indices of physical activity. Significant differences were found in bone mass in healthy women divided according to the age of menarche, parity and duration of lactation. These data identify previously established risk factors for osteoporosis and suggest that the MEDOS questionnaire will provide a powerful tool for the future assessment of risk factors in osteoporosis |
0 | Cemented and uncemented total hip arthroplasty using the same femoral component | PJI DX Updated Search | Purpose: The purpose of this study was to evaluate the same femoral component after cemented and uncemented total hip arthroplasty. The results were compared in terms of hip scores, subsidence, and survivorship. Methods: Between 1986 and 1996, 1017 primary THAs were implanted in 882 patients using the same porouscoated, titanium-alloy, femoral component. 507 cemented stems (441 patients) and 510 uncemented stems (441 patients) were compared. The primary diagnosis was osteoarthritis in 866 hips (85%). 541 patients were female (61%). The clinical results were evaluated based on the Harris hip score. Radiographs were evaluated at each follow-up for stem subsidence and loosening. Kaplan-Meier survival analysis was used to determine stem survivorship. The average follow-up of the entire cohort was 13.2 years (range, 2-26 y). Results: The average Harris Hip Scores at 20 years follow-up was 87 points in the cemented group and 85 points in the uncemented group. Pain scores averaged 42 and 38 in the cemented and uncemented group, respectively, at 20 years. There were 6 loose stems identified in the cemented group (1.2%) and 2 loose stems in the uncemented group (0.4%). Cemented and uncemented stem survivorship at 20 years was 98.1% and 99.6%, respectively. There was no difference in cemented or uncemented stem survivorship at any time period. Conclusions: Although there were more cases of aseptic cemented femoral component loosening, there was no significant difference in stem survivorship out to 20 years whether this stem was implanted with or without cement |
0 | Effects of the inhibition of RANKL in pre-menopausal early breast cancer patients | MSTS 2018 - Femur Mets and MM | INTERVENTION: Trade Name: XGEVA Pharmaceutical Form: Solution for injection INN or Proposed INN: DENOSUMAB CAS Number: 615258â?40â?7 Other descriptive name: XGEVA Concentration unit: mg milligram(s) Concentration type: equal Concentration number: 120â? CONDITION: Therapeutic area: Diseases [C] â? Cancer [C04] We have designed this study to investigate if denosumab can modulate a number of biological processes including prolferation, RANK signaling and the mammary stem cell subpopulation. ; MedDRA version: 19.0 Level: LLT Classification code 10006190 Term: Breast cancer invasive NOS System Organ Class: 100000004864 PRIMARY OUTCOME: Main Objective: To determine if a short course of RANKL inhibition with denosumab can induce a decrease in proliferation rates as determined by KI67 immunohistochemistry (IHC) in newly diagnosed, early stage breast cancer in preâ?menopausal women Primary end point(s): Geometric mean change in Ki67 response assessed by immunohistochemistry from baseline to prior to surgery Secondary Objective: â?To determine the number of absolute Ki67 responders; â?To determine the effects of denosumab on serum Câ?terminal telepeptide levels ; â?To determine the effects of denosumab on RANK/RANKL gene expression and signaling ; â?To determine the effect of denosumab on tumor apoptosis rates using IHC.; â?To determine the effect of denosumab on modulating the immature mammary epithelial cell populations ; â?To determine the effect of on estrogen signaling pathways ; â?To determine the effect of denosumab on various immune functions, particularly modulation of T regulatory cells ; â?To determine effect of safety profile of denosumab; â?To determine these relative changes described above in surrounding serial normal tissue biopsies; â?To compare the relative changes in surrounding normal tissue to that occuring in the serial tumor biopsies; â?To determine relative changes according to subgroups defined on PgR status and on RANKL status; â?To determine the above changes taking phase of menstrual cycle; Timepoint(s) of evaluation of this end point: Surgery SECONDARY OUTCOME: Secondary end point(s): â? Absolute Ki67 responders after a short course of denosumab treatment, defined as below 2.7% Ki67 IHC staining in the post treatment tumor biopsy ; â? Decrease in serum Câ?terminal telepeptide (CTX) levels ; â? Change in RANK/RANKL gene expression and signaling as assessed by immunohistochemistry (IHC) and gene expression profile in the tumor. ; â? Change in tumor proliferation rates using gene expression (single genes and gene modules, i.e. AURKA, Kiâ?67, and proliferationâ?related gene modules, ie. GGI) in the tumor ; â? Change in tumor apoptosis rates as measured using TUNEL and caspaseâ?3 IHC from baseline to prior to surgery ; â? Change in expression levels from genes corresponding to immature mammary epithelial cell populations (MaSCs and luminal progenitors developed by Lim et al; Nature 2009), and in IHC expression of ALDH1, a stem cell marker in the tumor. ; â? Change in expression levels from single genes related to the estrogen pathways (i.e. ESR1, PgR, BCL2 using both gene expression and IHC) and estrogenâ?related gene expression modules (i.e. ESR module) in the tumor ; â? Change in expression levels from single genes related to immune pathways using both gene expression and IHC, and in immuneâ?related gene expression modules. This will be done to explore the hypothesis that RANKL can modulate T regulatory cells in the tumor. ; â? Change in the quantity of tumor infiltrating lymphocytes as measured by percentage infiltration of surrounding tumor stroma and intraâ?tumoral on the H&E slide pre and post treatment ; â? Safety and tolerability of a short course of denosumab. ; â? The above endpoints will also be characterized in the paired samples of surrounding normal tissue ; â? The above endpoints in surrounding normal tissue will be compared to that occurring in the serial tumor tissue biopsies ; ; Subgroup analyses will also be performed according to: ; â? PgR sta us (positive vs negative) ; â? RANKL status (IHC high vs low) in normal breast tissue, in infiltrating cells or stroma and in tumor tissue ; â? RANK status ( IHC high vs low ) in tumor and normal tissue ; â? According to stage of menstrual cycle (luteal or follicular) ; Timepoint(s) of evaluation of this end point: end of the study INCLUSION CRITERIA: 1) Female gender 2) Age = 18 years 3) Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1 4) Premenopausal status defined as the presence of active menstrual cycle or normal menses during the 6 weeks preceding the start of study treatment. Plasma levels of estradiol, FSH and LH are required to document phase of menstrual cycle. In women previously exposed to hysterectomy, or were using hormonal intrauterine device at the time of enrollment, premenopausal levels of estradiol, FSH and LH are required to be eligible 5) Non metastatic operable newly diagnosed primary invasive carcinoma of the breast that is: a. Histologically confirmed b. Primary tumor size greater than 1.5 cm, measured by any of clinical examination, mammography, ultrasound or magnetic resonance imaging c. Any clinical nodal status d. Fully operable and not fixed to chest wall. 6) Known HER2 status 7) Known estrogen receptor status (ER) and p |
1 | Intermediate follow-up of high tibial osteotomy: a comparison of two techniques | Non-Arthroplasty Treatment of Osteoarthritis of the Knee AUC | All high tibial osteotomies (HTOs) performed in the Royal Bournemouth Hospital from June 1987 to February 1995 were retrospectively analyzed looking at the preoperative and postoperative radiographs, preoperative and postoperative range of motion (ROM), alignment, and knee scores. Patient perception was also recorded. In all there were 68 high tibial osteotomies (HTOs), of which 40 were performed by Maquet's dome method and 28 were done by closing wedge osteotomy. Average follow up was 8.6 years (range: 5.2 to 13 years) and 16 (23.5%) cases went on to have total knee arthroplasty after an average interval of 3.7 years. The results of the two methods are compared. Average preoperative HTO alignment was a varus of 4.72 degrees and average postoperative HTO alignment was a valgus of 1.48 degrees. The average radiological grade of osteoarthritis and compartments affected was comparable in the two groups. Overall 35 (51.5%) patients were dissatisfied with their results. A larger percentage of people (57.5%) who had a Maquet's dome osteotomy were unhappy with their operation as compared to 42.9% of people who were unhappy following a closing wedge osteotomy. There was consistent undercorrection after dome osteotomy, with an average alignment of a varus of 1.45 degrees compared to a valgus of 5.67 degrees after a closing wedge procedure. The preoperative subluxation was greater in the patients with a relatively poor result, 3.86 mm compared to 2.03 mm in those with a good result. It is felt that the rather poor results following osteotomy in this series was due to insufficient correction obtained and the advanced stage of osteoarthritis resulting in subluxation. In this series the correction obtained with closing wedge method was better than with the dome method, although it was inadequate with both methods. Although the wedges appeared to do better than the domes, this was not statistically significant. Overall, there was no significant correlation of our results with post osteotomy alignment. Preoperative lateral tibial subluxation was, however, a poor prognosticator of results |
0 | Smoking, antioxidant vitamins, and the risk of hip fracture | Management of Hip Fractures in the Elderly | Smoking increases the concentrations of free radicals, which have been suggested to be involved in bone resorption. We examined whether the dietary intake of antioxidant vitamins may modify the increased hip fracture risk associated with smoking. We prospectively studied 66,651 women who were 40-76 years of age. Forty-four of the cohort members who sustained a first hip fracture within 2-64 months of follow-up (n = 247) and 93 out of 873 age-matched controls were current smokers. Information on diet was obtained by a validated food-frequency questionnaire. The relative risk of hip fracture for current versus never smokers was analyzed in relation to the dietary intake of antioxidant vitamins stratified into two categories (low/high), where median intakes among the controls were used as cut-off points. After adjustment for major osteoporosis risk factors, the odds ratio (OR) for hip fracture among current smokers with a low intake of vitamin E was 3.0 (95% confidence interval 1.6-5.4) and of vitamin C 3.0 (1.6-5.6). In contrast, the OR decreased to 1.1 (0.5-2.4) and 1.4 (0.7-3.0) with high intakes of vitamin E and C, respectively. This effect was not seen for beta-carotene, selenium, calcium, or vitamin B6. In current smokers with a low intake of both vitamins E and C, the OR increased to 4.9 (2.2-11.0). The influence of the intake of these two antioxidant vitamins on hip fracture risk was less pronounced in former smokers. Our results suggest a role for oxidant stress in the adverse effects on the skeleton of smoking, and that an insufficient dietary intake of vitamin E and C may substantially increase the risk of hip fracture in current smokers, whereas a more adequate intake seems to be protective |
0 | Distal Femoral Osteotomy: Lateral Opening Wedge Technique | OAK 3 - Non-arthroplasty tx of OAK | Coronal limb malalignment is a significant contributor to asymmetric joint wear, gait abnormalities, and the development and progression of degenerative joint disease. Osteotomies about the knee were developed to realign the mechanical axis of the limb to unload the affected compartment. Valgus malalignment is less common than varus malalignment, but can contribute to a variety of clinical conditions, including lateral compartment cartilage defects and arthritis, lateral patellofemoral instability, and medial collateral ligament laxity. In this article, we describe our preferred operative technique for a lateral opening wedge varus-producing distal femoral osteotomy to correct mild to moderate valgus malalignment. |
0 | Prevalence and clinical outcomes of hip fractures and subchondral insufficiency fractures of the femoral head in patients with tumour-induced osteomalacia | Hip Fx in the Elderly 2019 | PURPOSE: Tumour-induced osteomalacia (TIO) is a rare paraneoplastic syndrome usually caused by phosphaturic mesenchymal tumours, leading to great distress due to bone pain and affecting quality of life (QoL). This study aimed to investigate the prevalence and clinical outcomes of hip fractures and subchondral insufficiency fractures (SIF) of the femoral head.
METHODS: Twelve TIO patients were treated between January 2000 and December 2016 at our hospital. All underwent surgery for the tumour causing TIO, and complete removal of the tumour was accomplished in nine of 12 cases. Plain radiographs of the hip were obtained in all cases, and magnetic resonance imaging (MRI) was obtained from 15 hips representing eight patients before tumour removal. We evaluated the prevalence of hip fractures or SIF and their clinical outcomes.
RESULTS: Hip fractures were observed in six of 12 cases, and the total number of fractures was nine, of which five were femoral neck, two were intertrochanteric and two were subtrochanteric fractures. Conservative treatment, regardless of complete remission of TIO, was successful except in one case with impending subtrochanteric fracture. SIFs were observed in 11 of 24 hips. Seven of 11 hips with SIF showed progression after surgery for tumour resection.
CONCLUSIONS: Hip fractures and SIF are highly prevalent in TIO patients. Surgical and medical treatment for TIO is sufficient for treating hip fractures conservatively. However, SIF tends to show progression of femoral head collapse, serving as the main cause of pain after successful TIO treatment. |
0 | Analgesia after total knee arthroplasty: is continuous sciatic blockade needed in addition to continuous femoral blockade? | AAHKS (8) Anesthetic Infiltration | Continuous femoral "3-in-1" nerve blocks are commonly used for analgesia after total knee arthroplasty (TKA). There are conflicting data as to whether additional sciatic blockade is needed. Our routine use of both continuous femoral (CFI) and sciatic (CSI) peripheral nerve blocks was changed because of concerns that sciatic blockade, and its motor consequences in particular, might obscure diagnosis of perioperative sciatic nerve injury. The revised protocol includes placing single-shot blocks and perineural catheters at both sites, but infusing local anesthetic postoperatively only in the CFI. CSI is reserved for patients having poorly controlled posterior knee or calf pain. A sample group of 12 patients treated with this protocol was followed. Ten of 12 patients required use of the CSI. Within 1 h of a 5-10 mL CSI bolus of 0.2% ropivacaine and beginning an infusion of the same drug at 5 mL/h, patients' median pain by verbal analog scale decreased from 7.5 to 2.0 (mean scores from 7.3 to 2.4). It was possible to maintain this level of analgesia until the third postoperative day when catheters were discontinued. Our experience suggests that, in most patients, adequate analgesia after TKA cannot be achieved with CFI alone and that the addition of CSI renders a significant improvement in analgesia. |
0 | Breast and Body Contouring for Transgender and Gender Nonconforming Individuals | Panniculectomy & Abdominoplasty CPG | Even after long-term hormone therapy, many transwomen still have challenges in the size and shape of their breasts and also of the contour of their trunk areas. Though distinct anthropomorphic differences in skeletal structure exist and pose limitations to an ideal result, considerable improvements can be obtained through breast augmentation and trunk feminization. There are challenges that are unique to the transfeminine chest and trunk, and important considerations for the priority of fat grafting to the buttocks and hips when grafted fat is in short supply. |
1 | Bone-targeted therapy use in patients with bone metastases from lung cancer: A systematic review of randomized controlled trials | MSTS 2018 - Femur Mets and MM | Background Patients with advanced lung cancer commonly have bone metastases. Compared with other malignancies, the use of bone-targeted agents (e.g. bisphosphonates and denosumab) is less common in lung cancer patients. This may be due to the perception that bone-targeted agents are less effective in this population. Objective To perform a systematic review to evaluate data from randomized trials of bone-targeted agents in lung cancer patients with bone metastases. Methods A systematic search of Medline, Embase and the Cochrane Register of Controlled Trials through May 2015 was performed. Randomized trials of bone-targeted therapies in lung cancer patients with bone metastases were sought. Outcomes studied included skeletal related events (SREs), pain, quality of life, progression-free survival and overall survival. Random effects meta-analyses were planned if studies were judged homogeneous. Results Of 632 abstracts, 17 publications describing 13 studies were included. Sample sizes ranged between 50 and 1776. Of 3379 patients, 1903 had lung cancer, with subgroup data available for 8 of 13 studies. Patient demographics were comparable, but enrollment criteria and endpoints were heterogeneous across studies, precluding meta-analysis. Study-specific results suggested that bone-modifying agents reduce the incidence of SREs and bone pain in lung cancer patients. Three studies suggested a survival benefit. Conclusion Data from included trials suggests benefit of bone-targeted agents in lung cancer for the prevention of SREs and bone pain. There is a trend toward improvement in overall survival and progression-free survival, although further research is needed. Impact on quality of life and key subgroups for benefit both require future research. |
0 | Medial opening-wedge high tibial osteotomy fixation with short plate without any graft, synthetic material or spacer | OAK 3 - Non-arthroplasty tx of OAK | PURPOSE: Medial opening-wedge high tibial osteotomy (MOWHTO) is an effective surgical procedure for patients who have medial compartmental osteoarthritis of the knee with varus deformity of the limb. The abnormal load on the medial compartment of the knee is directed to the lateral compartment with this procedure. A gap occurs on the proximal tibia while providing adequate correction. Filling this gap with bone grafts or synthetic materials has gained wide acceptance for preventing bone union problems or osteotomy site collapse. The aim of this study is to report our results of MOWHTOs performed without any bone graft or any other synthetic materials.
METHODS: We evaluated 41 MOWHTOs that have been performed between 2009 and 2012 with no use of any grafts or synthetic materials and spacer. Age of the patients ranged from 43 to 67. Thirty-five of the patients were females and three of them were males. The follow-up time was 6 months.
RESULTS: Seven knees had opening at the osteotomy site <10 mm, 26 knees had 10-12.5 mm, and eight knees had >12.5 mm (range 7.5-14 mm, mean 11.07 mm). All osteotomies united without loss of correction. The mean bone union time was 12.8 weeks. We did not have any major complication regarding the technique.
CONCLUSION: The results of our study have shown that we can achieve satisfactory and good results by performing MOWHTO procedure without using any bone grafts or synthetic materials and spacer. |
0 | Reduction mammaplasty: a comparison between the Robbins and Pontes techniques | Reduction Mammoplasty for Female Breast Hypertrophy | The purpose of this paper is to propose a practical classification of mammary hypertrophy and compare perioperative factors in two types of reduction mammaplasty: the Pontes and Robbins techniques. In a series of 51 patients, the advantages and disadvantages of each method are compared and discussed. The Pontes method appears to be better for the low-volume and ptotic (type II and III) breast, whereas the Robbins technique has a more universal application. |
0 | Contemporary demographics and complications of patients treated for open ankle fractures | DOD - Acute Comp Syndrome CPG | Open ankle fractures are rare injuries with a high likelihood of wound complications and subsequent infections. There is limited information about the complications and outcomes of these injuries in different age groups. The aim of this study was to assess the contemporary demographics and complications related to this injury. We performed a chart review of all the 3030 patients treated for ankle fractures at a Level 1 trauma centre from 2006 to 2011. 137 (4.5%) patients had an open ankle fracture. The demographic data, injury mechanism, comorbidities, and fracture type were collected. Treatment, complications, length of stay and number of outpatient visits were also recorded. The mean age of the patients was 60 years and 56% were women. Most fractures were Weber type B with a medial sided wound (93%). Only 20% of the fractures were the result of high-energy trauma, and 31% were Gustilo grade III injuries. Immediate internal fixation was performed in 82% of patients, and the wound was primarily closed in most cases (80%). The incidence of postoperative wound necrosis and deep infection was 18% and 17%, respectively. There were more deep infections if pulsatile lavage was used during the wound debridement (p = 0.029). About 14 (10%) patients required a flap reconstruction to cover the soft-tissue defect. Every other patient (54%) had a complication, and 21 patients (15%) suffered a long-term disability related to the injury. The number complications did not differ for nighttime and daytime operations (p = 0.083). High-energy injuries were more common in younger patients (p < 0.001) and these patients also had more lateral sided open wounds than older patients (p = 0.002). Interestingly, younger patients also had significantly more complications (p = 0.024), suffered more often from chronic pain (p = 0.003), and required more flap reconstructions (p = 0.026), reoperations (p = 0.026), and outpatient clinic visits (p = 0.006). Open ankle fractures have a high complication rate and often require multiple surgical procedures. In young patients these injuries are more likely to be the consequence of high-energy trauma leading to more complications and subsequently increased healthcare resource utilisation. |
0 | Temporal in vivo assessment of fresh osteochondral allograft transplants to the distal aspect of the femur by dGEMRIC (delayed gadolinium-enhanced MRI of cartilage) and zonal T2 mapping MRI | OAK 3 - Non-arthroplasty tx of OAK | BACKGROUND: Zonal T2 mapping and dGEMRIC (delayed gadolinium-enhanced magnetic resonance imaging of cartilage) are diagnostic quantitative techniques to evaluate the biochemical health of articular cartilage. We adapted these techniques to investigate the results of osteochondral allograft transplantation and correlated the findings with patient-reported outcomes.
METHODS: Nine patients with contained ICRS (International Cartilage Repair Society) grade-4 defects of the articular portion of a femoral condyle were treated with fresh osteochondral allografts and were evaluated prospectively with dGEMRIC and T2 mapping before and after gadolinium administration. The KOOS (Knee Injury Osteoarthritis Outcome Score) and IKDC (International Knee Documentation Committee) subjective scores were obtained at baseline and at one and two years postoperatively. For quantitative T2 mapping, regions of interest were drawn in the deep and superficial layers of allograft and control cartilage. For dGEMRIC analyses, the relaxation rate, post-gadolinium change in relaxation rate, and ratio between changes in the allograft and control regions of interest were calculated from T1 values.
RESULTS: The mean ratio between the post-gadolinium changes in the allograft and control cartilage was 1.13 at one year and 1.55 at two years, and the ratio increased in eight of nine patients from one to two years. There was no difference between the mean T2 values in the deep zone of the allograft and control cartilage at one or two years (p > 0.05), but mean T2 values were higher in the superficial zone of the allograft cartilage at one (p < 0.0001) and two (p < 0.028) years. The mean improvement from baseline was significant at one and two years for the IKDC and all five KOOS subdomains (p < 0.05). All or nearly all patients showed improvements in all clinical outcomes scores at one year.
CONCLUSIONS: Functional MRI techniques can be applied to noninvasively assess the biochemical health of cartilage after osteochondral allograft transplantation. The MRI findings correlated with certain patient-reported outcomes in the early postoperative period. Relative glycosaminoglycan content and the collagen structure of allograft cartilage may undergo time-dependent degeneration. A patient's perception of clinical outcome and quality of life is likely multifactorial and is impacted by more than the health of the allograft cartilage. |
0 | Efficacy of 10% Povidone Iodine in children affected with early childhood caries: an in vivo study | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | For prevention of dental caries, S. mutans numbers must be reduced and prevented from returning to the original level. An antibacterial agent that is effective and also acceptable to young children can help to establish a favorable oral environment and halt the caries process. PURPOSE: This study was conducted to evaluate the efficacy of topical antimicrobial (10% Povidone- Iodine) on S. mutans counts in children with Early Childhood Caries after full mouth rehabilitation. Also its effects on the clinical outcomes in terms of incidence of new caries and secondary caries were evaluated. METHOD: Full mouth rehabilitation was done in 30 children (mean age 4.2 years) suffering from Severe Early Childhood Caries (SECC). Stimulated saliva samples were collected to determine the post operative baseline S. mutans counts. Thereafter the subjects were randomly divided into two groups. The experimental group received 10% Povidone Iodine at 3 months interval for a period of 12 months while the control group received placebo (deionized water) at similar intervals. Change in the S.mutans count at 6 and 12 month intervals were compared to the baseline post-operative mutans score. Results revealed that application of 10% Povidone Iodine caused a significant reduction in the rise of Streptococcus mutans levels from the baseline postoperative score after 12 months of treatment thus decreasing the oral load of the organisms. Reduction in counts; in turn decreased the relapse of caries in these children. CONCLUSION: Thus oral rehabilitation coupled with regular application of 10% Povidone Iodine application can be a good alternative to control dental caries in children affected with Early Childhood Caries (ECC) |
0 | Dehydration, Hypernatremia, and Hyponatremia | Hip Fx in the Elderly 2019 | Disturbances of serum sodium are one of the most common findings in older persons. They are also a major cause of hospital admissions and delirium and are associated with frailty, falls, and hip fractures. Both hypernatremia and hyponatremia are potentially preventable. Treatment involves treating the underlying cause and restoring sodium and volume status to normal. The arginine vasopressin antagonists, vaptans, have increased the therapeutic armamentarium available to physicians. |
0 | Use of Vascularized Fibular Free Flap in the Reconstruction of the Femur in Pediatric and Adolescent Bone Sarcomas: Complications and Functional Outcome | Pediatric Diaphyseal Femur Fractures 2020 Review | BACKGROUND: â??Most reports on skeletal reconstruction using vascularized fibular free flap include patients with varying age groups and anatomic locations. This study has limited the inclusion criteria to pediatric and adolescent patients diagnosed with bone sarcoma of the femoral shaft. METHODS: â??Forty-one patients, diagnosed with a malignant bone tumor of the femoral shaft (21 Ewing's sarcomas and 20 osteosarcomas), were locally treated by joint sparing wide resection and reconstruction using a vascularized fibular free flap. All clinical and radiographic data were reviewed for graft healing and hypertrophy as well as oncologic and functional outcome. RESULTS: â??The mean follow-up period was 48.7 months (12-104 months). The mean age at presentation was 10.3 years (5-17 years). The average length of the resected femoral shaft was 19.2 cm (15-24 cm) and the average length of the harvested fibula was 17.4 cm (15-21 cm). The mean time to union was 4.8 months (1-6 months) and the mean hypertrophy index was 78% (15.5-184%). Complications included 12 fractures (33.3%), 5 non-unions (13.8%), and 5 failures of graft hypertrophy (13.8%). At the latest clinical evaluation, the mean MSTS score was 81% (56-100%) and the mean limb length inequality was 4.75 cm (3-11 cm). CONCLUSION: â??Despite the high functional demand and deleterious effect of chemotherapy on bone healing, reconstruction of the femur by vascularized fibular free flap in pediatric bone sarcomas can lead to a good functional outcome. Complications, such as fracture and non-union, can be successfully treated by revision of fixation and autologous iliac crest grafting. LEVEL OF EVIDENCE: â??IV. |
1 | Avascular necrosis after surgical treatment for development dysplasia of the hip | Developmental Dysplasia of the Hip CPG | We reviewed the medical records of 101 patients with developmental dysplasia of the hip who were treated with Dega's (102 hips), or Salter's (42 hips)osteotomy preceded by open reduction and femoral intertrochanteric osteotomy. The minimal follow-up was 17 years. At the last follow-up, there were proximal fem-oral growth disturbances in 52 hips (36%). In 20 hips, the disturbances were graded as mild and in six as severe. We found significantly better clinical and radiological results in hips without avascular changes. Risk factors for the development of avascular necrosis were: involvement of the left side and surgical treatment initiated after 2 years of age without pre-operative traction and without femoral shaft shortening. We found that the incidence of avascular necrosis increased with the length of follow-up. The avascular necrosis influenced both clinical and radiological results |
0 | An integer programming model for distal humerus fracture fixation planning | The Treatment of Pediatric Supracondylar Humerus Fractures AUC | OBJECTIVE: To demonstrate the feasibility of an integer programming model to assist in pre-operative planning for open reduction and internal fixation of a distal humerus fracture. MATERIALS AND METHODS: We describe an integer programming model based on the objective of maximizing the reward for screws placed while satisfying the requirements for sound internal fixation. The model maximizes the number of bicortical screws placed while avoiding screw collision and favoring screws of greater length that cross multiple fracture planes. RESULTS: The model was tested on three types of total articular fractures of the distal humerus. Solutions were generated using 5, 9, 21 and 33 possible screw orientations per hole. Solutions generated using 33 possible screw orientations per hole and five screw lengths resulted in the most clinically relevant fixation plan and required the calculation of 1,191,975 pairs of screws that resulted in collision. At this level of complexity, the pre-processor took 104 seconds to generate the constraints for the solver, and a solution was generated in under one minute in all three cases. CONCLUSION: Despite the large size of this problem, it can be solved in a reasonable amount of time, making use of the model practical in pre-surgical planning |
0 | Determinants of incidence of osteoporotic fractures in the female Spanish population older than 50 | Distal Radius Fractures | It is well known that the adoption of preventive measures for osteoporosis may contribute to minimizing its impact as a result of bone fractures. However, there are well-recognized risk factors involved in the onset of osteoporosis that are not possible to modify. Better knowledge of these non-modifiable factors could aid prevention in subjects at high risk of fractures. The aim of this study was to evaluate the likely association between gynecological, reproductive and family history of hip fracture with the incidence of vertebral and nonvertebral osteoporotic fractures in women older than 50. We studied 255 women aged 50 and over, randomly selected from a Spanish population that had participated in a study of prevalence of vertebral fractures (EVOS study). This cohort was prospectively followed for 8 years by means of four postal questionnaires, in order to find out the incidence of nonvertebral fractures. Concerning the incidence of vertebral fractures, participants were invited to repeat the lumbar spine X-rays 4 years after the initial study. A total of 31 women had incident osteoporotic fractures. The analysis of gynecological variables showed that an increase in the age at menarche was a risk factor for all incident osteoporotic fractures [OR=1.57 (1.04-2.37)]. The presence of amenorrhea at any age during the fertile period was associated with higher incidence of all osteoporotic fractures [OR=6.30 (1.61-24.70)]. Among all the reproductive variables analyzed (pregnancy, number of live births and breast-feeding) only pregnancy was an important protective factor in preventing incident Colles fracture [OR=0.15 (0.03-0.62)]. A family history of hip fracture was associated with a higher incidence of all osteoporotic fractures [OR=3.59 (1.01-12.79)]. In summary, a late age at menarche, the presence of amenorrhea and having close relatives with hip fracture were all risk factors which, independently of bone mineral density (BMD) and age, were associated with higher incidence of all osteoporotic fractures. Pregnancy was an important protective factor for the incidence of Colles fractures. |
0 | Osteoporosis, falls, and age in fracture of the proximal femur | Management of Hip Fractures in the Elderly | The relative importance of osteoporosis and risk of falling in causing hip fracture is not known. Femoral neck bone mass was measured in 708 elderly people, all of whom had fallen and injured a hip. Below 75 years of age there was a steep increase in relative risk of fracture with reduced bone mass, measured by Singh grade. Above that age the increase in risk was small, and neuromuscular responses which protect the skeleton against trauma may be more important than bone mass |
0 | Molecular alterations of bone quality in sequesters of bisphosphonates-related osteonecrosis of the jaws | MSTS 2018 - Femur Mets and MM | UNLABELLED: Compared to healthy bone, the intrinsic bone materials properties in the pre-existing lamellar bone are altered in jaw bone sequesters of bisphosphonates (BP)-related osteonecrosis.
INTRODUCTION: The aim of this study was to evaluate the human jaw bone quality, especially intrinsic bone material properties among sequesters of osteonecrosis of the jaw (ONJ) induced by BP.
METHODS: Bone sequesters were obtained from 24 patients suffering from ONJ following a BP treatment. Within BP-exposed bone samples, benign-BP and malignant-BP groups were distinguished in relation to the underlying disease: osteoporosis and bone metastases or multiple myeloma, respectively. Healthy cadaveric cortical jaw bone samples were used as controls. The physicochemical parameters of bone samples - mineral/organic ratio, relative proteoglycan content, crystallinity, monohydrogen phosphate content, and type-B carbonate substitution - were evaluated by Raman microspectroscopy. Representative Raman spectral features of bones control and BP-exposed bone sequesters were identified with the Partial-Least-Square Discriminant Analysis (PLS-DA).
RESULTS: BP-exposed bone sequesters are characterized by a significant increase of mineral to organic ratio (+12 %) and a significant decrease of relative proteoglycan content (-35 %), thus regulating initial collagen matrix mineral deposition. Structural changes on mineral components are revealed by a significant decrease of both crystallinity (-2 %) and mineral maturation (-41 %) in the BP-exposed bone sequesters compared to healthy bones. These modifications were also observed distinctly in both benign-BP and malignant-BP groups. In addition, a shift of the phosphate v1 band was highlighted by PLS-DA between bones control and BP-exposed bone sequesters, revealing a disruption of the apatitic phosphate environment in the jaw bone sequesters.
CONCLUSIONS: The present data show that jaw bone quality can be altered with an overmineralization and ultrastructural modifications of apatitic mineral in bone sequesters of BP-related ONJ. |
0 | Analysis of complications after a floating elbow injury | Distal Radius Fractures | BACKGROUND: The aim of the present study is to analyse complications after a floating elbow injury, attempting to establish which of them act as a poor prognosis factor regarding clinical and functional results.
MATERIALS AND METHODS: Twenty-three patients who suffered a floating elbow injury, treated at our institution from 2004 to 2013, were retrospectively reviewed. Patients were divided into four groups depending on the type of injury. An analysis of demographic data, associated injuries, treatment options and complications was carried out. Clinical evaluation was made by a conventional goniometer, testing flexo-extension and prono-supination ranges. For functional evaluation, the Mayo Elbow Performance Score was employed. Association between radioulnar synostosis, articular surface disruption, nerve injury and clinical and functional results was analysed.
RESULTS: Patients with radioulnar synostosis had worse results in functional evaluation than patients without it (56.6 vs. 75); this difference was statistically significant (p = 0.05). Regarding intra-articular extension, we found statistical association with worse results in functional evaluation (p = 0.018); however, nerve palsy does not seem to influence functional results.
CONCLUSIONS: Radioulnar synostosis and intra-articular extension of the injury are poor prognosis factor in floating elbow. |
0 | Reproducibility and sensitivity to change of various methods to measure joint space width in osteoarthritis of the hip: a double reading of three different radiographic views taken with a three-year interval | Management of Hip Fractures in the Elderly | Joint space width (JSW) and narrowing (JSN) measurements on radiographs are currently the best way to assess disease severity or progression in hip osteoarthritis, yet we lack data regarding the most accurate and sensitive measurement technique. This study was conducted to determine the optimal radiograph and number of readers for measuring JSW and JSN. Fifty pairs of radiographs taken three years apart were obtained from patients included in a structure modification trial in hip osteoarthritis. Three radiographs were taken with the patient standing: pelvis, target hip anteroposterior (AP) and oblique views. Two trained readers, blinded to each other's findings, time sequence and treatment, each read the six radiographs gathered for each patient twice (time interval > or = 15 days), using a 0.1 mm graduated magnifying glass. Radiographs were randomly coded for each reading. The interobserver and intraobserver cross-sectional (M0 and M36) and longitudinal (M0-M36) reproducibilities were assessed using the intraclass coefficient (ICC) and Bland-Altman method for readers 1 and 2 and their mean. Sensitivity to change was estimated using the standardized response mean (SRM = change/standard deviation of change) for M0-M36 changes. For interobserver reliability on M0-M36 changes, the ICCs (95% confidence interval [CI]) were 0.79 (0.65-0.88) for pelvic view, 0.87 (0.78-0.93) for hip AP view and 0.86 (0.76-0.92) for oblique view. Intraobserver reliability ICCs were 0.81 (0.69-0.89) for observer 1 and 0.97 (0.95-0.98) for observer 2 for the pelvic view; 0.87 (0.78-0.92) and 0.97 (0.96-0.99) for the hip AP view; and 0.73 (0.57-0.84) and 0.93 (0.88-0.96) for the oblique view. SRMs were 0.61 (observer 1) and 0.82 (observer 2) for pelvic view; 0.64 and 0.75 for hip AP view; and 0.77 and 0.70 for oblique view. All three views yielded accurate JSW and JSN. According to the best reader, the pelvic view performed slightly better. Both readers exhibited high precision, with SRMs of 0.6 or greater for assessing JSN over three years. Selecting a single reader was the most accurate method, with 0.3 mm precision. Using this cutoff, 50% of patients were classified as 'progressors' |
0 | Fragility Fracture Risk in Elderly Patients With Cervical Myelopathy | Distal Radius Fractures | STUDY DESIGN: Retrospective review.
OBJECTIVE: To identify and compare the incidences of fragility fractures amongst three elderly populations: the general population, patients with surgically treated cervical spondylotic myelopathy (CSM), and patients with CSM not surgically treated.
SUMMARY OF BACKGROUND DATA: CSM is a common disease in the elderly. Progression of myelopathic symptoms, including gait imbalance, can be a source of morbidity as it can lead to increased falls.
METHODS: Records of elderly patients with Medicare insurance from 2005 to 2014 were retrospectively reviewed. Three mutually exclusive populations of patients were identified for analysis, including a cohort of patients with a diagnosis of CSM who were not treated with surgery; a cohort of patients with CSM who were treated with surgery; and a group of control patients who had never been treated with cervical spine surgery nor were diagnosed with CSM. Incidence of fractures of the distal radius, proximal humerus, proximal femur, and lumbar spine were assessed and compared between cohorts, adjusted by age, sex, osteoporosis, dementia, cerebrovascular disease, and Charlson Comorbidity Index.
RESULTS: A total of 891,864 patients were identified, of which 60,332 had a diagnosis of CSM and 24,439 underwent cervical spine surgery. Compared to general population controls, the 12-month adjusted odds of experiencing at least one fragility fracture were 1.59 times higher in patients with CSM who were not treated with surgery (P < 0.001). The analogous odds ratio was 1.34 (P < 0.001) at 3 years. Compared to nonsurgically treated patients with CSM, the odds of experiencing at least one fragility fracture were reduced to 0.89 in surgically treated patients (P = 0.008).
CONCLUSION: Fragility fractures are a significant source of morbidity and mortality in elderly patients. CSM is associated with increased rates of fragility fractures, although surgical management of CSM may be protective against risk of fragility fracture.
Level of evidence: 3. |
0 | Depression and post-traumatic stress disorder in individuals with hereditary hemorrhagic telangiectasia: A cross-sectional survey | DoD PRF (Psychosocial RF) | INTRODUCTION: Hereditary hemorrhagic telangiectasia (HHT) is characterized by frequent severe bleeding, particularly epistaxis, and life-threatening complications including stroke, brain abscess and heart failure. The psychological impact of HHT is not known. We conducted this cross sectional study to determine the prevalence of depression and post-traumatic stress disorder (PTSD) related to HHT.
METHODS: A survey tool comprising demographic and clinical information and two validated self-administered questionnaires, the PTSD checklist for DSM-5 (PCL-5) and Beck Depression Inventory-II (BDI-II), was distributed to individuals with HHT. Associations with clinical and demographic variables with depression and PTSD were evaluated in a logistic regression model.
RESULTS: A total of 222 individuals responded to the survey. Of these, 185 completed either the BDI II or PCL-5 and were included in the analysis. Median age was 54years and 142 (76.8%) were female. An existing diagnosis of depression, anxiety disorder and PTSD was present in 81 (43.8%), 59 (31.9%) and 16(8.6%) respondents, respectively. BDI-II scores>13 indicating at least mild depressive symptoms were present in 142 (88.7%) patients and 52 (28.1%) patients had a positive screen for PTSD (PCL-5 score>=38). On multivariable analysis, depression [OR 2.17 (95% CI 1.045-4.489), p=0.038], anxiety disorder [OR 2.232 (95% CI 1.066-4.676), p=0.033], and being unemployed [OR 2.234 (95% CI 1.46-4.714), p=0.019) were associated with PTSD.
CONCLUSION: We report a high prevalence of depressive and PTSD symptoms in individuals with HHT. While selection bias may lead to overestimation of prevalence in this study, our results are concerning and clinicians should remain vigilant for signs of psychological distress and consider screening for these disorders. |
0 | Skin retraction after liposuction in patients over the age of 40 | Panniculectomy & Abdominoplasty CPG | BACKGROUND: A commonly held misperception regarding liposuction in patients over 40 years of age is that the skin will not retract and redrape following removal of the fat. OBJECTIVE: In order to evaluate tissue retraction in the abdomen, neck, and arms in patients undergoing liposuction after 40 years of age, the following study was conducted. METHOD: A total of 58 patients ranging in age from 40 to 75 years underwent liposuction. Thirty had liposuction of the abdomen, 20 had liposuction of the neck, and 8 had liposuction of the arms. Measurements in inches and weight in pounds were recorded before and at 1, 3, and 6 months after the procedure. RESULTS: Ninety percent of the patients were women. The rest of the patients were men. The average age of the patients undergoing liposuction of the abdomen was 55 years old. The average supranatant fat extracted from these patients was 1725 ml, with an average lidocaine dose of 36 mg/kg of body weight. The patients who had liposuction of the abdomen demonstrated an average weight loss of 5 lb and a decrease of 3 inches in waistline 6 months after the procedure. For those patients who had liposuction of the neck, the average age was 57 years old. The average supranatant fat extracted from these patients was 75 ml, with an average lidocaine dose of 4 mg/kg of body weight. The patients who had liposuction of the neck decreased an average of 1.3 inches in circumference without any weight change 6 months after the procedure. For those patients having liposuction of the arms, the average age was 44 years. The average supranatant fat extracted from these patients was 525 ml, with an average lidocaine dose of 16 mg/kg of body weight. The patients who had liposuction of the arms had an average of 0.5 inch decrease in circumference without any weight change 6 months after the procedure. The cosmetic results were good to excellent. Our highest lidocaine dose occurred in a patient having suction of the abdomen and was 71 mg/kg of body weight. No patients experienced any objective or subjective signs of lidocaine toxicity. CONCLUSION: Tumescent liposuction of the abdomen, neck, and arms is a safe alternative for contour improvement with good cosmetic results in patients over 40 years of age. |
1 | A computed tomography analysis of three-dimensional glenoid orientation modified by glenoid torsion | Glenohumeral Joint OA | Background: The longitudinal axis of the glenoid is not always parallel to the scapular body, and glenoid torsion could affect the values of glenoid orientation. The purpose of this study was to evaluate 3-dimensional glenoid version and inclination modified by glenoid torsion and to clarify the differences between the values of conventional and of modified glenoid orientations.
Methods: Computed tomography scans of 30 shoulders without shoulder pathology, 30 shoulders with primary osteoarthritis, and 30 shoulders with a massive rotator cuff tear or cuff tear arthropathy were retrospectively evaluated. After determining the glenoid axis and the scapular planes and calculating conventional glenoid version and inclination, modified glenoid version and inclination, and glenoid torsion, the values of conventional glenoid orientation and those of modified glenoid orientation were compared statistically.
Results: All shoulders showed anterior torsion of the glenoid with an average of 16degree +/- 5degree. The values of modified glenoid retroversion were significantly smaller than those of conventional glenoid retroversion in all groups (P < .033), and the values of the modified glenoid inferior inclination were significantly larger than those of conventional glenoid inferior inclination in all groups (P < .001).
Conclusions: The present study showed that the glenoid twists with respect to the scapular body and that modification by glenoid torsion could affect the values of glenoid orientation. These results indicated that glenoid orientation with respect to the glenoid longitudinal axis will help surgeons determine proper placement of the glenoid component during shoulder arthroplasty. |
0 | Essential elements of the preoperative breast reconstruction evaluation | Reduction Mammoplasty for Female Breast Hypertrophy | A plethora of options exist for breast reconstruction and preoperative evaluation must be thorough to lead to a successful outcome. We review multiple components of the preoperative assessment including the patient's history, goals, imaging, and key elements of the physical exam. Consideration for tumor biology, staging, need or response to chemotherapy or radiation therapy is important in deciding on immediate versus delayed reconstruction. It is also important to consider the patient's anatomy, breast size and whether the reconstruction will be unilateral or bilateral. The reconstructive surgeon must accommodate all these factors to consider partial or complete mastectomy defects and guide the patient to the most appropriate reconstructive technique whether it be an oncoplastic reduction mammoplasty, expander-based reconstruction, immediate implant reconstruction, or immediate versus delayed autologous tissue reconstruction such as the deep inferior epigastric artery perforator (DIEP)/transverse rectus abdominis muscle (TRAM), latissimus, transverse upper gracilis (TUG)/profunda femoris artery perforator (PAP), or gluteal artery perforator (GAP) flaps. |
0 | Invasive infections of Aggregatibacter (Actinobacillus) actinomycetemcomitans | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | BACKGROUND/PURPOSE: Aggregatibacter (Actinobacillus) actinomycetemcomitans, part of the normal flora of the mouth, is frequently found in human periodontal cultures and is an important pathogen causing various invasive infections, particularly infective endocarditis. In this study, we describe the clinical course and outcome of patients with A. actinomycetemcomitans infection. METHODS: All patients suffering invasive A. actinomycetemcomitans infections at the National Taiwan University Hospital from January 1985 to December 2004 were included in this study. Relevant data regarding clinical presentation, antimicrobial treatment and outcome of these patients were analyzed. RESULTS: During the study period, there were 11 patients with invasive A. actinomycetemcomitans infections, including eight patients with infective endocarditis, one with osteonecrosis and two with pneumonia and chest wall lesions. Among the patients with infective endocarditis, four had prosthetic valve replacement, four suffered from rheumatic heart disease and one had undergone surgical repair of ventricular septal defect. Lesions in the oral cavity were the probable portals of entry of the microorganism, and included carious teeth, periodontitis or radiotherapy of the ear-nose-throat field, and were noted in nine patients. Transthoracic echocardiography and/or transesophageal echocardiography were performed on the patients with probable infective endocarditis but growth was demonstrated in only four of these patients. Blood culture yielded A. actinomycetemcomitans after prolonged incubation. Three isolates were resistant to penicillin and two of these were also resistant to ampicillin. CONCLUSION: The diagnosis of invasive A. actinomycetemcomitans infection was delayed due to the indolent clinical course, non-specific presentation and slow growth of the organism. Antibiotic therapy using amoxicillin/clavulanic acid, ampicillin, ampicillin/sulbactam, ceftriaxone, clindamycin, cefotaxime, or levofloxacin was successful in all patients. None of the patients demonstrated recurrence of infection 2-36 months following treatment |
1 | The risk for a cruciate ligament injury of the knee in adolescents and young adults: a population-based cohort study of 46 500 people with a 9 year follow-up | Anterior Cruciate Ligament Injuries CPG | OBJECTIVES: The knee joint is the most common site for injury among younger people, the injury often resulting in expensive (surgical) treatment, long-term rehabilitation and permanent functional impairment and disability. METHODS: We investigated the incidence and risk factors for a major knee-ligament injury in an adolescent Finnish population. A population-based cohort of 46 472 adolescents was followed for an average of 9 years. All patients hospitalised with the diagnosis of anterior or posterior cruciate ligament injury (ACL or PCL injury) were included in the analysis. RESULTS: 265 (0.6%) people (194 male and 71 female subjects) from the total cohort of 46 472 were treated for a cruciate ligament injury of the knee during the follow-up period, giving an injury incidence of 60.9 (95% CI 53.6 to 68.2) per 100 000 person-years. When the socioeconomic, health and lifestyle background variables were taken into account, the adjusted hazard ratio for a cruciate ligament injury of the knee was 8.5 (95% CI 4.3 to 16.4) for female and 4.0 (95% CI 2.7 to 6.1) for male subjects who participated in organised sports > or =4 times/week. CONCLUSIONS: The general risk for a cruciate ligament injury of the knee is relatively low among adolescents and young adults, but participation in organised sports increases the risk significantly. The risk is especially high in active young women. Preventive measures should be adopted to decrease the short-term and long-term burden of these severe injuries |
0 | Minimally Invasive Plate Osteosynthesis in Open Pediatric Tibial Fractures | PJI DX Updated Search | OBJECTIVES: The aim of this study is to investigate the effectiveness and reliability of limited-contact locking plates in minimally invasive percutaneous osteosynthesis (MIPO) of the lateral tibia. DESIGN: A retrospective study. PATIENTS AND METHODS: The retrospective study included 14 patients who were operatively treated with an MIPO technique due to open tibial fractures between 2006 and 2012. The patients were 11 males and 3 females with a mean age of 13.2 (range, 9 to 16) years. The patients were followed up for a mean period of 2.4 (range, 1 to 5) years. The mechanism of the injuries included a motor vehicle accident (n=11), a shotgun injury (n=2), and a fall from height (n=1). According to the Gustilo-Anderson classification, 10 patients had type I (72%), 2 had type II (14%), and 2 had type III (14%) open fractures. RESULTS: The mean time to radiologic union was 18 (range, 11 to 32) weeks. No infection was detected that would require implant removal. No complications such as early epiphyseal closure, angulation, or limb-length inequality were observed. CONCLUSIONS: Limited-contact locking plates in MIPO of the lateral tibia is an effective alternative method in the treatment of open pediatric tibial fractures. LEVEL OF EVIDENCE: Level IV-therapeutic |
0 | Physical activity and quality of life of amputees in southern Brazil | DoD LSA (Limb Salvage vs Amputation) | BACKGROUND: Physical activity is a positive component of human health. Its effects are associated with improvement in physical, psychological and social aspects of quality of life. Physical activity is therefore an important factor in the rehabilitation of amputees. OBJECTIVE: To analyse the relationship between physical activity and quality of life for amputees in southern Brazil. STUDY DESIGN: Descriptive, cross-sectional design with nonrandomized sample. METHODS: A total of 40 questionnaire instruments were distributed to subjects who met the inclusion criteria, with a response rate of 55% (22 individuals, n = 15 males, n = 7 females). Outcome measurements were obtained through the International Physical Activity Questionnaire and World Health Organization Quality of Life-Bref. RESULTS: The sample was characterized by physically active adult male prosthetic users with positive quality of life, and amputation below the right knee caused by mechanical trauma related to traffic accidents with motorcycles. Significant correlations were identified between all domains of quality of life and between level of physical activity and psychological quality of life. No correlation was identified between gender and quality of life variables or physical activity levels. CONCLUSIONS: This study showed that in very active amputees of both genders, level of physical activity is not associated with quality of life except for the psychological domain. |
1 | The local infiltration of analgesia following total knee replacement: A review of current literature | AAHKS (8) Anesthetic Infiltration | Controversy remains regarding the optimal post-operative analgesic regimen following total knee replacement. A delicate balance is required between the provision of adequate pain relief and early mobilisation. By reviewing 29 randomised trials we sought to establish whether local infiltration of analgesia directly into the knee during surgery provides better pain relief and a more rapid rehabilitation. Although we were able to conclude that local infiltration can provide improved post-operative pain relief, and to suggest the most promising technique of administration, there is no evidence that it reduces hospital stay. ©2012 British Editorial Society of Bone and Joint Surgery. |
0 | Update on MRI Pulse Sequences for the Knee: Imaging of Cartilage, Meniscus, Tendon, and Hardware | AMP (Acute Meniscal Pathology) | Magnetic resonance imaging (MRI) is widely used in the clinical setting as well as for research applications. Since its inception, technical development has broadly progressed as a response to challenges in both the clinical and research settings. Higher magnetic field strength and advances in hardware and software have revolutionized the diagnostic potential of MRI and moved well beyond diagnosis to characterization of tissue metabolism, biochemistry, disease pathogenesis, and material property, to name a few. This article focuses on state-of-the-art clinical and cutting-edge novel pulse sequences applied to knee MRI. |
0 | Biomechanical comparison of fixed- and mobile-bearing for unicomparmental knee arthroplasty using finite element analysis | OAK 3 - Non-arthroplasty tx of OAK | Unicomparmental knee arthroplasty (UKA) is a popular alternative to total knee arthroplasty (TKA) and high tibial osteotomy for unicompartmental knee conditions, especially in young patients. However, failure of UKA occurs due to either progressive osteoarthritis (OA) in the other compartment or wear on the polyethylene (PE) insert. This study used finite element (FE) analysis to investigate the effects of PE insert contact pressure and stress in opposite compartments for fixed- and mobile-bearing UKA. Analysis was performed using high kinematics displacement and rotation inputs, which were based on the kinematics of the natural knee. ISO standards were used for axial load and flexion. The mobile-bearing PE insert had lower contact pressure than the fixed-bearing PE insert. With the mobile-bearing UKA, lower stress on the opposite compartment reduces the overall risk of progressive OA in the knee. The fixed-bearing UKA increases the overall risk of progressive OA in the knee due to higher stress on the opposite compartment. However, the PE insert of mobile-bearing showed pronounced backside stress at the inferior surface. |
1 | Factors impacting 1-year mortality after hip fractures in elderly patients: A retrospective clinical study | Hip Fx in the Elderly 2019 | Background: This study aimed to evaluate risk factors that impact 1-year mortality in elderly patients with hip fractures after treatment with primary arthroplasty and proximal femoral nail.
Patients and Methods: Overall, 109 patients aged >=65 years with nonpathological hip fractures, treated between 2015 and 2016, were included in this study. Thirty-nine patients (35.8%) were treated with primary arthroplasty, and 70 patients (64.2%) were treated with proximal femoral nail. To determine whether the risk factors affected mortality, Kaplan-Meier and log-rank analyses were conducted, and a Cox regression analysis was conducted to include the factors determined to have an impact on mortality.
Results: Twelve patients (11%) died during hospitalization, and 24 patients (22%) died within 1 year after discharge from the hospital. The mortality risk was high for patients who underwent surgery 72 h after fracture, who could not independently perform their daily activities before the operation, had accompanying diseases, had an American Society of Anaesthesiologists score of 3 or 4, and had postoperative complications. There was no statistically significant difference between primary arthroplasty group and proximal femoral nail group with respect to mortality risk.
Conclusion: Delayed surgery and postoperative complications may be the most important risk factors increasing 1-year mortality in elderly patients with hip fractures after treatment with primary arthroplasty and proximal femoral nail. These two risk factors can be prevented with proper precautions, and the rate of 1-year survival for these patients can be increased. |
0 | Screening for osteopenia and osteoporosis: do the accepted normal ranges lead to overdiagnosis? | Management of Hip Fractures in the Elderly | Osteoporosis is a common disease which causes significant morbidity and mortality and in many cases may be preventable. In the absence of fragility fractures the accepted method of identifying those at high risk is based upon bone mineral density (BMD) measurements with defined cut-off points. To correctly delineate normal from abnormal, reliable reference ranges appropriate to the observed population are required. We have studied the age-dependent changes in mean BMD and standard deviation at the lumbar spine and femoral neck in a normal population extracted from 4280 women screened for osteopenia and compared our findings with the manufacturer's normal range (MNR). The recent World Health Organization criteria for the diagnosis of osteopenia and osteoporosis using the 'manufacturer's young normal' (MYN) values and our 'study young normal' (SYN) values have been applied. The study normal population (SNP) included 2068 women (mixed social class; mean age 53 years, range 30-79 years). The distribution of mean lumbar spine BMD with age in SNP was generally similar to the MNR. In contrast mean femoral neck bone density from SNP was significantly different from the MNR, ranging from 3% to 12% lower in each 5-year group analysed (p < 0.05). Comparison of standard deviations in spine BMD in SNP against the fixed MNR standard deviation showed a statistically significant increase commencing at 45 years of age. The magnitude of this increase appeared to rise with age and remained significant in the 75- to 79-year age group (p < 0.05). In contrast, standard deviation in femoral neck BMD in SNP appeared relatively constant with age except in the group of women at and around the time of the menopause. The SYN value for mean lumbar spine BMD was 0.994 g/cm2 (cf. MYN value 1.047, p < 0.0001) with a standard deviation of 0.122 g/cm2 (cf. MYN 0.11, p = 0.0005). Similarly our SYN value for femoral neck BMD was 0.787 (cf. MYN value 0.895, p < 0.0001) with a standard deviation of 0.109 (cf. MYN value 0.10, p = 0.0027). Using SYN values 36% (748) for the spine and 33% (675) for the hip of our normal population are classified as osteopenic or osteoporotic. Using MYN values increases the proportion of women classified as osteopenic or osteoporotic to 52% (1078) for the spine and 68% (1409) for the femur. If both sites of measurement are considered simultaneously SYN classifies 46% (952) as either osteopenic or osteoporotic at one or other site, which is increased to 73% (1513) when the MYN values are used. We observe that manufacturer's reference ranges may not be appropriate for the local population and may lead to an erroneously high diagnosis of osteopenia and osteoporosis, which would lead to unnecessary patient anxiety and perhaps errors regarding treatment |
1 | Antibiotic prophylaxis in oral and maxillofacial surgery: a systematic review | Dental Implant Infection | Surgical site infections are a complication of oral and maxillofacial procedures, with the potential for significant morbidity and mortality. Use of preoperative, perioperative, and postoperative antibiotic prophylaxis to reduce the incidence of surgical site infections must be balanced with considerations of a patients' risk of antibiotic-related adverse events. This review aimed to provide evidence-based recommendations for antibiotic prophylaxis. Searches were conducted using MEDLINE, the Cochrane Library, EMBASE, and PUBMED for maxillofacial procedures including: treatment of dental abscesses, extractions, implants, trauma, temporomandibular joints, orthognathics, malignant and benign tumour removal, and bone grafting, limited to articles published since 2000. A total of 98 out of 280 retrieved papers were included in the final analysis. Systematic reviews were assessed using AMSTAR criteria. Randomised controlled trials were assessed for bias using Cochrane Collaborative tools. The overall quality of evidence was assessed using GRADE. Prophylactic antibiotic use is recommended in surgical extractions of third molars, comminuted mandibular fractures, temporomandibular joint replacements, clean-contaminated tumour removal, and complex implants. Prophylactic antibiotic use is not routinely recommended in fractures of the upper or midface facial thirds. Further research is required to provide recommendations in orthognathic, cleft lip, palate, temporomandibular joint surgery, and maxillofacial surgical procedures in medically-compromised patients. Crown Copyright © 2020. Published by Elsevier Ltd. All rights reserved. |
0 | Cementless total hip arthroplasty in patients with ankylosing spondylitis: A retrospective observational study | Hip Fx in the Elderly 2019 | Controversies on the surgical protocols and efficacies of total hip arthroplasty (THA) in ankylosing spondylitis (AS) still exist. The aim of this study was to retrospectively analyze the perioperative managements and their outcomes related to performing THA on patients with AS.Data of 54 AS patients who underwent 81 THAs between 2008 and 2014 were retrospectively analyzed. Clinical and imaging data were collected preoperatively, postoperatively, and during the follow-up period for surgical efficacy.Using posterolateral approach, cementless prostheses were selected in all cases. Mean follow-up period was 3.6 years (range, 2-8 years). Inclinations and anteversions of acetabular cups were 36.3degree+/-4.5degree (range, 30degree-50degree) and 12.3degree+/-4.9degree (range, 0degree-25degree) respectively. Mean visual analog scale (VAS) score decreased from 6.7 +/- 2.1 (range, 4-10) preoperatively to 1.5 +/- 1.0 (range, 0-4) at final follow-up, and mean Harris hip score (HHS) improved from 31.2 +/- 11.6 (range, 15-45) to 86.1 +/- 4.3 (range, 80-95) (P < 0.05). Postoperative range of motion (ROM) in flexion was improved from 6.7degree+/-13.5degree (range, 0degree-50degree) preoperatively to 82.5degree+/-6.4degree (range, 70degree-100degree) at final follow-up, and ROM in extension was improved from 1.8degree+/-5.7degree(range, 0degree-15degree) to 15.4degree+/-2.6degree (range, 10degree-20degree) (P < 0.05). Heterotopic ossification (HO) was documented in 9 hips (11.1%). Signs of stable fibrous ingrowth and bone ingrowth were detected in 52 and 29 hips, respectively. Sciatic never injury was occurred in 3 cases, and treated conservatively. There were no signs of periprosthetic fractures, dislocation, or prosthesis loosening.Surgical efficacies of THA for AS patients with severe hip involvement are satisfactory. |
0 | Mechanisms of lytic and blastic metastatic disease of bone | MSTS 2018 - Femur Mets and MM | In the majority of skeletal metastases, new bone develops simultaneously with bone destruction. The roentgenogram indicates the net effect of these two processes. Where the bone formation predominates, the lesion appears sclerotic. Where bone destruction predominates, it appears lytic. Mixed lesions may also occur. There are two main mechanisms for the new bone formation. Those tumors associated with a suitable fibrous stroma develop islands of intramembranous ossification within the stroma, e.g., metastases from prostatic carcinoma. In the vast majority of metastases bone destruction is associated with reactive new bone formation. The latter is similar to callus associated with fracture repair. Myelomata and lymphomata are not associated with this reactive new bone formation. There are at least two main mechanisms for the bone destruction. The earlier and quantitatively more important phase is mediated via osteoclasts, neoplasms secreting a variety of osteoclast stimulating factors. The main humoral factor in myeloma and the lymphomata is probably osteoclast activating factor (OAF), whereas in the carcinomata it may be prostaglandin. Two thirds of human mammary carcinomata are osteolytically active in vitro. In a co-culture model, the osteolysis can be significantly reduced by prostaglandin inhibitors, diphosphonates and particularly, their combination. At a late stage, neoplastic or monocytic cells are directly responsible for the continuing bone destruction. |
0 | Countrywise results of total hip replacement. An analysis of 438,733 hips based on the Nordic Arthroplasty Register Association database | Hip Fx in the Elderly 2019 | BACKGROUND AND PURPOSE: An earlier Nordic Arthroplasty Register Association (NARA) report on 280,201 total hip replacements (THRs) based on data from 1995-2006, from Sweden, Norway, and Denmark, was published in 2009. The present study assessed THR survival according to country, based on the NARA database with the Finnish data included.
MATERIAL AND METHODS: 438,733 THRs performed during the period 1995-2011 in Sweden, Denmark, Norway, and Finland were included. Kaplan-Meier survival analysis was used to calculate survival probabilities with 95% confidence interval (CI). Cox multiple regression, with adjustment for age, sex, and diagnosis, was used to analyze implant survival with revision for any reason as endpoint.
RESULTS: The 15-year survival, with any revision as an endpoint, for all THRs was 86% (CI: 85.7-86.9) in Denmark, 88% (CI: 87.6-88.3) in Sweden, 87% (CI: 86.4-87.4) in Norway, and 84% (CI: 82.9-84.1) in Finland. Revision risk for all THRs was less in Sweden than in the 3 other countries during the first 5 years. However, revision risk for uncemented THR was less in Denmark than in Sweden during the sixth (HR = 0.53, CI: 0.34-0.82), seventh (HR = 0.60, CI: 0.37-0.97), and ninth (HR = 0.59, CI: 0.36-0.98) year of follow-up.
INTERPRETATION: The differences in THR survival rates were considerable, with inferior results in Finland. Brand-level comparison of THRs in Nordic countries will be required. |
0 | Diffuse idiopathic skeletal hyperostosis (DISH) and the association with high serum cholesterol and triglycerides | Surgical Management of Osteoarthritis of the Knee CPG | Objective(s): The aim of the study is to assess the association between diffuse idiopathic skeletal hyperostosis (DISH), serum cholesterol and triglycerides. Material & Methods: DISH were studied in 204 patients with back pain, knee or hip joint replacement due to DISH or osteoarthritis in Clinic of Rheumatology, UMHAT nullSveti Georginull and rheumatologic practice in Plovdiv, Bulgaria. Participants had a standardized interview and examination. Radiographs of the joint as well as both knee and a blood sample were obtained. Serum cholesterol and triglycerides levels were divided into tertiles and hypercholesterolemia was defined as (greater-than or equal to)6.0 mmol/l and hypertriglycerides was as (greater-than or equal to)1.8 mmol/l. The control groups was 100 patterns with osteoarthritis (OA) and 60 patients with knee OA. Odds ratios and 95% Cls for the association of serum cholesterol and triglycerides with DISH patterns were calculated with logistic regression, adjusting for potential confounders. Results: Hypercholesterolemia (OR 1.72; 95% CI 1.16- 2.32) and high serum cholesterol levels (3rd vs. 1st tertile: OR 1.81; 95% CI 1.03-2.96) were independently associated with DISH. Hypertriglyceridemia (OR 1.69; 95% CI 1.2- 2.14) were independently associated with DISH. No association was observed between hypercholesterolemia and hypertriglyceridemia and OA. Hypercholesterolemia (OR 1.61; 95% CI 1.06-2.47) and high serum triglycerides were independently associated with knee OA. Conclusion(s): These data add to the evidence regarding the independent role of serum cholesterol and triglycerides as a systemic risk factor for DISH. The discrepant associations observed for different OA patterns are likely due to the relative weight of other risk factors |
0 | Nutrition and Inflammation Influence 1-Year Mortality of Surgically Treated Elderly Intertrochanteric Fractures: A Prospective International Multicenter Case Series | DoD SSI (Surgical Site Infections) | Introduction: Hip fracture is a common and devastating event in older adults causing increased dependence, comorbidity, and mortality. Since new surgical techniques have not significantly improved the mortality rate, a better understanding of patient risk factors could improve the treatment algorithm and outcomes. This prospective study aimed to document the 1-year survival rate of patients with intertrochanteric fracture treated surgically in Latin America and to investigate risk factors associated with 1-year mortality. Patients and Methods: Between January 2013 and March 2015, 199 patients were prospectively enrolled. Inclusion criteria were aged 60 years or older, isolated intertrochanteric fracture (AO/OTA 31-A), and time to surgery within 10 days after injury. The follow-up period was 1 year. The association between mortality and patient demographics, comorbidity, surgical details, and preoperative laboratory parameters was assessed using log-rank tests. Results: Twenty patients died by 365 days after surgery (including 5 that died within 30 days of surgery) resulting in a 1-year survival rate of 89.8% (95% confidence interval = 84.6-93.3). The 1-year mortality was significantly associated with age (=85 years old, P =.032), existing comorbidity (P =.002), preinjury mobility level (P =.026), mental state (Mini-Mental State Examination > 23, P =.040), low preoperative plasma albumin level (P =.007), and high preoperative blood C-reactive protein level (CRP; P =.012). At the 1-year follow-up, patients on average did not regain their preinjury hip function and mobility, although the self-assessed quality of life was equal or better than before the injury. Discussion: As a prospective study, the current patient population had clear inclusion and exclusion criteria and was relatively homogeneous. The resulting associations between 1-year postoperative mortality and preoperative hypoalbuminemia and preoperative elevated CRP level are therefore especially notable. Previously identified risk factors such as male gender and time to surgery showed no significant association with 1-year mortality—the overall favorable condition of the current population or the lack of statistical power maybe responsible for this observation. Conclusion: The current results showed that under the condition of optimal surgical treatment and low surgery-related complication, preinjury health status as indicated by the blood level of albumin and CRP has a direct and significant impact on 1-year mortality rate. |
0 | Mid-term Results of Oxford Phase 3 Unicompartmental Knee Arthroplasties at a Small-Volume Center | OAK 3 - Non-arthroplasty tx of OAK | BACKGROUND AND AIMS: Unicompartmental knee arthroplasty is considered as an alternative to total knee arthroplasty for patients who have osteoarthritis limited to the medial compartment of the knee. The aim of this retrospective study was to find out clinical and radiological outcomes and related complications using the Oxford phase 3 prosthesis at a small-volume center. MATERIAL AND METHODS: In all, 95 Oxford unicompartmental knee arthroplasties (87 patients) were performed between 2000 and 2010 in North Karelia Central Hospital. Of these, five patients had undergone revision surgery. In all, 52 unicompartmental knee arthroplasties (46 patients) participated in this study. The mean age of patients was 61.4â??years, and 78.2% of patients were females. Pain and function levels were evaluated by using the Knee Society score. Radiographic analyses were performed on preoperative and postoperative and follow-up radiographs. RESULTS AND CONCLUSIONS: The mean follow-up time was 6.5â??years, and the Kaplan-Meier estimated 9-year implant survival rate was 88.9% (95% confidence intervalâ??=â??78.7%-99.1%). The median Knee Society score of 77 (range: 18-93) at follow-up was considered good (range: 70-79). In this study, we found out that medial knee pain remains in 10% of unicompartmental knee arthroplasties several years after surgery, although the reason for the pain remained unclear. These mid-term results are promising, and good results can be achieved also at a small-volume center when strict patient selection is followed. |
0 | Patellofemoral arthroplasty with a customized trochlear prosthesis | Surgical Management of Osteoarthritis of the Knee CPG | Successful patellofemoral arthroplasty depends on appropriate patient selection, proper prosthesis design, and correct surgical technique. Clinical results using off-the-shelf patellofemoral prostheses have reported mixed results primarily because of an inability to address these important characteristics adequately. This article reviews the design rationale, excellent clinical history, and straightforward surgical technique of a unique approach to patellofemoral arthroplasty that incorporates a customized trochlear prosthesis designed to fit the individual patient's patellofemoral groove. Clinical results using this customized approach demonstrate that it is a safe and effective treatment option for patients who have isolated patellofemoral arthritis |
0 | In vivo somatostatin receptor imaging in medullary thyroid carcinoma | MSTS 2018 - Femur Mets and MM | Using in vivo scintigraphy with the 111In-labeled somatostatin analog octreotide, tumor localizations were demonstrated in 11 of 17 patients (65%) with medullary thyroid carcinoma (MTC). Tumor localizations in the liver in 7 patients, and in the thyroid in 1 patient were not detected on octreotide scintigraphy, most probably because of normal uptake of labeled octreotide in these organs. Specific somatostatin receptors were demonstrated in vitro on all 5 investigated tumors which had also been visualized in vivo, as well as on 1 tumor that was not. Immunohistochemically, somatostatin was present in 1 of 6 tumors that were visualized in vivo, and in neither of 2 tumors that were not. The ratio of serum calcitonin over carcino-embryonic antigen concentrations was significantly higher in patients whose MTCs were visualized during octreotide scintigraphy than in those whose tumors were not. We have formed the following conclusions: 1) In the majority of patients with metastatic MTC, tumor sites can be visualized using octreotide scintigraphy, although this technique is insensitive in detecting liver metastases or intrathyroidal tumor; 2) The visualization of MTC during in vivo somatostatin receptor imaging correlates with the in vitro presence of somatostatin receptors; 3) The immunohistochemical presence of somatostatin in the tumor does not seem to influence the outcome of in vivo somatostatin receptor imaging; and 4) Higher serum calcitonin over carcino-embryonic antigen ratios in patients whose MTC is visualized during octreotide scintigraphy might imply that somatostatin receptors are present on more differentiated MTC. |
1 | Bone Metastases Pattern in Newly Diagnosed Metastatic Bladder Cancer: A Population-Based Study | MSTS 2022 - Metastatic Disease of the Humerus | <b>Purpose:</b> Based on a large-population analysis, we aimed to estimate the incidence and survival of bone metastases (BM) in initial bladder cancer (BC) patients and to identify the risk and prognostic factors of BC patients with BM. <b>Patients and methods:</b> Using the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database, bladder cancer patients diagnosed between 2010 and 2014 were retrieved. Multivariate logistic and Cox regression analyses were employed to identify risk factors and prognostic factors for BM in BC patients. A Kaplan-Meier analysis with log-rank test was used to estimate the overall survival for BC and the difference between the survival curves. |
0 | Severe paroxysmal hypertension. An automatic syndrome and its relationship to repressed emotions | DoD PRF (Psychosocial RF) | In most patients with severe and symptomatic paroxysmal hypertension, a pheochromocytoma or other medical cause is rarely identified. This article presents the psychosocial assessment of 10 such patients, in whom the absence of any emotional distress preceding paroxysms had discouraged consideration of any psychological basis. However, a causative role of repressed unreported emotions was strongly suggested by 1) a history of unusually severe emotional trauma in 8 of 10 patients, 2) the absence of feelings related to the trauma, and 3) the prompt and sustained response of 3 patients to psychotherapeutic or psychopharmacologic intervention. These observations suggest that some cases of unexplained paroxysmal hypertension have a psychosomatic etiology and result from repressed rather than perceived and reported emotions. Treatment options are explored. |
0 | Does Diastasis Width Influence the Variation of the Intra-Abdominal Pressure After Correction of Rectus Diastasis? | Panniculectomy & Abdominoplasty CPG | BACKGROUND: It has been demonstrated that there is an increase of intra-abdominal pressure (IAP) after correction of rectus diastasis. OBJECTIVE: To evaluate the correlation between the diastasis width and IAP variation after the plication of the anterior rectus sheath. METHODS: Seventeen patients met the inclusion criteria and were selected. The diastasis width was measured at three levels: 3 cm above the umbilicus, 2 cm above the umbilicus, and 2 cm below the umbilicus. Rectus sheath plication was performed in two layers: the first layer with separate stitches, and the second with continuous suture. The IAP was measured at two stages: before and after the correction of rectus diastasis. The distance between the iliac spines (IS) and that between the xiphoid process and pubic symphysis (XP) were measured. The abdominal surface index (ASI) was calculated using the formula: ASI = (IS x XP)/2. This index was used to determine the individual abdominal surface. The relative diastasis coefficient (RDC) was calculated using the formula: RDC = diastasis/ASI. These measurements were correlated to the IAP variation. The results of the IAP measurements obtained in each stage and the RDC values were compared, using the Pearson's linear correlation coefficient. RESULTS: There was no statistically significant correlation between the IAP variation and the RDC values at the three levels studied. CONCLUSIONS: The diastasis width does not interfere with the increase of the IAP when a plication of the anterior aponeurosis is performed. LEVEL OF EVIDENCE: 3 Diagnostic. |
0 | Perspectives in the elderly patient: Benefits and limits of bisphosphonates and denosumab | MSTS 2018 - Femur Mets and MM | Skeletal metastases affect a large percentage of the cancer population and contribute to a marked decrease in their quality of life and survival, in particular in elderly population. A future end-point of bone-protecting therapy is the demonstration of its ability to prevent or improve results in the treatment of metastatic disease, enlarging their clinical indications in metastatic and osteoporotic setting with different schedules. In this chapter we will discuss on pharmacokinetic and pharmacodynamic interactions of bisphosphonates in elderly, and the preclinical and clinical evidences of anticancer activity of bone-targeted therapies will be critically described. The clinical results of new targeted therapies (such as rank/rankl/OPG inhibition) will be reported both in bone metastatic and in adjuvant settings. Finally, the prevention of cancer treatment-induced bone loss (CTIBL) represents both in young and more in old patients an emerging issue in the bone health care. For this reason, this chapter will discuss the results of current therapies in this clinical setting. © 2012 Springer-Verlag Berlin Heidelberg. |
0 | Vitamin D deficiency is associated with greater tumor size and poorer outcome in Merkel cell carcinoma patients | MSTS 2018 - Femur Mets and MM | BACKGROUND: Merkel cell polyomavirus has been recognized to be associated with Merkel cell carcinoma (MCC), but the evolution of this cancer probably depends on various factors. Vitamin D deficiency, defined by serum 25-hydroxyvitamin D levels <50 nmol/L, seems to influence cancer behavior and progression, but has never been assessed in MCC patients.
OBJECTIVES: First, to evaluate whether vitamin D deficiency was associated with tumor characteristics and prognosis in a cohort of MCC patients. Second, to assess expression of the vitamin D receptor (VDR) in MCC tumors.
METHODS: Clinical findings, Merkel cell polyomavirus markers and vitamin D status were assessed in a cohort of French MCC patients. The study was limited to the 89 patients for whom the serum sample had been collected within 3 years after the diagnosis of MCC. Correlation between vitamin D deficiency and MCC characteristics and outcome were determined in regression analyses. VDR expression in MCC tumours was assessed by immunohistochemistry.
RESULTS: Vitamin D deficiency was noted in 65.1% of the patients and was independently associated with greater tumor size at diagnosis (P = 0.006) and with metastasis recurrence (HR, 2.89; 95% CI, 1.03 to 8.13; P = 0.043), but not with death from MCC, although there was a trend (HR, 5.28; 95% CI, 0.75 to 36.96; P = 0.093). VDR was found to be strongly expressed in all 28 MCC tumor specimens investigated.
CONCLUSION: The association between vitamin D deficiency and MCC characteristics and outcome, together with detection of the VDR in MCC cells, suggest that vitamin D could influence the biology of MCC. |
0 | Mecobalamin | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | Background: Mecobalamin, one of the coenzyme forms of vitamin B(12), acts as an important cofactor in the activities of B(12)-dependent methyltransferases. Since the discovery of mecobalamin, it has been applied mainly in the treatment of hyperhomocysteinaemia and peripheral neuropathy. However, there is still lack of a systemic review on the clinical administration of mecobalamin and its potential mechanism. Objective: To review the mechanism, clinical efficacy and safety of mecobalamin in the treatment of hyperhomocysteinaemia and peripheral neuropathy. Methods: First, the potential mechanism, pharmacokinetics and metabolism of mecobalamin were clarified. In addition, the clinical administration including efficacy, safety Jnd tolerability of mecobalamin as monotherapy or combined therapy in the treatment of hyperhomocysteinaemia and peripheral neuropathy were also detailed. Results/conclusions: Although both monotherapy and combined therapy can lower plasma/serum homocysteine levels and improve the neuropathic symptoms, combined therapy with other B vitamins seems to be more effective. However, more precise, double-blind and randomised control studies are necessary to confirm the efficacy of mecobalamin on hyperhomocysteinaemia, peripheral neuropathy interaction, and cardiovascular, neurological and osteoporotic mortality or morbidity. (copyright) 2008 Informa UK Ltd |
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