recall
int64 0
1
| article_title
stringlengths 5
500
| topic
stringlengths 21
84
| abstract
stringlengths 2
65.8k
|
|---|---|---|---|
1 |
Treatment of acute injuries of the triangular fibrocartilage complex associated with distal radioulnar joint instability
|
Distal Radius Fractures
|
One hundred thirty patients who had an injury of the triangular fibrocartilage complex (TFCC) with distal radioulnar joint (DRU) instability were treated operatively. The TFCC injury with DRUJ instability occurred as an isolated lesion in 20. After appropriate fracture stabilization, 86 patients were treated with closed reduction of the DRUJ and radioulnar transfixation with one to two Kirschner wires with the forearm in neutral rotation. In 19 patients the avulsed ulnar styloid was internally fixed, and the DRUJ supplemented with radioulnar transfixation. In 13 patients the ulnar styloid was internally fixed. In 12 patients with radial avulsion fractures the displaced bony fragment was percutaneously fixed with a Kirschner-wire. Postoperatively all the patients were immobilized in a long arm cast in neutral rotation for 6 weeks. The results were excellent in 95%, fair in 30, and poor in 5.
|
0 |
Management of chronic pain in whiplash injury
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
We investigated the response of chronic neck and shoulder pain to decompression of the carpal tunnel in 38 patients with whiplash injury. We also determined the plasma levels of substance P (SP) and calcitonin gene-related peptide (CGRP), which are inflammatory peptides that sensitise nociceptors. Compared with normal control subjects, the mean concentrations of SP (220 v 28 ng/l; p < 0.0001) and CGRP (400 v 85 ng/l; p < 0.0005) were high in patients with chronic shoulder and neck pain before surgery. After operation their levels fell to normal. There was resolution of neurological symptoms with improvement of pain in 90% of patients. Only two of the 30 with chronic neck and shoulder pain who had been treated conservatively showed improvement when followed up at two years. In spite of having neuropathic pain arising from the median nerve, all these patients had normal electromyographic and nerve-conduction studies. Chronic pain in whiplash injury may be caused by 'atypical' carpal tunnel syndrome and responds favourably to surgery which is indicated in patients with neck, shoulder and arm pain but not in those with mild symptoms in the hand. Previously, the presence of persistent neurological symptoms has been accepted as a sign of a poor outcome after a whiplash injury, but our study suggests that it may be possible to treat chronic pain by carpal tunnel decompression
|
0 |
Bone Mass and Strength and Fall-Related Fractures in Older Age
|
Distal Radius Fractures
|
Introduction: Low bone mineral density is a risk factor for fractures. The aim of this follow-up study was to assess the association of various bone properties with fall-related fractures., Materials and Methods: 187 healthy women aged 55 to 83 years at baseline who were either physically active or inactive were followed for 20 years. They were divided into two groups by whether or not they sustained fall-related fractures: fracture group (F) and nonfracture group (NF). At baseline, several bone properties were measured with DXA and pQCT, and their physical performance was also assessed., Results: During the follow-up, 120 women had no fall-related fractures, while 67 (38%) sustained at least one fall with fracture. NF group had about 4 to 11% greater BMD at the femoral neck and distal radius; the mean differences (95% CI) were 4.5 (0.3 to 8.6) % and 11.1 (6.3 to 16.1) %, respectively. NF group also had stronger bone structure at the tibia, the mean difference in BMC at the distal tibia was 6.0 (2.2 to 9.7) %, and at the tibial shaft 3.6 (0.4 to 6.8) %. However, there was no mean difference in physical performance., Conclusions: Low bone properties contribute to the risk of fracture if a person falls. Therefore, in the prevention of fragility fractures, it is essential to focus on improving bone mass, density, and strength during the lifetime. Reduction of falls by improving physical performance, balance, mobility, and muscle power is equally important. Copyright © 2019 Kirsti Uusi-Rasi et al.
|
0 |
Endodontic failures--changing the approach
|
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
The underlying reason for endodontic failures is almost invariably due to bacterial infection. The bacteria may be situated within a previously missed or uninstrumented portion of a root canal, infiltrate via a leaky coronal restoration and root filling, or cause contamination from an extra-radicular infection. Management of the failing root canal filling begins with the identification of the source of persistent infection. Should the infection be present within the root canal system, such as a missed canal, orthograde retreatment is the choice of treatment. This is also true for asymptomatic cases which had been inadequately obturated and which require the placement of a dowel into the canal for restorative reasons. Periapical surgery is best reserved for cases with no sign of healing after orthograde retreatment and those with extra-radicular infection. This paper discusses the relationship between endodontics and restorative dentistry, treatment planning for endodontic failures, and the reported rates of success with orthograde and surgical retreatments
|
0 |
A decade of reversal: An analysis of 146 contradicted medical practices
|
AAHKS (2) Corticosteroids
|
Objective: To identify medical practices that offer no net benefits. Methods: We reviewed all original articles published in 10 years (2001-2010) in one high-impact journal. Articles were classified on the basis of whether they addressed a medical practice, whether they tested a new or existing therapy, and whether results were positive or negative. Articles were then classified as 1 of 4 types: replacement, when a new practice surpasses standard of care; back to the drawing board, when a new practice is no better than current practice; reaffirmation, when an existing practice is found to be better than a lesser standard; and reversal, when an existing practice is found to be no better than a lesser therapy. This study was conducted from August 1, 2011, through October 31, 2012. Results: We reviewed 2044 original articles, 1344 of which concerned a medical practice. Of these, 981 articles (73.0%) examined a new medical practice, whereas 363 (27.0%) tested an established practice. A total of 947 studies (70.5%) had positive findings, whereas 397 (29.5%) reached a negative conclusion. A total of 756 articles addressing a medical practice constituted replacement, 165 were back to the drawing board, 146 were medical reversals, 138 were reaffirmations, and 139 were inconclusive. Of the 363 articles testing standard of care, 146 (40.2%) reversed that practice, whereas 138 (38.0%) reaffirmed it. Conclusion: The reversal of established medical practice is common and occurs across all classes of medical practice. This investigation sheds light on low-value practices and patterns of medical research.© 2013 Mayo Foundation for Medical Education and Research.
|
0 |
Transcriptomic biomarkers of the response of hospitalized geriatric patients admitted with heart failure. Comparison to hospitalized geriatric patients with infectious diseases or hip fracture
|
Management of Hip Fractures in the Elderly
|
The abundance of a preselection of transcripts involved in inflammation, immunosenescence and stress response was compared between PBMC of healthy aged donors and aged patients in acute phase of heart failure and at recovery. This study identified 22 transcripts differentially abundant in acute phase of heart failure versus healthy aged subjects. Transcripts involved in inflammation and oxidative stress were more abundant. Those associated with T-cell functions were less abundant. The results were compared to two other major acute geriatric issues: infectious diseases and hip fracture. In acute phase, compared to healthy aged subjects, the abundance of 15/22 transcripts was also altered in both geriatric infectious diseases and hip fracture. Many variations had not vanished at the recovery phase. The abundance of CD28, CD69, LCK, HMOX1, TNFRSF1A transcripts, known to be altered in healthy aged versus healthy young subjects, was further affected in acute phase of the three geriatric diseases considered. The transcript levels of BCL2, CASP8, CCL5, DDIT3, EGR3, IL10RB, IL1R2, SERPINB2 and TIMP1 were affected in all three pathological conditions compared to healthy aged, but not versus healthy young subjects. In conclusion, this work provides critical targets for therapeutic research on geriatric heart failure, infectious diseases and hip fracture. (copyright) 2011 Elsevier Ireland Ltd
|
0 |
Total knee arthroplasty for rheumatoid arthritis patients with large tibial condyle defects
|
Surgical Management of Osteoarthritis of the Knee CPG
|
PURPOSE: To review clinical results of total knee arthroplasty (TKA) in rheumatoid arthritis (RA) patients with large bone defects of the tibial condyle. METHODS: Records of 33 knees in 27 women and 3 men aged 44 to 80 (mean, 63.6) years who underwent primary TKA for RA with large tibial bone defects were reviewed. 16 knees had peripheral defects extending to the bone cortex, whereas 17 knees had central defects that did not extend to the bone cortex. The femorotibial angle (FTA) was <170 masculine in 15 knees, 170 masculine to 180 masculine in 3 knees, and >180 masculine in 15 knees. The mean duration of RA was 13.5 (range, 3-35) years. In 14 knees with severe bone defects, bone grafts (harvested from articular surfaces of knee bones and fixed without screws or Kirschner wires) and/ or metal wedges (for peripheral defects) were used to fill the defects. Clinical outcome was assessed pre- and post-operatively using Knee Society scores. RESULTS: The mean follow-up duration was 6.3 (range, 2.3-13.2) years. The mean depth of tibial bone defects was 11.2 (range, 1-25) mm, whereas the mean width ratio of the bone defects was 36.5% (range, 16.4-76.9%). Mean extension and flexion (range of motion) improved from -12.5 masculine and 113.4 masculine to -5.1 masculine and 115.6 masculine, respectively. The mean Knee Society knee score improved from 35 (range, 21-59) to 85 (range, 49-95), whereas the mean Knee Society function score improved from 30 (range, 25-53) to 80 (range, 44-97) [p<0.001, Wilcoxon signed rank test]. The cruciate retention prosthesis was used in 6 knees; the posterior stabilised prosthesis was used in 27 knees; and the constrained condylar knee prosthesis was used in 3 knees. No patient had any infection or implant loosening. CONCLUSION: TKA achieved favourable outcome for RA patients with large tibial bone defects. The type of prosthesis used and the use of bone grafts and/ or metal wedges were based on the depth and width ratio of the bone defects
|
1 |
Observation of single spinal anesthesia by 25G needle puncture through a lateral crypt for hip surgery in elderly patients
|
Hip Fx in the Elderly 2019
|
BACKGROUND: Lumbar spine hyperosteogeny and ligament calcification are common in the elderly and anesthesia puncture through the conventional approach is difficult in this age group, and repeated puncture can increase the risk of spinal hematoma and nerve injury. This study aimed to observe the feasibility and safety of single spinal anesthesia administered with 25G needle through the lateral crypt for lower-extremity fracture surgery in elderly patients.
METHODS: The subjects were 60 elderly patients in our hospital (aged 65-80 years; ASA grades I and II) scheduled for lower-extremity fracture surgery (procedure was predicted to last within 2 h) under single spinal anesthesia by different approaches through L3-4. They were randomly divided into 2 groups: in the first group, 25G needle was used in a vertical approach (group C, n=30); in the second, 25G needle was passed through the inner edge of the small joints of L3-4 to the lateral crypt (group L, n=30). After successful completion of the puncture procedure, 2.5 mL of 0.5% hyperbaric ropivacaine was used for spinal anesthesia. We then recorded the puncture times, sensory block level, and adverse reactions (e.g., headache, lumbago, and lower limb pain).
RESULTS: No significant differences in onset time, sensory block level and adverse reaction were noted between the 2 groups. The puncture success rate in group L was not significantly higher and the number of attempts per puncture was not significantly less than that in group C (93.3% vs 70%) (P = .063). Nerve-root irritation was more frequent in group L than in group C but with no significant difference (P > .05).
CONCLUSION: Single spinal anesthesia through the lateral crypt approach is safe and effective for lower-extremity fracture surgery in elderly patients. Thus, this approach is a feasible alternative when the conventional approach fails.
|
0 |
Serum ACE for sarcoidosis is not such an ACE test
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
Background A serum angiotensin-converting enzyme (ACE) level can be elevated in patients with active sarcoidosis. This association was first described Dr Lieberman in 1975 (1). He looked at serum ACE levels in 200 control patients and 200 patients with chronic lung disease. He found that 15 of 17 patients with active sarcoidosis had a serum ACE level, which was greater than two standard deviations above the mean (1). As a result serum ACE levels are routinely tested in patients with suspected sarcoidosis. A serum ACE test has been reported to be elevated in 75% of patients with untreated sarcoidosis (2). The rate of false positive results is less than 10% (2,3). Other granulomatous conditions which may cause an elevated ACE level are tuberculosis, primary biliary cirrhosis, Crohn's disease, leprosy and Gaucher's disease (2,4). The sensitivity and specificity of the test are reported to be 60 and 70% respectively (5). A serum ACE analysis costs (euro)11.5 per test in our laboratory. Methods We have completed a retrospective evaluation of the serum ACE test at our busy district general hospital. The serum ACE tests which have been requested by the rheumatology department over the last six years have been reviewed. Over this time period, 130 tests were performed on 126 cases. Results There were three positive results. The upper limit of normal in our laboratory is 92iu/L. None of these cases were ultimately diagnosed with sarcoidosis. The three cases were each diagnosed with seronegative inflammatory arthritis, Systemic Lupus Erythematosus and bilateral carpal tunnel syndrome. Consequently we found the false positive rate to be 100% (Specificity 0%). In our cohort there were 13 cases of sarcoidosis. All of the cases had a negative serum ACE level (False negative rate 100%, Sensitivity 0%). There were 12 cases of acute sarcoidosis, where a raised serum ACE level would have been expected. The one known case of chronic sarcoidosis was treated with sulphasalazine. The diagnosis of sarcoidosis was made with a positive biopsy (9/13 [69%]) or on clinical grounds (Bilateral Hilar lymphadenopathy on CXR at presentation 10/12 [83%], erythema nodosum 7/13 [54%]). Conclusions In this study, serum ACE testing does not appear to have any diagnostic benefit whilst being a relatively expensive test. All our cases over a 6 year period had an ACE level in the normal range. We estimate that our department has spent (euro)1500 on serum ACE testing over the last six years. This money could perhaps be spent more effectively. We suggest that a CXR combined with good clinical assessments are better diagnostic tools in our setting of a busy district general hospital. As a result of this study, our department has stopped requesting serum ACE levels
|
0 |
Maternal Height and Infant Body Mass Index Are Possible Risk Factors for Developmental Dysplasia of the Hip in Female Infants
|
Developmental Dysplasia of the Hip 2020 Review
|
Developmental dysplasia of the hip (DDH) is a wide-spectrum disease with a multifactorial etiology and, despite its prevalence, no definitive etiology has yet been established. The aim of this study was to investigate new risk factors for DDH by evaluating newly defined potential risk factors. A total of 71 infants were separated into 2 groups:Group I, 28 female first-born infants diagnosed with DDH and their mothers;and Group II, 43 healthy female first-born infants and their mothers. The maternal height and weight before pregnancy, infant height and weight at birth, and body mass index (BMI) of both mother and infant were determined. Calculations were made of the ratios between these parameters. Of the examined risk factors, only maternal height and the ratio of maternal height to infant BMI (MH/I-BMI) were found to be significant for DDH in infants. In conclusion, the results of this study show that a short maternal height and a low MH/I-BMI increase the risk of DDH. Further studies with a larger series are necessary to confirm these results.
|
0 |
Ketamine-assisted intravenous sedation with midazolam: benefits and potential problems
|
Panniculectomy & Abdominoplasty CPG
|
A review of 134 cases of ketamine-induced intravenous sedation was undertaken. It was concluded that (1) whereas properly titrated midazolam with low-dose ketamine (0.5 mg/kg) can provide almost complete absence of behavioral problems and complete analgesia, transient oxygen desaturation may be seen, and (2) the induction phase of ketamine is an opportunity for the surgeon to rehearse mask ventilation.
|
1 |
Resilience, traumatic brain injury, depression, and posttraumatic stress among Iraq/Afghanistan war veterans
|
DoD PRF (Psychosocial RF)
|
OBJECTIVE: We examined the prospective influence of the resilient, undercontrolled, and overcontrolled personality prototypes on depression and posttraumatic stress disorder (PTSD) symptoms among Iraq/Afghanistan war veterans. After accounting for the possible influence of combat exposure, we expected that the resilient prototype would predict lower depression and PTSD over time and would be associated with adaptive coping strategies, higher social support, lower psychological inflexibility, and higher self-reported resilience relative to overcontrolled and undercontrolled prototypes, independent of traumatic brain injury (TBI) status.
METHOD: One hundred twenty-seven veterans (107 men, 20 women; average age = 37) participated in the study. Personality was assessed at baseline, and PTSD and depression symptoms were assessed 8 months later. Path analysis was used to test the direct and indirect effects of personality on distress.
RESULTS: No direct effects were observed from personality to distress. The resilient prototype did have significant indirect effects on PTSD and depression through its beneficial effects on social support, coping and psychological inflexibility. TBI also had direct effects on PTSD.
CONCLUSIONS: A resilient personality prototype appears to influence veteran adjustment through its positive associations with greater social support and psychological flexibility, and lower use of avoidant coping. Low social support, avoidant coping, and psychological inflexibility are related to overcontrolled and undercontrolled personality prototypes, and these behaviors seem to characterize veterans who experience problems with depression and PTSD over time. A positive TBI status is directly and prospectively associated with PTSD symptomology independent of personality prototype. Implications for clinical interventions and future research are discussed.
|
0 |
Risk factors for osteoporosis and fracture in patients attending rheumatology outpatient clinics
|
Management of Hip Fractures in the Elderly
|
Background: Bone mineral density (BMD) using dual energy X-ray absorptiometry (DXA) scanning is the best predictor of osteoporotic fracture but may not be cost effective for all patient groups. Risk factors (RF) other than BMD may be useful for fracture prediction. Aim: To assess the prevalence of RF for osteoporosis (OP) and fracture in patients attending a public hospital rheumatology clinic and to document physician awareness of these RF. Methods: Two hundred and twenty rheumatology outpatients completed a self- administered questionnaire pertaining to known RF for OP and fracture. Initiatives were documented by the treating rheumatologist. Results: One hundred and fifty-four females and 66 males completed questionnaires: 57% had an inflammatory disorder and 32% had received significant glucocorticoid therapy. Forty-five (68%) males and 126 (82%) females had three or more RF for OP and fracture. Diagnosis of rheumatoid arthritis or connective tissue disorder (CTD) was the variable most significantly associated with increasing numbers of RF. Antiosteoporotic medication (AOM) use at assessment (64/219, 29.2%) was accounted for primarily by the use of hormone replacement therapy in females between 45-54 years. Prednisolone use predicted intervention in 103 (48%) patients. Conclusion: Many rheumatology outpatients have multiple RF for OP and fracture. Infrequent AOM use could be explained by inadequate awareness of high risk patients and the lack of an ideal long term agent. With restricted outpatient resources; the feasibility of identifying high risk patients for OP and fracture would increase if the hierarchical status of RF was better understood
|
0 |
Comparative study of skin closure in hip surgery
|
Management of Hip Fractures in the Elderly
|
A prospective, randomized controlled study was performed to compare skin staplers for closure of skin following hip surgery. Patients were randomized to have their skin closed with either continuous subcuticular non-absorbable polypropylene 'prolene' suture (33 patients) or metal skin staples (Autosuture 'Premium' or Davis and Geck 'Oppose'; 33 patients). All patients received prophylactic cephalosporin (Cephalothin) in pre- and postoperative antibiotic therapy. The wounds were examined daily and the presence of discharge, wound dehiscence and infection were noted. Any discharge at 7 days was swabbed for microbiological examination. The final cosmetic appearance was assessed at 8-12 weeks postoperatively. Scar length and width were measured and the presence of cross-hatching noted. Wound dehiscence occurred in 1 patient (closed with staples). Wound infection developed in 2 patients at a rate of 3% (1 patient from each group). At final review (8-12 weeks postop), the scar produced by subcuticular prolene was narrower than that produced by the skin stapler (P less than 0.05). There was no significant difference in scar width between a wound which had staples removed at 10 days post operation and one where the staples were removed at 14 days. Staple insertion sites were more obvious in scars that had had the staples removed at the later time (P less than 0.05)
|
0 |
Ultrasound-guided procedures to treat periarticular calcifications
|
Pediatric Supracondylar Humerus Fracture 2020 Review
|
Calcific tendinitis of the rotator cuff is one of the most common causes of shoulder pain, having an impact on patientsâ?? daily and professional activities. After failure of first-line treatments (analgesics/NSAIDs, physiotherapy, corticosteroid injection), a percutaneous procedure to remove the calcification under ultrasound is generally proposed. This review discusses different ultrasound-guided procedures currently available: one- or two-needles lavage or needling, which describes the techniques, their effectiveness and complications. The three methods appear to be equally effective although few comparative studies are available. The reported complications are not severe, mainly vagal reactions during the procedure and a transient increase in pain within 3 to 4 months of the procedure. Rare cases of septic bursitis have been reported (4 in total). Finally, although the technique is almost exclusively studied on the shoulder, other locations (hip, knee and elbow) have also been successfully treated.
|
0 |
Animal model of implant capsular contracture: effects of chitosan
|
Reduction Mammoplasty for Female Breast Hypertrophy
|
BACKGROUND: The mechanism(s) responsible for breast capsular contracture (CC) remain unknown, but inflammatory pathways play a role. Various molecules have been attached to implant shells in the hope of modifying or preventing CC. The intrinsic antibacterial and antifungal activities of chitosan and related oligochitosan molecules lend themselves well to the study of the infectious hypothesis; chitosan's ability to bind to growth factors, its hemostatic action, and its ability to activate macrophages, cause cytokine stimulation, and increase the production of transforming growth factor (TGF)-beta1 allow study of the hypertrophic scar hypothesis. OBJECTIVE: The authors perform a comprehensive evaluation, in a rabbit model, of the relationship between CC and histological, microbiological, and immunological characteristics in the presence of a chitooligosaccharide (COS) mixture and a low molecular weight chitosan (LMWC). METHODS: Eleven adult New Zealand rabbits were each implanted with three silicone implants: a control implant, one impregnated with COS, and one impregnated with LMWC. At four-week sacrifice, microdialysates were obtained in the capsule-implant interfaces for tumor necrosis factor alpha (TNF-alpha) and interleukin-8 (IL-8) level assessment. Histological and microbiological analyses were performed. RESULTS: Baker grade III/IV contractures were observed in the LMWC group, with thick capsules, dense connective tissue, and decreased IL-8 levels (p < .05) compared to control and COS groups. Capsule tissue bacterial types and microdialysate TNF-alpha levels were similar among all groups. CONCLUSIONS: Chitosan-associated silicone implantation in a rabbit model resulted in Baker grade III/IV CC. This preclinical study may provide a model to test various mechanistic hypotheses of breast capsule formation and subsequent CC.
|
0 |
dGEMRIC as a tool for measuring changes in cartilage quality following high tibial osteotomy: a feasibility study
|
OAK 3 - Non-arthroplasty tx of OAK
|
OBJECTIVE: The high tibial osteotomy (HTO) is an effective strategy for treatment of painful medial compartment knee osteoarthritis. Effects on cartilage quality are largely unknown. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) enables non-invasive assessment of cartilage glycosaminoglycan content. This study aimed to evaluate if dGEMRIC could detect relevant changes in cartilage glycosaminoglycan content following HTO.
DESIGN: Ten patients with medial compartment osteoarthritis underwent a dGEMRIC scan prior to HTO, and after bone healing and subsequent hardware removal. A dGEMRIC index (T1Gd) was used for changes in cartilage glycosaminoglycan content, a high T1Gd indicating a high glycosaminoglycan content and vice versa. Radiographic analysis included mechanical axis and tibial slope measurement. clinical scores [knee osteoarthritis outcome scale (KOOS), visual analogue score (VAS) for pain, Knee Society clinical rating system (KSCRS)] before, 3 and 6 months after HTO and after hardware removal were correlated to T1Gd changes.
RESULTS: Overall a trend towards a decreased T1Gd, despite HTO, was observed. Before and after HTO, lateral femoral condyle T1Gd was higher than medial femoral condyle (MFC) T1Gd and tibial cartilage T1Gd was higher than that of femoral cartilage (P < 0.001). The MFC had the lowest T1Gd before and after HTO. Clinical scores all improved significantly (P < 0.01), KOOS Symptoms and QOL were moderately related to changes in MFC T1Gd.
CONCLUSIONS: dGEMRIC effectively detected differences in cartilage quality within knee compartments before and after HTO, but no changes due to HTO were detected. Hardware removal post-HTO seems essential for adequate T(1)Gd interpretation. T(1)Gd was correlated to improved clinical scores on a subscore level only. Longer follow-up after HTO may reveal lasting changes. ClinicalTrials.gov registration ID: NCT01269944.
|
0 |
Factors affecting long-term results after arthroscopic partial meniscectomy
|
AMP (Acute Meniscal Pathology)
|
The purpose of this study was to determine functional and radiographic changes on long-term followup of knees with isolated meniscal tears. Sixty-seven patients were evaluated retrospectively with an average of 12.2 years' followup using the scale of Tapper and Hoover. The criteria for the radiographic results were the Fairbank's changes as the standard comparing the preoperative and the postoperative conditions of the affected knee with the contralateral knee. Seventy-nine percent of the patients had a satisfactory outcome in terms of function. The amount of meniscus removed and the Outerbridge classification of the articular cartilage at the time of the meniscectomy were determining factors for long-term functional results. Osteoarthritic deterioration was seen in 48% of patients after the surgery, but radiographic deterioration after arthroscopic partial meniscectomy was mild on long-term followup. Medial meniscectomy and the amount of meniscus removed were risk factors for postoperative radiographic change. Age, gender, and the degree of cartilage degeneration at the time of operation, in contrast, showed no significant association. Arthroscopic partial meniscectomy for isolated meniscal injury yields favorable functional results but leads to significantly increased osteoarthritic change in the long-term.
|
0 |
Evaluation of arthroscopic articular cartilage biopsy for osteoarthritis of the knee
|
Surgical Management of Osteoarthritis of the Knee CPG
|
PURPOSE: Arthroscopic evaluation of the articular surface by visualization and palpation has proved to be unreliable; therefore, we investigated arthroscopically procured biopsy specimens and conventional sections by using the same histopathomorphologic techniques and compared the results for possible differences. METHODS: Cartilage biopsy specimens of 1.7 mm in diameter and conventional cartilage sections (pieces of 8 x 2 mm) were removed from the lateral femoral condyle of 53 osteoarthritis patients undergoing total knee arthroplasty. Biopsies and conventional sections were evaluated histologically by using Mankin's grading system and immunohistochemically by assessing the immunoreactivity of the chondrocytes to MMP-1 and MMP-3. RESULTS: The comparison between the biopsies and conventional sections revealed that there were no differences between these forms of obtaining specimens. Moreover, the expression of MMP-1 and MMP-3 in biopsy specimens showed a strong correlation with that in conventional sections. CONCLUSIONS: We conclude that in small biopsy specimens taken (e.g., during arthoscopy), the histological grading of osteoarthritis severity and the evaluation of MMP expression yield results similar to those obtained in conventional sections
|
0 |
A new approach in the miniminvasive treatment of fractures
|
The Treatment of Pediatric Supracondylar Humerus Fractures AUC
|
The use of biological cement with provisory closed percutaneous Kirschner wire (K-wire) Wxation enabled the treatment of 12 patients with fractures. Within the period November 2010 - February 2011, we have treated at Saint Pantelimon Emergency Orthopaedics Clinic 12 patients using this specific method, namely: 8 humeral fractures, 1 distal radial fracture, 1 distal radial fracture associated with carpal scaphoid fracture, 1 ankle fracture, and a delayed union of distal tibial fracture. In the specialized literature, the use of bone substitutes or of biological bone cement has never been described in the treatment of fractures without the opening of the fracture site. Some bone Wllers for bone defects have been injected before, together with osteosynthesis means, plates and screws, respectively. The assessment of the results has to take into account the consolidation range of each type of fracture, and the cast Wxation must be extended accordingly. The recovery shall depend upon the fracture's callus biology, the fracture's type and location as well as the age of the patient. We evaluate the results after clinical and radiological criteria. Consolidation was achieved in all cases. We will present also the complications related to Wrst use of this new method. The use of Kryptonite-X injected under Xuoroscopic control in the conservative treatment of the fractures is a novelty. Thus, it is introduced the perspective of an innovative way of treating the fractures. Consolidation was achieved in all cases. (copyright) Springer-Verlag 2011
|
0 |
Influence of Acetabular Shell Position and Component Design on Hip Dynamic Dislocation
|
Developmental Dysplasia of the Hip 2020 Review
|
BACKGROUND: Dislocation is a major complication following total hip arthroplasty, with risk factors such as surgical technique, implant positioning, and implant design. Literature has suggested the distance the femoral head must travel before dislocation to be a predictive factor of dislocation where smaller travel distance has increased dislocation risk. The purpose of this study was to compare 3 designs (hemispherical, metal-on-metal, and dual mobility [DM]) in terms of the dynamic dislocation distance and force required to dislocate. METHODS: This dynamic dislocation distance model used a material testing system that defined acetabular component inclination (30°, 45°, and 60°), anteversion angles (0°, 15°, and 30°), and pelvic tilt (5° [standing] and 26° [chair rise]). Testing groups included a hemispherical shell with a modular polyethylene liner and 32-mm head, a metal-on-metal hip resurfacing cup design with a 40-mm CoCr head, and a DM design with a 42-mm outside diameter articulating liner and an inner 28-mm articulating head. RESULTS: The dynamic dislocation distance of the DM hip was greater than that of the other designs for all inclination, anteversion, and pelvic tilt angles tested with the exception of 60° inclination/0° anteversion. At 26° pelvic tilt, it was observed that dislocation distance increased with greater anteversion and decreased with larger inclination. CONCLUSION: Clinical results have shown the DM design may reduce dislocation. These data support those findings and suggest that if instability is a concern preoperatively or intraoperatively, using a DM implant increases the dynamic dislocation distance.
|
0 |
A new uncemented hydroxyapatite-coated femoral component for the treatment of femoral neck fractures: two-year radiostereometric and bone densitometric evaluation in 50 hips
|
Dental Implant Infection
|
Our aim in this pilot study was to evaluate the fixation of, the bone remodelling around, and the clinical outcome after surgery of a new, uncemented, fully hydroxyapatite-coated, collared and tapered femoral component, designed specifically for elderly patients with a fracture of the femoral neck. We enrolled 50 patients, of at least 70 years of age, with an acute displaced fracture of the femoral neck in this prospective single-series study. They received a total hip replacement using the new component and were followed up regularly for two years. Fixation was evaluated by radiostereometric analysis and bone remodelling by dual-energy x-ray absorptiometry. Hip function and the health-related quality of life were assessed using the Harris hip score and the EuroQol-5D. Up to six weeks post-operatively there was a mean subsidence of 0.2 mm (-2.1 to +0.5) and a retroversion of a mean of 1.2degree (-8.2degree to +1.5degree). No component migrated after three months. The patients had a continuous loss of peri-prosthetic bone which amounted to a mean of 16% (-49% to +10%) at two years. The mean Harris hip score was 82 (51 to 100) after two years. The two-year results from this pilot study indicate that this new, uncemented femoral component can be used for elderly patients with osteoporotic fractures of the femoral neck.
|
0 |
Internal fixation for displaced fractures of the femoral neck
|
Management of Hip Fractures in the Elderly
|
The results of meta-analysis show a revision rate of 33% for internal fixation of displaced fractures of the femoral neck, mostly because of nonunion. Osteopenia and osteoporosis are highly prevalent in elderly patients. Bone density has been shown to correlate with the intrinsic stability of the fixation of the fracture in cadaver and retrospective studies. We aimed to confirm or refute this finding in a clinical setting. We performed a prospective, multicentre study of 111 active patients over 60 years of age with a displaced fracture of the femoral neck which was eligible for internal fixation. The bone density of the femoral neck was measured pro-operatively by dual-energy x-ray absorptiometry (DEXA). The patients were divided into two groups namely, those with osteopenia (66%, mean T-score -1.6) and those with osteoporosis (34%, mean T-score -3.0). Age (p = 0.47), gender (p = 0.67), delay to surgery (p = 0.07), the angle of the fracture (p = 0.33) and the type of implant (p = 0.48) were similar in both groups. Revision to arthroplasty was performed in 41% of osteopenic and 42% of osteoporotic patients (p = 0.87). Morbidity (p = 0.60) and mortality were similar in both groups (p = 0.65). Our findings show that the clinical outcome of internal fixation for displaced fractures of the femoral neck does not depend on bone density and that pre-operative DEXA is not useful. (copyright) 2005 British Editorial Society of Bone and Joint Surgery
|
0 |
Early Morbidity but Not Mortality Increases With Surgery Delayed Greater Than 24 Hours in Patients With a Periprosthetic Fracture of the Hip
|
DoD SSI (Surgical Site Infections)
|
Background: Studies have identified a possible morbidity and mortality benefit with expedited time to surgery after a native hip fracture. This association after hip periprosthetic fractures (PPF) has been less clearly delineated. The purpose of this study is to assess the effect of time to surgery on rates of 30-day complications. Methods: The National Surgical Quality Improvement Program registry was used to identify all patients who underwent surgical intervention for hip PPF between 2005 and 2016. Patients were stratified into 2 cohorts based on time from hospital admission to surgery, either =24 hours (expedited) or >24 hours (non-expedited). Thirty-day outcome variables were assessed using bivariate and multivariate analyses. Results: We identified 857 patients undergoing surgical intervention for hip PPF, of whom 402 (46.9%) underwent expedited surgery and 455 (53.1%) underwent non-expedited surgery. Patients with non-expedited surgery had an average time to surgery of 2.4 days (range, 1-14 days). Multivariate analysis adjusting for differences in baseline patient characteristics revealed that patients with a non-expedited procedure had higher rates of overall complications (odds ratio [OR] = 1.72; P =.014), respiratory complications (OR = 4.15; P =.0029), urinary tract infections (OR = 2.77; P =.020), nonhome discharge (OR = 2.22; P <.001), and blood transfusions (OR = 1.86; P <.001). There was no statistical difference in mortality (P =.093). Patients with non-expedited surgery also had longer total and postoperative (+2.7 days; P <.001) length of stay. Conclusion: This study did not identify any statistical difference in mortality but found an association with increased postoperative complications and non-expedited surgery for PPF. Additional prospective studies may be warranted to identify the causative factors behind this association.
|
0 |
A Comparison of Elliptical Mastectomy to Inverted-T Pattern Mastectomy in Two-Stage Prosthetic Breast Reconstruction
|
Reduction Mammoplasty for Female Breast Hypertrophy
|
BACKGROUND: Patients with large or ptotic breasts undergoing mastectomy followed by tissue expander/implant-based reconstruction may benefit from a Wise (inverted-T) pattern reduction mammaplasty incision compared with the traditional horizontal elliptical incision. The authors compared these two groups of patients with regard to complication rates and outcomes.
METHODS: Sixty-nine patients (117 breasts) were identified who underwent Wise pattern mastectomy and two-stage reconstruction. A control group of 89 patients (136 breasts) who underwent reconstruction after horizontal elliptical mastectomy were selected over the same period. Patient demographics, clinical characteristics, and complication rates were recorded and analyzed statistically.
RESULTS: Patient demographics (age, body mass index, diabetes, smoking, and irradiation history) and clinical characteristics (laterality, expander size and fill volume, and time to expansion) were similar, with the exception of body mass index (control, 26.7 kg/m; inverted-T, 28.7 kg/m; p = 0.04) and mean intraoperative fill volume (control, 158.7 cc; inverted-T, 196.9 cc; p = 0.02). Of all complications (infection, seroma, flap necrosis, expander loss, and salvage), only the rate of mastectomy flap necrosis was significantly greater (p = 0.002) in patients undergoing inverted-T mastectomy (25.6 percent versus 11.0 percent). This difference did not result in a significantly higher rate of expander loss or need for salvage surgery.
CONCLUSIONS: The inverted-T mastectomy approach can be performed safely with acceptable complication rates. When compared with an internal control group, complication rates were similar, with the exception of mastectomy flap necrosis. Despite a higher rate of flap necrosis, 91 percent of inverted-T patients successfully completed the expansion process.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
|
0 |
Culture and PCR analysis of joint fluid in the diagnosis of prosthetic joint infection
|
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
This prospective study compared PCR and culture techniques in the diagnosis of prosthetic joint infection (PJI). We obtained joint fluid samples (JFS; n=115) from patients who had failed total joint arthroplasty between January 2003 and June 2005; 49 were positive for PJI according to established strict criteria. JFS were analyzed by PCR (n=35; control n=66) or culture (n=46, control n=48). PCR was positive in 71% of PJI cases, resulting in sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and likelihood ratio for positive results as follows: 0.71; 0.97; 0.88; 0.93; 0.87 and 23.6, respectively. Culture was positive in 44% of PJI samples. Corresponding statistics were 0.44; 0.94; 0.69; 0.87; 0.63 and 7.0, respectively. Significantly higher sensitivity, accuracy and negative predictive values were calculated for PCR versus culture, and there was 83% concordance between the results of intraoperative culture and PCR detection of causative bacteria. Therefore, we conclude that PCR analysis of synovial fluid increases the utility of pre-operative aspiration for patients who require revision total joint surgery
|
0 |
Early recognition of chemical dependence
|
DoD PRF (Psychosocial RF)
|
Chemical dependence is a leading cause of morbidity and death in the United States. At least 20% of patients seen by primary care physicians in both the outpatient and inpatient setting are chemically dependent. Up to 90% of these patients go undiagnosed by their primary physicians. Chemical dependence is defined as a chronic, progressive illness characterized by the repeated and persistent use of alcohol or drugs despite negative health, family, work, financial, or legal consequences. Primary care physicians are in an ideal position to detect chemical dependence at its earliest stages, when irreversible medical consequences and death are most likely preventable. Alcohol is the most common drug of abuse. Improving the rate of recognition of chemical dependence depends on being familiar with the constellation of physical, mental, and social indicators. Early medical manifestations of alcoholism common in the primary care setting include: gastric complaints, elevated blood pressure, palpitations, traumatic injuries, headaches, impotence, and gout. Early psychosocial manifestations common in both alcohol and drug dependence include anxiety, depression, insomnia, persistent relationship conflicts, work or school problems, and financial or legal problems. Particularly useful laboratory indicators of alcoholism include elevated levels of GGT and MCV, both displaying high specificity, with the GGT level being the most sensitive. Similarly specific laboratory tests for drug dependence are not available. Any patient presenting with any of the above medical, psychosocial, or laboratory manifestations should be screened for chemical dependence. The CAGE questionnaire for alcoholism, a four-question test, is particularly well suited to the primary care setting, where it can be administered in fewer than 60 seconds. The CAGE has demonstrated high sensitivity (in the 80% range) and specificity (approximately 85%) for alcoholism. Comparably convenient instruments do not yet exist for drug dependence, although a 28-item instrument, the DAST (Drug Abuse Screening Test), has demonstrated high sensitivity and specificity for drug abuse. [References: 72]
|
0 |
Staining of demineralized cartilage. II. Quantitation of articular cartilage proteoglycan after fixation and rapid demineralization
|
Management of Hip Fractures in the Elderly
|
Safranin O in the orthochromatic form stains articular cartilage proteoglycan quantitatively in histological sections of demineralized cartilage. This was shown by scanning microdensitometry of stained sections of undemineralized and demineralized articular cartilage and by biochemical analysis of 35S labelled cartilage subjected to demineralization. In contrast, Alcian Blue staining is affected by unknown factors other than simply the amount of proteoglycan present. Alcoholic formalin fixes articular cartilage proteoglycan more successfully than formol Zenker for subsequent rapid demineralization. Alcoholic formalin does not preserve cellular appearance as well as formol Zenker. Staining of articular cartilage with PAS appears unaffected by demineralization
|
0 |
European Congress on Osteoporosis and Osteoarthritis, ECCEO11-IOF
|
SR for PM on OA of All Extremities
|
The proceedings contain 641 papers. The topics discussed include: the burden of fractures in France, Germany, Italy, Spain, Sweden, and the UK; bone microarchitecture assesment by high-resolution peripheral quantitative computed tomography(HR-PQCT) in healthy women; DAPS (denosumab adherence preference satisfaction): results of the second year of the crossover study; quantitative ultrasound of the heel and fracture risk assessment: an updated meta-analysis; force directions for optimal proximal femoral strength and hip fracture risk assessment in men and women: the ages-Reykjavik study; local topological analysis at the distal radius by HR-pQCT: application to in vivo bone microarchitecture and fracture assessment in the ofely study; clinical risk factors, bone mineral density and falls history in the prediction of incident fracture among men and women; and effects of the cathepsin K inhibitor, ONO-5334, on BMD as measured by 3D QCT in the hip and the spine after 12 months treatment
|
1 |
The effect of partial lateral meniscectomy in patients > or = 60 years
|
AMP (Acute Meniscal Pathology)
|
To determine the benefit, if any, of meniscectomy in an older population, all patients > or = 60 years who underwent partial lateral meniscectomy were evaluated. Thirty-five patients (36 knees) were available for follow-up. The average patient age was 64.9 years. Patients were divided into two groups based on the degree of articular cartilage damage. Patients in group 1 had no damage worse than grade II and underwent arthroscopic partial meniscectomy only, while patients in Group 2 had grade III or IV damage and underwent arthroscopic debridement as well as partial meniscectomy. With an average follow-up of 36.8 months, the overall failure rate was 13.9%. Eighty-six percent of the patients reported the overall assessment of their knee as improved (94% and 80% in groups 1 and 2, respectively). While patients in group 2 tended to have less favorable results than patients in group 1, these results indicate that this procedure is warranted and that both groups benefited significantly from partial meniscectomy.
|
1 |
High short-term return to sports rate despite an ongoing healing process after acute meniscus repair in young athletes
|
AMP (Acute Meniscal Pathology)
|
PURPOSE: Acute meniscus repair in young athletes is always a challenge due to the long rehabilitation process and time to return to sport (RTS). The purpose was to investigate signal alterations in short-term follow-up after acute meniscus repair on specific magnetic resonance imaging (MRI) scan sequences. It was hypothesized that (1) MRI signal changes over the first postoperative healing phase and represent a continuous healing process and (2) meniscus healing properties correlates with clinical outcomes and RTS.
METHODS: Young athletes with traumatic meniscus lesion and arthroscopic meniscus repair within 6 weeks and available preoperative MRI were enrolled. Clinical examination, outcome scores (IKDC, KOOS, Lysholm Score, Tegner activity score) and RTS were surveyed preoperatively and 6 and 12 weeks and 6 months after surgery. Radiological follow-up examinations were performed 2, 4, 6, 12 weeks and 6 months after operation using a 3T-MRI. Evaluation was based on ISAKOS meniscus classification system, meniscus healing were classified according to Henning's criteria.
RESULTS: At final follow-up (FU) 30 patients (28 month, 2 week) with a total of 35 meniscus tears (19 medial, 16 lateral) were included. Clinical scores improved significantly after surgery: IKDC Score (preOP: 39.4 +/- 18.5, final FU: 78.8 +/- 15.3) KOOS (preOP: 45.7 +/- 22.1, final FU: 82.7 +/- 12.5) and Lysholm Score (preOP: 42.8 +/- 23.7, final FU: 84.4 +/- 13.8) (p < 0.01). Tegner activity score showed a steadily increase to 4 (range 3-9) at 6 months but did not reached the pre-injury level of 6 (range 3-9). RTS rate was 100% whereof 44.8% reached their pre-injury level. MRI examination revealed a continuous healing process and menisci were classified as 55.9% healed, 35.3% partially healed and 8.8% non-healed at final FU.
CONCLUSION: This study showed that MRI signal alterations of the meniscus steadily occur within the first 6 months postoperatively. MRI reveals an ongoing healing process at final FU that have to be carefully considered when RTS is discussed with high demanding patients. However, young athletes provide good clinical results and RTS rate even though MRI alterations are still present.
LEVEL OF EVIDENCE: Therapeutic study, prospective case series, Level IV.
|
0 |
Building resistance, resilience, and recovery in the wake of school and workplace violence
|
DoD PRF (Psychosocial RF)
|
Incidents of school and workplace violence are rare but devastating events that can result in significant psychological consequences in communities. The majority of people in the United States will experience some type of traumatic event in their lifetime, but most of them will have no disruption or only transient disruption in functioning. They are either resistant to the development of symptoms or resilient, able to bounce back quickly. By enhancing resistance and promoting resilience, even fewer individuals may develop mental disorders. This article takes a closer look at the concepts of resistance, resilience, and recovery and the need for research on interventions that promote them, in the hope of applying the concepts and interventions to schools and the workplace.
|
0 |
Ultrasound measures of muscle thickness may be superior to strength testing in adults with knee osteoarthritis: a cross-sectional study
|
OAK 3 - Non-arthroplasty tx of OAK
|
BACKGROUND: Evaluation of muscle strength as performed routinely with a dynamometer may be limited by important factors such as pain during muscle contraction. Few studies have compared formal strength testing with ultrasound to measure muscle bulk in adults with knee osteoarthritis (OA).
METHODS: We investigated the muscle bulk of lower limb muscles in adults with knee OA using quantitative ultrasound. We analyzed the relationship between patient reported function and the muscle bulk of hip adductors, hip abductors, knee extensors and ankle plantarflexors. We further correlated muscle bulk measures with joint torques calculated with a hand held dynamometer. We hypothesized that ultrasound muscle bulk would have high levels of interrater reliability and correlate more strongly with pain and function than strength measured by a dynamometer. 23 subjects with unilateral symptomatic knee OA completed baseline questionnaires including the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Lower Extremity Activity Scale. Joint torque was measured with a dynamometer and muscle bulk was assessed with ultrasound.
RESULTS: Higher ultrasound measured muscle bulk was correlated with less pain in all muscle groups. When comparing muscle bulk and torque measures, ultrasound-measured muscle bulk of the quadriceps was more strongly correlated with measures of pain and function than quadriceps isometric strength measured with a dynamometer.
CONCLUSIONS: Ultrasound is a feasible method to assess muscle bulk of lower limb muscles in adults with knee OA, with high levels of interrater reliability, and correlates negatively with patient reported function. Compared with use of a hand held dynamometer to measure muscle function, ultrasound may be a superior modality.
|
0 |
Carpal tunnel syndrome in amyloidosis: Prevalence, risk factors and correlation with cardiac involvement in a large cohort of 435 consecutive patients
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
Purpose: Carpal tunnel syndrome (CTS) is one of the most common clinical manifestations of TTR-related amyloidosis, both hereditary (ATTR), and wild type (senile systemic amyloidosis, SSA) and often precedes cardiac symptoms. The exact prevalence of CTS in amyloidosis however is not known. We therefore aimed to establish prevalence, risk factors and possible association with cardiac involvement in patients with TTR-related and AL amyloidosis. Methods: We retrospectively analyzed clinical and instrumental (ECG and echocardographic) findings of 260 patients with TTR-related and 175 with AL amyloidosis evaluated at our Centre between 1990 and September 2013. Results: Prevalence was 35% in TTR-related amyloidosis (35% in ATTR and 32% in SSA) and 8% in patients with AL (p<0.001). Among TTR patients, CTS was more frequently associated with cardiac involvement (76% vs. 42%; p<0.0001) as reflected in the ECG and echo findings (Table 1), and manifested 9 years before the onset of cardiac symptoms. Among patients with cardiomyopathy with/without CTS there were no significant clinical/instrumental differences. At univariate analysis male gender and genotype were not associated with CTS. Conclusions: CTS is specifically associated with TTR-related amyloidosis (but not AL) independently from patient gender. In TTR-related amyloidosis, CTS is more frequently associated with cardiac involvement, even though patients with cardiomyopathy with/without CTS have a comparable clinical/instrumental profile. CTS precedes cardiac symptom onset by 9 years, this finding is important for an early diagnosis of amyloidotic cardiomyopathy. (Table Presented)
|
0 |
Lumbar facet joint osteoarthritis: a review
|
SR for PM on OA of All Extremities
|
OBJECTIVES: The facet joints (FJ) can be a potentially important source of symptoms because of the high level of mobility and load forces, especially in the lumbar area. We reviewed the anatomy, biomechanics, and possible sources of pain of the FJ, natural history, and risk factors of lumbar FJ osteoarthritis and briefly reviewed the relevant imaging methods. METHODS: PubMed and MEDLINE databases (1950-2006) were searched for the key words "facet joints," "zygapophyseal joints," "osteoarthritis," "low back pain," and "spondyloarthritis." All relevant articles in English were reviewed. Pertinent secondary references were also retrieved. RESULTS: The FJ play an important role in load transmission; they provide a posterior load-bearing helper, stabilizing the motion segment in flexion and extension and also restricting axial rotation. The capsule of the FJ, subchondral bone, and synovium are richly innervated and can be a potential source of the low back pain. Degenerative changes in the FJ comprise cartilage degradation that leads to the formation of focal and then diffuse erosions with joint space narrowing, and sclerosis of the subchondral bone. Because the most prominent changes occur in bone, the best method of evaluation of the FJ is computed tomography. Risk factors for lumbar FJ osteoarthritis include advanced age, relatively more sagittal orientation of the FJ, and a background of intervertebral disk degeneration. CONCLUSIONS: An up-to-date knowledge of this subject can be helpful in the development of diagnostic techniques and in the prevention of lumbar FJ osteoarthritis and low back pain and can assist in the determination of future research goals
|
0 |
Evaluation of Meniscal Regeneration in a Mini Pig Model Treated With a Novel Polyglycolic Acid Meniscal Scaffold
|
OAK 3 - Non-arthroplasty tx of OAK
|
BACKGROUND: Meniscal injury is a severe impediment to movement and results in accelerated deterioration of the knee joint. PURPOSE: To evaluate the effect of a novel meniscal scaffold prepared from polyglycolic acid coated with polylactic acid/caprolactone on the treatment of meniscal injury in a mini pig model. STUDY DESIGN: Controlled laboratory study. METHODS: The model was established with a 10-mm resection at the anterior medial meniscus on both knee joints. A scaffold was implanted in the right knee joint. The meniscal scaffold was inserted and sutured next to the native meniscus. The histological analysis was performed to determine meniscal regeneration with safranin O staining, cell proliferation with PCNA, inflammation with TNF, and collagen structure and production with picrosirius red and immunofluorescence. Cartilage degeneration was evaluated with Safranin O. Meniscal regeneration and joint fluid were evaluated with magnetic resonance imaging. RESULTS: Although compressive stress and elastic modulus were significantly lower in the scaffold than in the native porcine menisci, ultimate tensile stress was similar. Implanted scaffolds were covered with tissue beginning at 4 weeks, with increased migration of proliferating cells to the implant area at 4 and 8 weeks. Scaffolds were absorbed with freshly produced collagen at 24 weeks. Cartilage degeneration was significantly lower in the meniscus-implanted group than in the meniscectomy group. Magnetic resonance imaging results did not show severe accumulation of joint fluids, suggesting negligible inflammation. Density of the implanted menisci was comparable with that of the native menisci. CONCLUSION: Meniscal scaffold prepared from polyglycolic acid has therapeutic potential for meniscal regeneration. CLINICAL RELEVANCE: This meniscal scaffold can improve biological knee reconstruction and prevent the increase of total knee arthroplasty.
|
0 |
Cementless total hip arthroplasty in renal transplant patients
|
AAHKS (2) Corticosteroids
|
Twenty-seven cementless total hip arthroplasties were performed in 17 steroid-dependent renal transplant patients. The average age at operation was 39 years, and the average daily dose of prednisone was 10.9 mg. At a mean of 48 months post-surgery, all patients had good to excellent hip ratings on clinical examination and the results compared favorably with 235 non-steroid-dependent age-matched patients using the identical prosthetic hip system. The results of this study suggest that long-term immunosuppression does not prevent bone ingrowth. Noncemented total hip arthroplasty appears to be a reasonable therapeutic option for end-stage osteonecrosis in steroid-dependent renal transplant patients.
|
1 |
Hospital management preparedness tools in biological events: A scoping review
|
Coronavirus Disease 2019 (COVID-19)
|
INTRODUCTION: The objective of the present study was to systematically review the current research knowledge on hospital preparedness tools used in biological events and factors affecting hospital preparedness in such incidents in using a scoping review methodology. MATERIALS AND METHODS: The review process was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guideline. Online databases (PubMed, Scopus, Web of Science, and Google Scholar) were used to identify papers published that evaluated instruments or tools for hospital preparedness in biological disasters (such as influenza, Ebola, and bioterrorism events). The search, article selection, and data extraction were carried out by two researchers independently. RESULTS: A total of 3440 articles were screened, with 20 articles identified for final analysis. The majority of research studies identified were conducted in the United States (45%) and were focused on CBRN incident (20%), Ebola, infectious disease and bioterrorism events (15%), mass casualty incidents and influenza pandemic (10%), public health emergency, SARS, and biological events (5%). Factors that were identified in the study to hospitals preparedness in biological events classified in seven areas including planning, surge capacity, communication, training and education, medical management, surveillance and standard operation process. CONCLUSIONS: Published evidences of hospital preparedness on biological events as well as the overall quality of the psychometric properties of most studies were limited. The results of the current scoping review could be used as a basis for designing and developing a standard assessment tool for hospital preparedness in biological events, and it can also be used as a clear vision for the healthcare managers and policymakers in their future plans to confront the challenges identified by healthcare institutes in biologic events.
|
0 |
Arthroplasty hip infection: The physician point of view
|
AAHKS (2) Corticosteroids
|
Total hip replacement is one of the most common orthopaedic surgeries, and its most frequent indication is osteoarthritis. Prosthetic Hip infection (PHI) can occur in 1 to 1.5 percent of cases. Some risk factors have been identified (modifiable or not), such as obesity, diabetes, corticosteroids, malnutrition, anemia, or smoking. These risk factors must be screened before surgery, and be corrected preoperatively to decrease the risk. Sometimes surgery must be delayed or abandoned. Prescription of some of our chronic inflammatory rheumatism patientsâ?? immunosuppressive drugs must be modified and steroids prescription must be lowered under 10 mg per day. PHI treatment is based on 2 axes: surgery and antibiotic therapy. In this paper we describe the most important molecules the rheumatologist has to know in correlation with the most frequent microorganism found in prosthesis infections, and how to deal with immunosuppressive drugs we usually prescribe to our RA patients.
|
0 |
Accuracy of implant alignment and early results after minimally invasive vs conventional OrthoPilot-navigated Columbus TKA
|
Surgical Management of Osteoarthritis of the Knee CPG
|
The goal of this study was to evaluate potential risks and benefits of minimally invasive vs conventional approaches in navigated total knee arthroplasty (TKA) in 50 patients. Preoperatively, no statistically significant differences between the two groups were found for deformity, range of motion (ROM), clinical scores, and ligament stability in the native joint or after prosthesis implantation measurements intraoperatively. Postoperatively, there were no significant differences between the two groups for deformity and clinical scores. In contrast, significantly less pain according to VAS measures and quicker improvements in ROM during the first 10 postoperative days were experienced in the minimally invasive group. Complication rates were similar in both groups. According to our results, minimally invasive navigated TKA is characterized by high implant positioning accuracy, soft tissue management quality, and complication rates similar to those for conventional approaches. Compared with the conventional approach, minimally invasive TKA provides superior functional results and less pain in the early postoperative period
|
0 |
The efficacy and safety of Calidron tablets for management of osteoporosis in Jordanian women: a randomised clinical trial
|
Management of Hip Fractures in the Elderly
|
The aim of this study was to evaluate the efficacy and safety of daily alendronate (Calidron) 5 and 10 mg for treatment and prevention of osteoporosis in postmenopausal Jordanian women. Subjects were randomly assigned to receive oral treatment with alendronate in the form of Calidron 5mg or 10 mg; or identically appearing oral placebo pills. Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry at lumbar spine, femoral neck, trochanter and wards at baseline and 12-month visits. After 12 months of treatment, 20 women (74%) in 10 mg/d Calidron, 18 (50%) in 10 mg/d placebo, 11 (55%) in 5 mg/d Calidron, and 13 (38%) in 5 mg/d placebo arms remained in the study and had BMD measurements. Much greater effect of Calidron 5 mg tablets was observed at other sites of the hip; 3.9% (vs YA), 6.4% (vs AM), 7.13% (vs YA), 10.9% (vs AM), 10.1% (vs YA), and 12% (vs AM) increase at the femoral neck, wards and trochanter (p<0.01). In conclusion, our study generally support the conclusion that Calidron 10 mg is relatively effective for maintenance of BMD and it possess real clinical value for preserving and normalizing bone mass in menopausal women with or without osteoporosis or osteopenia. Copyright © 2011 Elsevier B. V., Amsterdam. All Rights Reserved
|
0 |
Service provision for patients with chronic pain after knee replacement: An evaluation of current practice in high volume orthopaedic centres
|
Surgical Management of Osteoarthritis of the Knee CPG
|
Background: Total knee replacement is one of the most commonly performed elective surgical procedures. The operation is usually conducted to relieve pain and improve function, but recent studies indicate that up to 20% of patients experience chronic post-surgical pain (CPSP) after total knee replacement; this equates to around 16,000 new cases of CPSP in the UK each year. The wider literature on chronic pain indicates that people with chronic pain encounter patchy service provision. People with CPSP after knee replacement have already undergone major surgery for pain, and follow-up after surgery may have a role in care and pain management. However, we do not know what services are on offer to this group, nor whether there is consistency in service provision including identification of need and any associated referral processes.We therefore conducted a survey to scope current UK service provision for patients with CPSP after total knee replacement. Methods: This ongoing project is funded through a National Institute for Health Research (NIHR) Programme Development Grant on the treatment and management of chronic pain after total knee replacement (the STAR programme). The project was conducted as a service evaluation of services at high volume NHS orthopaedic centres across the UK. The 23 NHS orthopaedic centres that conduct 500 or more primary total knee replacements per year were identified from the National Joint Registry. Contact was made with a key health professional at each centre who was familiar with the processes of postoperative assessment and follow-up. A structured telephone interview was conducted to obtain information about usual patient pathways at the different centres. Questions focused on identification, triage, treatment, management, and referral of patients with CPSP after total knee replacement. Information was recorded on a standardised proforma and entered into an Access database. Information was then collated and summarised in Excel. Results: The survey has been completed by 14/23 NHS orthopaedic centres. Data collection is ongoing, with completion by February 2014. All centres routinely follow-up patients at 6 weeks after total knee replacement, although the provision and timing of subsequent appointments vary. The majority of centres do not have a specific time point at which patients are diagnosed with CPSP; in those that do, time points range from 4.5-18 months post-operative. When assessing pain levels, most centres use patient narrative, and there is some use of a standardised tool, most frequently a visual analogue scale. Four centres reported using a standardised protocol for assessment of patients with CPSP, and two centres reported use of a standardised protocol for management and treatment. Treatment and management options offered to patients vary between and within centres, and include further orthopaedic interventions, referral to pain management services, analgesia review, and referral for physiotherapy. Conclusion: This survey of current service provision for patients with CPSP after total knee replacement identified national variation in the identification, assessment and management of these patients. Although some centres have developed a care pathway for patients with CPSP, the majority of centres lack standardised protocols to guide care provision. This highlights the potential to develop and evaluate standardised referral pathways and integrated service provision for patients with CPSP after total knee replacement
|
0 |
Vague Posterior Knee Discomfort in a Soccer Player: A Clinical Vignette
|
Pediatric Supracondylar Humerus Fracture 2020 Review
|
A 24-yr-old male soccer player presented with a 7-yr history of left posterior knee "looseness." Evaluation 7 yrs ago, at the time of initial injury, revealed atraumatic anterior and posterior cruciate ligament sprains. On representation, the patient described the pain as a constant, dull ache, 3/10, but his biggest complaint was this feeling of "instability" and looseness where his knee would "buckle" 3-4 times a week. Physical examination was positive for grade 1 posterior drawer and grade 1 posterior sag signs. Reverse KT-1000 testing showed a 3-mm side-to-side difference. Sonographic evaluation confirmed magnetic resonance imaging findings of posterior cruciate ligament laxity and buckling and a small cystic lesion abutting the posteromedial margin of the distal 1/3 of the posterior cruciate ligament. After a trial of physical therapy, the patient elected to undergo experimental injection of dextrose hyperosmolar solution. This resulted in resolution of the cyst and reverse KT-1000 measurements improved to a side-to-side difference of 1 mm. The patient's subjective feeling of looseness and instability resolved by 7 wks.
|
0 |
Colour Doppler ultrasonography to detect pannus in knee joint synovitis
|
Surgical Management of Osteoarthritis of the Knee CPG
|
OBJECTIVE: To determine if colour Doppler ultrasonography can characterise the nature of intraarticular echogenic structures and synovial villi more precisely than conventional ultrasonography. METHODS: This is a prospective study on 20 patients--10 with rheumatoid arthritis and 10 with osteoarthritis. Colour Doppler ultrasonography of the knee joints was performed prior to total prosthetic replacement. Two independent, trained physician ultrasonographers examined the knee to be replaced with different ultrasound equipment using colour Doppler and power Doppler ultrasonography. The existence and extent of pannus were then assessed surgically and histologically. RESULTS: All 9 patients with histologically detected pannus had perfused, echogenic, intraarticular structures (ultrasonographer 2; ultrasonographer 1: 8 out of 9 patients). Sparse perfusion was detected in 1 patient (investigator 1) and in 5 patients (investigator 2) with extensive non-destructive synovial proliferation. Colour Doppler and power Doppler ultrasonography were equivalent in detecting small intraarticular vessels. CONCLUSION: Colour Doppler ultrasonography improves the differentiation of intraarticular structures compared to conventional ultrasonography
|
0 |
Transtemporal midface lifting to blend the lower eyelid-cheek junction
|
Upper Eyelid and Brow Surgery
|
When examining the results of this technique, improvement is noticed in the infraorbital hollowing, midface tissue ptosis, depth of nasolabial folds, and degree of jowling. The greatest overall improvement is the extent of midface ptosis and infraorbital hollowing at the lower eyelid-cheek junction followed by improvement in the nasolabial region. Improvement in jowling was common but less significant than the improvement of the midface structures. The authors think that this dramatic improvement is owing to multiple factors. With wide and complete release of the central and lateral midfacial structures, the en bloc suspension of the SOOF and malar fat pad is thoroughly accomplished. Unlike other midfacial techniques, the transtemporal midface achieves pull in 2 vectors, directing the repositioning of tissuesboth superiorly and laterally. The superior vector repositions the SOOF and malar fat pad over the bony infraorbital rim and malar/zygomatic complex, whereas the lateral pull effaces the nasolabialfold. This superior vector more accurately reverses the forces of aging displayed on the ptotic midface. Lastly, although this technique is not designed primarily to eliminate jowling at the mandible, it has been noted that elevation of 1.0 to 1.5 cm of skin overlying the mandible is typical. Although the endoscopic forehead midface lift is not without its complications or pitfalls, all of these can be minimized, easily managed, or avoided completely through the intraoperative techniques and postoperative care. Careful and deliberate preoperative counseling of patients regarding the possible bumps in the road to recovery is critical. By using the techniques available to limit and manage complications and setting appropriate patient expectations should these complications occur, the endoscopic forehead midface lift can become an extremely powerful and safe technique in the facial cosmetic surgeon's armamentarium to efface the lid-cheek junction with a high degree of patient satisfaction.
|
0 |
Conversion from temporary external fixation to definitive fixation: shaft fractures
|
DoD SSI (Surgical Site Infections)
|
Temporary external fixation is the most common method of initial stabilization of diaphyseal fractures in forward surgical hospitals. Once the patient arrives at a stable environment, usually the United States, the fracture is managed with intramedullary nailing, small-pin external fixation, or a modified external fixator. Future research should be directed toward improving methods of care. It is not precisely known when is the best time to convert to definitive fixation without increasing the risk of infection. The risk factors leading to infection and nonunion are not well-established, making that determination even more difficult. Clinical studies of a suitable size should provide insight into these problems. Although temporary external fixation is commonly used, an optimal construct has not been determined. Data from studies of in vivo fracture-site motion after application of the temporary external fixator should be compared with biomechanical testing of similar constructs. These data could be used to recommend optimal temporary external fixation constructs of tibia, femur, and humerus fractures using currently available devices as well as to provide groundwork for the next generation of fixators. [References: 33]
|
0 |
Tendinopathy
|
PRPs for Lateral Epicondylitis/Elbow Tendinopathies
|
Tendinopathy describes a complex multifaceted pathology of the tendon, characterized by pain, decline in function and reduced exercise tolerance. The most common overuse tendinopathies involve the rotator cuff tendon, medial and lateral elbow epicondyles, patellar tendon, gluteal tendons and the Achilles tendon. The prominent histological and molecular features of tendinopathy include disorganization of collagen fibres, an increase in the microvasculature and sensory nerve innervation, dysregulated extracellular matrix homeostasis, increased immune cells and inflammatory mediators, and enhanced cellular apoptosis. Although diagnosis is mostly achieved based on clinical symptoms, in some cases, additional pain-provoking tests and imaging might be necessary. Management consists of different exercise and loading programmes, therapeutic modalities and surgical interventions; however, their effectiveness remains ambiguous. Future research should focus on elucidating the key functional pathways implicated in clinical disease and on improved rehabilitation protocols.
|
1 |
Aseptic versus Sterile Acellular Dermal Matrices in Breast Reconstruction: An Updated Review
|
Acellular Dermal Matrix
|
BACKGROUND: As the use of acellular dermal matrices in breast reconstruction has become more commonplace and efforts are made to improve on postoperative outcomes, the method of acellular dermal matrix (ADM) processing (aseptic versus sterile) has become a subject of interest. This article provides an updated overview of the critical aspects of ADM processing in addition to application of ADMs in single- and two-stage breast reconstruction, a review of the morbidity associated with ADM use, and alternatives. METHODS: A literature review was performed in PubMed identifying recent systematic reviews, meta-analyses, and head-to-head comparisons on aseptically processed ADM and sterile-processed ADM in implant-based breast reconstruction. RESULTS: Recent meta-analyses have shown a 2- to 3-fold increase in infections and tissue expander/implant explantation rates and a 3- to 4-fold increase in seroma formation compared with non-ADM reconstruction techniques. Comparisons of aseptic and sterile ADMs in multiple studies have shown no significant difference in infection rates and equivocal findings for other specific complications such as seroma formation. CONCLUSIONS: Current evidence on the impact of processing techniques that improve ADM sterility on postoperative morbidity in implant breast reconstruction is unclear. Deficiencies of the available data highlight the need for well-designed, multicenter, randomized controlled studies that will aid in optimizing outcomes in implant-based breast reconstruction.
|
0 |
Depression following hip fracture is associated with increased physical frailty in older adults: the role of the cortisol: dehydroepiandrosterone sulphate ratio
|
Hip Fx in the Elderly 2019
|
BACKGROUND: Hip fracture in older adults is associated with depression and frailty. This study examined the synergistic effects of depression and hip fracture on physical frailty, and the mediating role of the cortisol:dehydroepiandrosterone sulphate (DHEAS) ratio.
METHODS: This was an observational longitudinal study of patients with a hip fracture carried out in a hospital setting and with follow up in the community. Participants were 101 patients aged 60+ years (81 female) with a fractured neck of femur. Measurements of the ability to carry out activities of daily living (ADL), cognitive function, physical frailty and assays for serum cortisol and DHEAS were performed six weeks and six months post-hip fracture. Depressed and non-depressed groups were compared by ANOVA at each time point.
RESULTS: Hip fracture patients who developed depression by week six (n = 38) had significantly poorer scores on ADL and walking indices of frailty at both week six and month six, and poorer balance at week six. The association with slower walking speed was mediated by a higher cortisol:DHEAS ratio in the depressed group.
CONCLUSION: Depression following hip fracture is associated with greater physical frailty and poorer long term recovery post-injury. Our data indicate that the underlying mechanisms may include an increased cortisol:DHEAS ratio and suggest that correcting this ratio for example with DHEA supplementation could benefit this patient population.
|
0 |
Expert consensus from the Italian Society for Colposcopy and Cervico-Vaginal Pathology (SICPCV) for colposcopy and outpatient surgery of the lower genital tract during the COVID-19 pandemic
|
Coronavirus Disease 2019 (COVID-19)
|
In the context of the COVID-19 pandemic, patients need to be evaluated within 2-4 weeks in the following cases: cytology result of "squamous cell carcinoma," "atypical glandular cells, favor neoplastic," "endocervical adenocarcinoma in situ," or "adenocarcinoma"; histopathological diagnosis of suspected invasion from cervical/vaginal biopsy, or invasive disease after a cervical excision procedure, vaginal excision, or vulvar biopsy/excision; sudden onset of strongly suggestive symptoms for malignancy. Digital imaging technologies represent an important opportunity during the COVID-19 pandemic to share colposcopic images with reference centers, with the aim of avoiding any concentration of patients. All patients must undergo screening for COVID-19 exposure and should wear a surgical mask. A high-efficiency filter smoke evacuation system is mandatory to remove surgical smoke. Electrosurgical instruments should be set at the lowest possible power and not be used for long continuous periods to reduce the amount of surgical smoke. The following personal protective equipment should be used: sterile fluid-repellant surgical gloves, an underlying pair of gloves, eye protection, FFP3 mask, surgical cap, and gown. The colposcope should be protected by a disposable transparent cover. A protective lens that must be disinfected after each use should be applied. The use of a video colposcope should be preferred.
|
0 |
Regulation of H19 and its encoded microRNA-675 in osteoarthritis and under anabolic and catabolic in vitro conditions
|
OAK 3 - Non-arthroplasty tx of OAK
|
Cartilage degeneration in the course of osteoarthritis (OA) is associated with an alteration in chondrocyte metabolism. In order to identify molecules representing putative key regulators for diagnosis and therapeutic intervention, we analyzed gene expression and microRNA (miR) levels in OA and normal knee cartilage using a customized cartilage cDNA array and quantitative RT-PCR. Among newly identified candidate molecules, H19, IGF2, and ITM2A were significantly elevated in OA compared to normal cartilage. H19 is an imprinted maternally expressed gene influencing IGF2 expression, whose transcript is a long noncoding (lnc) RNA of unknown biological function harboring the miR-675. H19 and IGF2 mRNA levels did not correlate significantly within cartilage samples suggesting that deregulation by imprinting effects are unlikely. A significant correlation was, however, observed for H19, COL2A1, and miR-675 expression levels in OA tissue, and functional regulation of these candidate molecules was assessed under anabolic and catabolic conditions. Culture of chondrocytes under hypoxic signaling showed co-upregulation of H19, COL2A1, and miRNA-675 levels in close correlation. Proinflammatory cytokines IL-1beta and TNF-alpha downregulated COL2A1, H19, and miR-675 significantly without close statistical correlation. In conclusion, this is the first report demonstrating deregulation of an lncRNA and its encoded miR in the context of OA-affected cartilage. Stress-induced regulation of H19 expression by hypoxic signaling and inflammation suggests that lncRNA H19 acts as a metabolic correlate in cartilage and cultured chondrocytes, while the miR-675 may indirectly influence COL2A1 levels. H19 may not only be an attractive marker for cell anabolism but also a potential target to stimulate cartilage recovery.
|
0 |
Bisphosphonate guidelines for treatment and prevention of myeloma bone disease
|
MSTS 2018 - Femur Mets and MM
|
Multiple myeloma (MM) is a haematological malignancy characterised by the clonal proliferation of plasma cells in the bone marrow. More than 80% of patients with MM display evidence of myeloma bone disease (MBD), characterised by the formation of osteolytic lesions throughout the axial and appendicular skeleton. MBD significantly increases the risk of skeletal-related events such as pathologic fracture, spinal cord compression and hypercalcaemia. MBD is the result of MM plasma cells-mediated activation of osteoclast activity and suppression of osteoblast activity. Bisphosphonates (BP), pyrophosphate analogues with high bone affinity, are the only pharmacological agents currently recommended for the treatment and prevention of MBD and remain the standard of care. Pamidronate and zoledronic acid are the most commonly used BP to treat MBD. Although generally safe, frequent high doses of BP are associated with adverse events such as renal toxicity and osteonecrosis of the jaw. As such, optimal duration and dosing of BP therapy is required in order to minimise BP-associated adverse events. The following guidelines provide currently available evidence for the adoption of a tailored approach when using BP for the management of MBD.
|
0 |
Novel therapies in the treatment of multiple myeloma
|
MSTS 2018 - Femur Mets and MM
|
Multiple myeloma (MM) is a clonal B-cell malignancy characterized by aberrant expansion of plasma cells within bone marrow and extramedullary sites. In 2009, 20,580 new cases of MM and 10,580 deaths from the disease occurred in the United States. Treatment traditionally consists of systemic chemotherapy, with adjunctive use of radiation or surgery in selected cases associated with extramedullary disease. The therapeutic landscape in MM has changed markedly in the past decade with the introduction of the novel immunomodulatory agents thalidomide and lenalidomide, and the first-in-class proteasome inhibitor bortezomib. Although MM remains an incurable malignancy, new approaches to therapy incorporating these agents have produced significantly higher response rates and improved intervals of both progression-free and overall survival in the context of randomized, controlled trials. In aggregate, the use of novel therapies in MM has been associated with substantial improvements in patient outcome. © Journal of the National Comprehensive Cancer Network.
|
0 |
Combined internal and external fixation of distal radius fractures
|
Distal Radius Fractures
|
Combined internal and external fixation of distal radius fractures is used most commonly to treat injuries with joint surface or metaphyseal comminution. External fixation aids reduction intraoperatively and facilitates arthroscopic, per-cutaneous, or open manipulation of the fracture. Internal fixation maintains precise reduction of critical anatomy, principally the contour and orientation of the articular surface. Postoperatively the fixator functions as a neutralization device, preventing fracture collapse and decreasing the biomechanical demands on the internal fixation hardware. The combined technique exploits the benefits of both forms of fixation, allowing each to be used to full advantage in the treatment of complex distal radius fractures. [References: 86]
|
1 |
Bacteria isolated from late prosthetic joint infections: dental treatment and chemoprophylaxis
|
Dental Implant Infection
|
The recommended administration of prophylactic antibiotics, before and during dental procedures, to persons with total joint prostheses is not without controversy. Hospital and dental charts of 2,693 patients in whom total prosthetic joints were placed at the Veterans Administration Hospitals of Ann Arbor and Allen Park, Michigan, as well as the University of Michigan Hospital, were analyzed. The identity of the micro-organism associated with the late (6 months after placement) infected prosthetic joint and the sensitivity of the organisms to specific antibiotics were recorded. Of the 30 (1.1%) late prosthetic joint infections, only one (0.04%) could be temporally associated with dental treatment. Fifty-three percent of the isolates were gram-positive staphylococci, the most common isolate being Staphylococcus epidermidis (36%). Pseudomonas aeruginosa was the most frequent gram-negative isolate cultured. Twenty-five of 34 isolates tested were resistant to penicillin, while only 3 of 36 isolates tested were resistant to a cephalosporin and 5 of 21 isolates tested were resistant to methicillin.
|
0 |
Quality of life after joint replacement for osteoarthritis
|
Surgical Management of Osteoarthritis of the Knee CPG
|
The increasing prevalence of osteoarthritis and the consequent demand for joint arthroplasty is reflected by the increasing use of health resources and quantification of the effectiveness of clinical and surgical interventions. Health-related quality-of-life instruments are valid in quantifying outcomes after joint arthroplasty. Many pre-and postoperative factors affect outcomes, which could be improved by greater adherence to osteoarthritis treatment guidelines, although there are considerable discrepancies on the importance of each individual factor. Age, in itself, is not a disqualification for joint arthroplasty. Health-related quality-of-life instruments provide valuable information for decision-making on the use of health resources and the prioritization of waiting lists. Standardization of instruments, study periods and the presentation of scores would enable better comparison of studies and homogeneity of cumulative data. (copyright) 2010 Future Medicine Ltd
|
0 |
Assessing recovery and establishing prognosis following total knee arthroplasty
|
Surgical Management of Osteoarthritis of the Knee CPG
|
BACKGROUND AND PURPOSE: Information about expected rate of change after arthroplasty is critical for making prognostic decisions related to rehabilitation. The goals of this study were: (1) to describe the pattern of change in lower-extremity functional status of patients over a 1-year period after total knee arthroplasty (TKA) and (2) to describe the effect of preoperative functional status on change over time. SUBJECTS: Eighty-four patients (44 female, 40 male) with osteoarthritis, mean age of 66 years (SD=9), participated. METHODS: Repeated measurements for the Lower Extremity Functional Scale (LEFS) and the Six-Minute Walk Test (6MWT) were taken over a 1-year period. Data were plotted to examine the pattern of change over time. Different models of recovery were explored using nonlinear mixed-effects modeling that accounted for preoperative status and gender. RESULTS: Growth curves were generated that depict the rate and amount of change in LEFS scores and 6MWT distances up to 1 year following TKA. The curves account for preoperative status and gender differences across participants. DISCUSSION AND CONCLUSION: The greatest improvement occurred in the first 12 weeks after TKA. Slower improvement continued to occur from 12 weeks to 26 weeks after TKA, and little improvement occurred beyond 26 weeks after TKA. The findings can be used by physical therapists to make prognostic judgments related to the expected rate of improvement following TKA and the total amount of improvement that may be expected
|
1 |
The prevalence of articular cartilage changes in the knee joint in patients undergoing arthroscopy for meniscal pathology
|
AMP (Acute Meniscal Pathology)
|
PURPOSE: The purposes of this study were to evaluate the prevalence of articular cartilage changes in the knee joint and to analyze predictive factors for these changes in patients undergoing arthroscopy for meniscal pathology.
METHODS: Between March 2005 and June 2009, 1,010 patients underwent arthroscopic meniscectomy or meniscal repair by the senior author. During surgery, a precise diagram was used to carefully note the presence, location, size, and Outerbridge grade of changes to the articular surfaces of the knee joint. The prevalence of articular cartilage changes was calculated for 6 age groups: younger than 20 years, 20 to 29 years, 30 to 39 years, 40 to 49 years, 50 to 59 years, and 60 years or older. Demographic data including gender, ethnicity, smoking status, and body mass index (BMI) were acquired from patient charts.
RESULTS: Overall, 48% of patients showed changes to the medial compartment, 25% to the lateral compartment, and 45% to the patellofemoral compartment. Eighty-five percent of patients aged 50 to 59 years and 86% of patients aged 60 years or older showed articular cartilage changes to at least 1 knee compartment. In contrast, only 13% of patients aged younger than 20 years and 32% of patients aged 20 to 29 years showed changes to at least 1 compartment. A significant relation was found between age and the development of articular cartilage changes in each of the 3 compartments (P < .0001). BMI was also significantly related to articular cartilage changes in the medial and patellofemoral compartments (P < .0001) but not the lateral compartment (P = .08).
CONCLUSIONS: This study shows a high prevalence of articular cartilage damage as defined by the Outerbridge classification in patients undergoing arthroscopic surgery for meniscal pathology. Risk factors that correlate with articular cartilage damage include increasing age, elevated BMI, medial compartment pathology, and knee contractures.
LEVEL OF EVIDENCE: Level IV, therapeutic case series.
|
0 |
A Prospective Randomized Controlled Trial Comparing the Efficacy of Fascia Iliaca Compartment Block Versus Local Anesthetic Infiltration After Hip Arthroscopic Surgery
|
AAHKS (8) Anesthetic Infiltration
|
Purpose To compare the efficacy of fascia iliaca compartment block (FICB) with local anesthetic infiltration (LAI) of the arthroscopy portals for pain control after hip arthroscopy. Methods A prospective single-blinded randomized controlled trial that involved patients who underwent hip arthroscopy was performed. Participants were randomized to receiving either FICB or LAI of the portal tracts with local anesthetic. Supplemental analgesia was also used in both groups on an on-demand basis. The primary outcome measure was the postoperative level of pain as assessed by numeric pain score at 1, 3, 6, and 24Â hours after the procedure in both groups. Secondary outcome measures were the frequency and the dose of morphine and other medications consumed at 1 and 24Â hours after surgery as well as any other adverse events relating to pain or medications used for pain relief in both the groups. Results The study had to be terminated early because there was a significant statistical difference in the primary outcome measure after the recruitment of 46 patients: 20 in the LAI group and 26 in the FICB group. Severity of pain in the FICB group was higher especially during the first hour postoperatively (PÂ =.02). This was associated with a higher consumption of opioids and other analgesics, which resulted in more side effects such as nausea and vomiting. Conclusions LAI provided a better analgesia after arthroscopic surgery of the hip in comparison with FICB and was also associated with reduced consumption of opioids and a lower rate of side effects. Level of Evidence Level I, single-blinded randomized controlled study.
|
0 |
Median nerve excursion in response to wrist movement after endoscopic and open carpal tunnel release
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
PURPOSE: To compare the perioperative kinematic effects of endoscopic versus open carpal tunnel release on longitudinal excursion (gliding) and volar displacement (bowstringing) of the median nerve at the wrist region in patients with idiopathic primary carpal tunnel syndrome. METHODS: Sixteen hands of 13 patients were randomly assigned into 2 groups (group 1, endoscopic; group 2, open carpal tunnel release). For the measurement of gliding and bowstringing of the median nerve, a metallic marker was used. Before and after the division of the transverse carpal ligament, longitudinal excursion and volar displacement of the median nerve were calculated based on fluoroscopic imaging for each wrist. Movement was analyzed for the measurement of the marker locations. RESULTS: The mean prerelease median nerve excursion during wrist range of motion was 20 mm (range, 10-28) in group 1 and 21 mm (range, 16-31 mm) in group 2. The mean postrelease median nerve excursion during wrist range of motion was 20 mm (range, 13-29) in group 1 and 18 mm (range, 8-26 mm) in group 2. There was no statistically significant difference in pre- and postrelease longitudinal excursion changes between the groups (p = .916 and p = .674, respectively). The mean prerelease volar displacement of the median nerve during wrist range of motion was 3 mm in group 1 and 4 mm in group 2; the postrelease mean values were 2 mm and 5 mm, respectively. There was no statistically significant difference between the groups with regard to pre- and postrelease volar displacement changes of the median nerve (p = .372 and p = .103, respectively). CONCLUSIONS: This study demonstrated that the endoscopic release and open carpal tunnel release produce similar perioperative effects on longitudinal and volar movements of the median nerve
|
0 |
Optimization of prosthetic foot stiffness to reduce metabolic cost and intact knee loading during below-knee amputee walking: a theoretical study
|
OAK 3 - Non-arthroplasty tx of OAK
|
Unilateral below-knee amputees develop abnormal gait characteristics that include bilateral asymmetries and an elevated metabolic cost relative to non-amputees. In addition, long-term prosthesis use has been linked to an increased prevalence of joint pain and osteoarthritis in the intact leg knee. To improve amputee mobility, prosthetic feet that utilize elastic energy storage and return (ESAR) have been designed, which perform important biomechanical functions such as providing body support and forward propulsion. However, the prescription of appropriate design characteristics (e.g., stiffness) is not well-defined since its influence on foot function and important in vivo biomechanical quantities such as metabolic cost and joint loading remain unclear. The design of feet that improve these quantities could provide considerable advancements in amputee care. Therefore, the purpose of this study was to couple design optimization with dynamic simulations of amputee walking to identify the optimal foot stiffness that minimizes metabolic cost and intact knee joint loading. A musculoskeletal model and distributed stiffness ESAR prosthetic foot model were developed to generate muscle-actuated forward dynamics simulations of amputee walking. Dynamic optimization was used to solve for the optimal muscle excitation patterns and foot stiffness profile that produced simulations that tracked experimental amputee walking data while minimizing metabolic cost and intact leg internal knee contact forces. Muscle and foot function were evaluated by calculating their contributions to the important walking subtasks of body support, forward propulsion and leg swing. The analyses showed that altering a nominal prosthetic foot stiffness distribution by stiffening the toe and mid-foot while making the ankle and heel less stiff improved ESAR foot performance by offloading the intact knee during early to mid-stance of the intact leg and reducing metabolic cost. The optimal design also provided moderate braking and body support during the first half of residual leg stance, while increasing the prosthesis contributions to forward propulsion and body support during the second half of residual leg stance. Future work will be directed at experimentally validating these results, which have important implications for future designs of prosthetic feet that could significantly improve amputee care.
|
0 |
The Role of Distal Third Radius Dual Energy X-ray Absorptiometry (DXA) and Central DXA in Evaluating for Osteopenia and Osteoporosis in Men Receiving Androgen Deprivation Therapy for Prostate Cancer
|
Management of Hip Fractures in the Elderly
|
The authors assessed the use of distal third radius dual energy X-ray absorptiometry (DXA) concomitantly with central (hip and lumbar spine) DXA to identify men with osteopenia or osteoporosis receiving androgen deprivation therapy (ADT) for prostate cancer. Initial classification with central DXA demonstrated 60 (17%) normal, 187 (55%) osteopenic, and 96 (28%) osteoporotic patients. Sixteen of 60 (27%) normal patients were reclassified as osteopenic (14) or osteoporotic (2), and 20 of 187 (11%) osteopenic patients were reclassified as osteoporotic with the combination of central DXA plus distal third radius DXA. The difference in reclassification was statistically significant. The addition of distal third radius to central DXA scanning in men with bone loss associated with ADT identifies a statistically significant number of men being reclassified as having osteopenia or osteoporosis. Combined central and distal third radius DXA scanning should be considered routine in the evaluation of all men suspected of bone loss associated with ADT. This has specific significant clinical relevance because of the large number of men with nonevaluable central DXA studies. Fracture risk prediction and treatment recommendations based on this reclassification will need to be determined by follow-up studies. (copyright) 2012 The International Society for Clinical Densitometry
|
0 |
Aripiprazole once-monthly 400 mg: Comparison of pharmacokinetics, tolerability, and safety of deltoid versus gluteal administration
|
AMP (Acute Meniscal Pathology)
|
Background: Two open-label, randomized, parallel-arm studies compared pharmacokinetics, safety, and tolerability of aripiprazole once-monthly 400 mg following deltoid vs gluteal injection in patients with schizophrenia. Methods: In the single-dose study, 1 injection of aripiprazole once-monthly 400 mg in the deltoid (n = 17) or gluteal (n = 18) muscle (NCT01646827) was administered. In the multiple-dose study, the first aripiprazole once-monthly 400 mg injection was administered in either the deltoid (n = 71) or gluteal (n = 67) muscle followed by 4 once-monthly deltoid injections (NCT01909466). Results: After single-dose administration, aripiprazole exposure (area under the concentration-time curve) was similar between deltoid and gluteal administrations, whereas median time to maximum plasma concentration was shorter (7.1 [deltoid] vs 24.1 days [gluteal]) and maximum concentration was 31% higher after deltoid administration. In the multipledose study, median time to maximum plasma concentration for deltoid administration was shorter (3.95 vs 7.1 days), whereas aripiprazole mean trough concentrations, maximum concentration, and area under the concentration-time curve were comparable between deltoid and gluteal muscles (historical data comparison). Multiple-dose pharmacokinetic results for the major metabolite, dehydro-aripiprazole, followed a similar pattern to that of the parent drug for both deltoid and gluteal injection sites. Safety and tolerability profiles were similar after gluteal or deltoid injections. Based on observed data, minimum aripiprazole concentrations achieved by aripiprazole once-monthly 400 mg are comparable with those of oral aripiprazole 15 to 20 mg/d. Conclusions: The deltoid muscle is a safe alternative injection site for aripiprazole once-monthly 400 mg in patients with schizophrenia.
|
0 |
Prediction of total knee replacement in a 6-month multicentre clinical trila with chondroitin sulfate in knee osteoarthritis: Results from a 4-year observation
|
Surgical Management of Osteoarthritis of the Knee CPG
|
Purpose: To identify predictive factors for the incidence of total knee replacement (TKR) during long-term follow-up of knee OA patients who formerly received treatment with chondroitin sulfate (CS) or placebo in a multicentre trial using clinical and quantitative magnetic resonance imaging (qMRI) data. Methods: Knee OA patients participating in a previous 6-month randomized, double-blind controlled trial evaluating the impact of CS (400 mg b.i.d.; Condrosan(registered trademark), Bioiberica, Spain,) vs. placebo who had serial MRI acquisitions of the symptomatic knee were recently contacted to evaluate retrospectively the incidence of TKR of the study knee. A sub-group of patients (n=70) who had taken all the study medication and had all clinical and MRI evaluations (according-to-protocol [ATP]) were selected for this post-hoc retrospective analysis. Of this cohort 51 patients were reachable for TKR incidence. The assessment was done blindly to treatment allocation with a standardized phone interview. Results: The patients' mean age was 62.9 years, 61% were female and the average BMI was 30.6 kg[[Unsupported Character - ]]m(2). A total of 7 (6 target knees and 1 contralateral) TKRs (13.7%) were performed on this subpopulation in the timeframe of 3-4 years after completion of the original study. Interestingly, there were more TKRs performed within the placebo group (n=5) than the CS group (n=2) (71% vs. 29%, p=0.15, logistic regression). The predictors of long-term TKRs for the target knee were investigated by comparing the patients who had TKR (n=6) of the target knee to those who did not (n=45), using data at baseline or the change at 1 year. At baseline, the strongest predictors of TKR were WOMAC pain (p=0.02, logistic regression), stiffness (p=0.01) and function (p=0.04), bone marrow lesions of the medial tibial plateau (p=0.03), and C reactive protein level (p=0.03). Changes at 1 year in medial cartilage volume (p=0.05) and WOMAC stiffness (p=0.01) also predicted the occurrence of TKR. Conclusions: These data demonstrate that, from a knee OA clinical trial, it is possible to predict a nullhardnull outcome such as TKR using clinical and qMRI data. Moreover, CS appeared to protect cartilage volume loss and improved clinical parameters
|
0 |
Generalised peripheral nerve dysfunction in acromegaly: a study by conventional and novel neurophysiological techniques
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
Twenty four patients with clinical, radiological and biochemical evidence of acromegaly were investigated by a number of independent neurophysiological tests. Two-thirds of the patients showed evidence of generalised peripheral nerve dysfunction. A significant correlation was found between total exchangeable body sodium, an indicator of disease activity, and the severity of the neuropathy. The generalised peripheral nerve abnormality was found to occur independently of the associated carbohydrate intolerance human growth hormone levels and other endocrinological dysfunction in this disorder
|
0 |
Cathepsin L activated by mutant p53 and Egr-1 promotes ionizing radiation-induced EMT in human NSCLC
|
MSTS 2018 - Femur Mets and MM
|
BACKGROUND: Ionizing radiation (IR) is one of the major clinical therapies of cancer, although it increases the epithelial-mesenchymal transition (EMT) of non-small cell lung cancer (NSCLC), unexpectedly. The cellular and molecular mechanisms underlying this role are not completely understood.
METHODS: We used NSCLC cell lines as well as tumor specimens from 78 patients with NSCLC to evaluate p53, Cathepsin L (CTSL) and EMT phenotypic changes. Xenograft models was also utilized to examine the roles of mutant p53 (mut-p53) and CTSL in regulating IR-induced EMT of NSCLC.
RESULTS: Expression of CTSL was markedly increased in human NSCLC tissues with mutant p53 (mut-p53), and p53 mutation positively correlated with metastasis of NSCLC patients. In human non-small cell lung cancer cell line, H1299 cells transfected with various p53 lentivirus vectors, mut-p53 could promote the invasion and motility of cells under IR, mainly through the EMT. This EMT process was induced by elevating intranuclear CTSL which was regulated by mut-p53 depending on Early growth response protein-1 (Egr-1) activation. In the subcutaneous tumor xenograft model, IR promoted the EMT of the cancer cells in the presence of mut-p53, owing to increase expression and nuclear transition of its downstream protein CTSL.
CONCLUSION: Taken together, these data reveal the role of the mut-p53/Egr-1/CTSL axis in regulating the signaling pathway responsible for IR-induced EMT.
|
0 |
Patients' perceptions of the potential complications of bilateral reduction mammaplasty
|
Reduction Mammoplasty for Female Breast Hypertrophy
|
Reduction mammaplasty aims to reduce breast mass whilst improving aesthetic appearance. Post-operative complications may include scar and nipple-related problems, haematoma, infection and glandular necrosis. In our unit, patients undergoing surgical procedures are counselled by a nurse practitioner in addition to initial specialist consultation to establish patients' understanding of the potential complications and risks of bilateral reduction mammaplasty. Fifty patients completed questionnaires on admission to the ward the day before bilateral reduction mammaplasty. The questionnaires assessed patients' awareness of potential complications before final consent. Over 90% of the patients appreciated that further surgery, infection, altered nipple sensation or nipple necrosis were potential post-operative complications. However, a small cohort of patients consistently failed to correctly identify important potential complications (8% felt that wound breakdown never occurred, 6% thought that nipple necrosis and breast asymmetry never occurred). It is interesting to note that 18% of the patients did not appreciate that scarring occurs. The majority of patients are well-informed about the potential complications and risks of reduction mammaplasty. However, despite initial consent by a plastic surgeon and nurse practitioner counselling, a minority still fail to fully appreciate certain important risks including the appearance of scarring. This may potentially manifest as patient dissatisfaction. © Springer-Verlag 2007.
|
0 |
Safety and efficacy of intravesical bacillus Calmette-Guerin plus interferon alpha-2b therapy for nonmuscle invasive bladder cancer in patients with prosthetic devices
|
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
PURPOSE: Patients with bladder cancer who have prosthetic devices, such as a cardiac pacemaker, artificial heart valve or orthopedic hardware, and who undergo intravesical bacillus Calmette-Guerin therapy are theoretically at higher risk for complications, including bacterial seeding of pacemaker wires or orthopedic hardware, and at further risk for infective endocarditis. We assessed the safety and efficacy of bacillus Calmette-Guerin plus interferon alpha-2b therapy in patients with nonmuscle invasive bladder cancer and a pacemaker, artificial heart valve or orthopedic hardware. MATERIALS AND METHODS: We evaluated 1,045 patients with nonmuscle invasive bladder cancer enrolled in a multicenter American phase II trial of bacillus Calmette-Guerin plus interferon alpha-2b therapy, including 143 with a prosthetic device (pacemaker in 87, artificial heart valve in 13 and orthopedic hardware in 43). Weekly physician toxicity assessments and standard adverse effect reporting were done. RESULTS: No patient had infective endocarditis or hardware infection. One patient with a pacemaker, 2 with orthopedic hardware and none with an artificial heart valve required treatment cessation for fever greater than 102.5F. All defervesced within 24 hours and had no long-term sequelae. Due to intolerable, nonlife threatening side effects 12 patients with a pacemaker, 2 with orthopedic hardware and 1 with an artificial heart valve stopped treatment. Of the remaining patients with a prosthesis 99 and 24 stopped treatment due to intolerable, nonlife threatening and serious side effects, respectively. CONCLUSIONS: Patients with a pacemaker, artificial heart valve or orthopedic hardware were no more likely than the general population to have infection or fever, or discontinue treatment due to side effects. These patients should not be excluded from intravesical bacillus Calmette-Guerin plus interferon alpha-2b therapy for nonmuscle invasive bladder cancer
|
0 |
A PC-based software test for measuring alcohol and drug effects in human subjects
|
Upper Eyelid and Brow Surgery
|
A new software-based visual search and divided-attention test of cognitive performance was developed and evaluated in an alcohol dose-response study with 24 human subjects aged 21-62 years. The test used language-free, color, graphic displays to represent the visuospatial demands of driving. Cognitive demands were increased over previous hardware-based tests, and the motor skills required for the test involved minimal eye movements and eye-hand coordination. Repeated performance on the test was evaluated with a latin-square design by using a placebo and two alcohol doses, low (0.48 g/kg/LBM) and moderate (0.72 g/kg/LBM). The data on 7 females and 17 males yielded significant falling and rising impairment effects coincident with moderate rising and falling breath alcohol levels (mean peak BrALs = 0.045 g/dl and 0.079 g/dl). None of the subjects reported eye-strain or psychomotor fatigue as compared with previous tests. The high sensitivity/variance relative to use in basic and applied research, and worksite fitness-for-duty testing, was discussed. The most distinct advantage of a software-based test that operates on readily available PCs is that it can be widely distributed to researchers with a common reference to compare a variety of alcohol and drug effects.
|
1 |
Cost-effectiveness analysis of coblation technology VS. Mechanical debridement with a shaver in the treatment of knee cartilage lesions-a Spanish payer perspective
|
AMP (Acute Meniscal Pathology)
|
Objectives: To conduct a cost-effectiveness analysis between Coblation technology and mechanical debridement with a shaver (MD) in a patient population presenting with chronic pain due to a medial meniscus tear and an International Cartilage Research Society (ICRS) grade III focal chondral lesion. Methods: A decisionanalytic model was developed comparing costs and clinical outcomes between Coblation and MD following a knee chondroplasty procedure in a patient population with medial meniscus tear and an International Cartilage Research Society (ICRS) grade III focal chondral lesion. Costs were obtained from the 2016 Spanish Health Costs database, an annual 3% discount rate was applied to future costs. Clinical outcomes data were extracted from published results of a randomized clinical trial (RCT). The time horizon for the analysis was 4 years for both costs and outcomes. Model robustness was tested using threshold analysis and multiple one-way sensitivity analyses. Results: The RCT reported a lower revision rate with Coblation, 14% compared to 48% with MD (p= 0.006). Furthermore, patients treated with Coblation reported a significantly higher Knee Injury and Osteoarthritis Outcome Score (KOOS) at the end of the study (p= 0.001). Over a 4-year post-operative period, the estimated total cost per patient was 2,858€ and 4,931€ for Coblation and MD respectively resulting in cost-savings of 2,073€ in favor of Coblation, making Coblation a dominant strategy as a result of lower costs and better improved clinical outcomes. The cost-saving realized with Coblation was robust to sensitivity analyses and threshold analysis determined that Coblation remained the dominant alternative when it was assumed that Coblation revision rate increased from the initially reported rate of 14% up to 69%. Conclusions: The use of Coblation technology vs. MD is a cost-effective option in the treatment of patients with a medial meniscus tear and idiopathic ICRS grade III defect.
|
0 |
LIMPING IN CHILDREN
|
Osteochondritis Dissecans 2020 Review
|
Limping in children is a common complaint at pediatric, pediatric orthopaedic offices and in emergency rooms. There are several causes for this condition, and identifying them is a challenge. The older the patient, the better the anamnesis and more detailed the physical examination will be, enabling an easier medical assessment for searching the source of the disorder. In order to make the approach easier, three age groups can and should be considered. Among infants (1 to 3 years old), diagnosis will most likely be: transitory synovitis, septic arthritis, neurological disorders (mild brain palsy (BP) and muscular dystrophy), congenital hip dislocation (CHD), varus thigh, juvenile rheumatoid arthritis (JRA) and neoplasias (osteoid osteoma, leukemia); in the scholar age group, between 4 and 10 years old, in addition to the diagnoses above, Legg-Calvé-Perthes disease, discoid meniscus, inferior limbs discrepancy and unspecific muscular pain; in adolescents (11 to 15 years old): slipped capital femoral epiphysis, congenital hip dislocation, chondrolysis, overuse syndromes, dissecans osteochondritis, and tarsal coalition. The purpose of this study is to provide an update on how to approach pediatric patients presenting with limping, and to discuss its potential causes.
|
0 |
Knee joint loads and surrounding muscle forces during stair ascent in patients with total knee replacement
|
OAK 3 - Non-arthroplasty tx of OAK
|
Total knee replacement (TKR) is commonly used to correct end-stage knee osteoarthritis. Unfortunately, difficulty with stair climbing often persists and prolongs the challenges of TKR patents. Complete understanding of loading at the knee is of great interest in order to aid patient populations, implant manufacturers, rehabilitation, and future healthcare research. Musculoskeletal modeling and simulation approximates joint loading and corresponding muscle forces during a movement. The purpose of this study was to determine if knee joint loadings following TKR are recovered to the level of healthy individuals, and determine the differences in muscle forces causing those loadings. Data from five healthy and five TKR patients were selected for musculoskeletal simulation. Variables of interest included knee joint reaction forces (JRF) and the corresponding muscle forces. A paired samples t-test was used to detect differences between groups for each variable of interest (p<0.05). No differences were observed for peak joint compressive forces between groups. Some muscle force compensatory strategies appear to be present in both the loading and push-off phases. Evidence from knee extension moment and muscle forces during the loading response phase indicates the presence of deficits in TKR in quadriceps muscle force production during stair ascent. This result combined with greater flexor muscle forces resulted in similar compressive JRF during loading response between groups.
|
0 |
Relationship between medial meniscal extrusion and cartilage loss in specific femorotibial subregions: Data from the osteoarthritis initiative
|
OAK 3 - Non-arthroplasty tx of OAK
|
Objective Medial meniscal extrusion is known to be related to structural progression of knee osteoarthritis. However, it is unclear whether medial meniscal extrusion is more strongly associated with cartilage loss in certain medial femorotibial subregions than in others. Methods Segmentation of the medial tibial and femoral cartilage (baseline; 1-year followup) and the medial meniscus (baseline) was performed in 60 participants with frequent knee pain (mean ± SD ages 61.3 ± 9.2 years, body mass index 31.3 ± 3.9 kg/m2) and with unilateral medial radiographic joint space narrowing (JSN) grades 1-3, using double-echo steady-state magnetic resonance images. Medial meniscal extrusion distance and extrusion area (percentage) between the external meniscal and tibial margin at baseline, and longitudinal medial cartilage loss in 8 anatomic subregions were determined. Results A significant association (Pearson's correlation coefficient) was seen between medial meniscal extrusion area in JSN knees and cartilage loss over 1 year throughout the entire medial femorotibial compartment. The strongest correlation was with cartilage loss in the external medial tibia (r =-0.34, P < 0.01 in JSN; r =-0.30, P = 0.02 in knees without JSN). Conclusion Medial meniscal extrusion was associated with subsequent medial cartilage loss. The external medial tibial cartilage may be particularly vulnerable to thinning once the meniscus extrudes and its surface is exposed to direct, nonphysiological, cartilage-to-cartilage contact.
|
0 |
A new consideration in athletic injuries. The classical ballet dancer
|
AMP (Acute Meniscal Pathology)
|
The professional ballet dancer presents all of the problems of any vigorous athlete. The problems include osteochondral fractures, sprains, chronic ligamentous instability of the knee, meniscal tears, impingement syndrome, degenerative arthritis of multiple joints and low back pain. Attention to minor problems with sound conservative therapy can avoid many major developments and lost hours. Observations included the extraordinary external rotation of at the hip without demonstrable alteration in the hip version angle and hypertrophy of the femur, tibia and particularly the second metatarsal (in female dancers). Careful evaluation of the range of motion of the extremities, serial roentgenographic examination, and sytematic review of previous injuries, training programs and rehearsal techniques have been evaluated in a series of cases to provide the basis for advice to directors and teachers of the ballet.
|
0 |
Alternatives for the treatment of local advanced disease: electrochemotherapy, limb perfusion, limb infusion, intralesional IL2. What is the role?
|
Reconstruction After Skin Cancer
|
Nowadays, melanoma is one of the most common fatal malignancy of young adults. Incidence is increasing, but mortality rates from melanoma have remained stable. In-transit metastases from extremity or trunk melanoma are subcutaneous or cutaneous deposits of melanoma distant from the primary site, but not reaching the draining nodal basin. According to American Joint Committee on Cancer classification of stages based on Tumor, Node, Metastases classification stages IIIb and IIIc are considered local advanced disease and survival outcomes is quite poor, with 5-year survival rates of 24-54%. Loco-regional recurrence is an important risk factor for distant metastatic disease, either synchrone or metachrone. Therapy for this pattern of recurrence is limited and options vary based on the volume and site of disease. Definitive surgical resection remains the preferred therapeutic approach. However, when surgery cannot be performed with a reasonable cosmetic and functional outcome, other options must be utilized. Treatment options are classified as local, regional, or systemic. The choice of therapy depends on the number of lesions, their anatomic location, whether or not they are dermal or subcutaneous, the size, and the presence or absence of extra-regional disease.
|
0 |
Association between the severity of femoral condylar cartilage erosion related to knee osteoarthritis by ultrasonographic evaluation and the clinical symptoms and functions
|
OAK 3 - Non-arthroplasty tx of OAK
|
Abstract Objective To determine the association between the severity of femoral condylar cartilage erosion resulting from knee osteoarthritis (OA) by an ultrasonographic grading system and the clinical symptoms and functions. Design Cross-sectional study. Setting A tertiary center. Participants Participants (N=101) with and without subjective complaints of knee discomfort were consecutively enrolled. Patients who had ever received knee arthroplasty, who had inflammatory arthritis, and whose knee flexion range of motion was <90° were excluded. A total of 194 knees were evaluated. Interventions Not applicable. Main Outcome Measures A semiquantitative ultrasonographic grading system was used to evaluate the severity of femoral condylar cartilage erosion. The clinical symptoms and functions were evaluated with the visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lequesne index. The association of the VAS/WOMAC/Lequesne index with the ultrasonographic grading was assessed. Results Positive linear associations were found between the ultrasonographic grading and the following: the VAS and the total scores and pain subscales of both the Lequesne index and WOMAC. Multivariate logistic regression analysis revealed grade-dependent association between VAS and ultrasonographic grading after adjusting for age, sex, and body mass index. The WOMAC and Lequesne index scores were associated with the ultrasonographic grading in more severe degrees, particularly in the pain subscales. Conclusions This semiquantitative ultrasonographic grading system may well reflect the clinical symptoms and functions related to knee OA as evaluated by the VAS, WOMAC, and Lequesne index. This method provides a more comprehensive description and measurement of knee OA.
|
0 |
Systematic review of rehabilitation versus operative stabilization for the treatment of first-time anterior shoulder dislocations
|
SR for PM on OA of All Extremities
|
CONTEXT: Primary anterior shoulder dislocation is a frequent injury in young active patients. Traditionally, conservative nonoperative primary treatment has been advocated for a majority of first-time dislocators, whereas operative stabilization has been reserved for recurrent dislocators or those involved in strenuous physical activity. Currently, no consensus exists on whether to treat a first-time anterior shoulder dislocation surgically. OBJECTIVE: (1) To provide clinical recommendations regarding the therapeutic intervention for first-time anterior shoulder dislocators and (2) to determine if there is sufficient Level 1 or 2 evidence available for the establishment of a uniform, optimal treatment protocol. DATA SOURCES: A systematic review of prospective randomized controlled trials with human participants was performed. PubMed, the Cochrane Database of Systematic Reviews, and secondary references were appraised for studies published between 1994 and 2009. STUDY SELECTION: Inclusion criteria were English-language Level 1 or 2 studies involving the treatment of primary anterior shoulder dislocation. Exclusion criteria included non-English-language articles; Level 3, 4, or 5 studies; and studies examining treatment of recurrent/posterior shoulder dislocation or diagnoses other than primary anterior shoulder dislocations. DATA EXTRACTION: Each author conducted an independent quality appraisal of the included studies, identifying strengths, weaknesses, and biases, then reached consensus regarding their values. RESULTS: Five randomized controlled trials were included, and they supported the use of operative management in a focused population. No long-term follow-up data were available describing the effects of surgical intervention or the development of osteoarthritis. Each study design had weaknesses that decreased the validity of the findings. CONCLUSIONS: While limited, the available evidence from randomized controlled trials supports operative stabilization as a reasonable alternative to nonoperative treatment for primary acute shoulder dislocation in young, active adults participating in highly demanding physical activities. Recommendations on the optimal surgical intervention cannot be provided. There is no conclusive evidence available to determine whether operative stabilization or conservative rehabilitation is superior for other patient or injury types
|
0 |
Adductor Canal Catheter vs Local Infiltration of Analgesia for Total Knee Arthroplasty
|
AAHKS (9/10) Regional Nerve Blocks
|
The study is a prospective, randomized controlled clinical trial comparing two methods of postoperative analgesia following primary TKA. Eligible primary TKA patients must be ASA I â? III and require less than 20 mg oxycodone daily (or its equivalent). Exclusion criteria are: allergy to anesthetics, contraindication to regional anesthesia, sensory/ motor disorder involving operative limb, nonâ?english speaking, ASA IV or greater, psychiatric or cognitive disorders, incarceration, renal insufficiency with Cr > 2.0 and hepatic failure. When patients agree to participate in the study the following data will be collected by the research staff: ASA physical status, age, height, weight, gender, quantitative opiate use, numeric pain score with visual descriptors, painDETECT score, WOMAC score and baseline Pain Management Questionnaire. When designated through randomization, local infiltration of analgesia will be placed intraoperatively by the surgeons, per usual protocol and patients in the LIA group will receive sham adductor canal catheter. All ACC's for both study groups will be placed postoperatively in the PACU. Those collecting data will be blinded from identifying patients in the control group, as both groups will have ACC placed with same technique. Potential risks for each procedure, which will be explained to the patient, include: bleeding, local infection, local anesthetic toxicity in the form of seizure and cardiac arrest and neuropathy. The preceding are commonly listed though infrequent complications of both procedures. Continuous ultrasound will guide the placement of the ACC. All adductor canal catheters will remain in for 72 hours. Pt from LIA group will be discharged home with sham catheter with a saline infusion at 10 ml/hr via an ambulatory pump. Patients in ACC group will be discharged with continuous adductor canal catheter delivering ropivacaine 0.2% at 10 ml/hr via an ambulatory pump. Patients will be called daily for pain diary results. As well as at 6â?8 weeks postoperatively to collect painDetect and WOMAC survey.
|
0 |
A comparison of stability and clinical outcomes in single-radius versus multi-radius femoral design for total knee arthroplasty
|
OAK 3 - Non-arthroplasty tx of OAK
|
We compared the intraoperative varus-valgus stability from 0° to 90° of flexion and postoperative clinical outcomes in patients receiving TKA via either a single-radius femoral design (50 TKA, SR group) or multi-radius femoral design (50 TKA, MR group). We measured stabilities at 0°, 30°, 60° and 90° of flexion using a navigation system. The clinical outcomes including HSS scores, WOMAC scores and VAS score during stair climbing were compared after a minimum of 2-year follow-up. The single-radius femoral designs in TKA showed better intra-operative stability at 30° of flexion (7.6 vs. 8.3) compared with the multi-radius femoral design, but not at other angles. However, the clinical outcomes revealed no other significant differences in terms of HSS scores, WOMAC scores and VAS score between two groups.
|
0 |
Myeloma bone disease
|
MSTS 2018 - Femur Mets and MM
|
Bone destruction is a hallmark of myeloma, with 70% to 80% of patients manifesting bone involvement. Destruction is mediated through normal osteoclasts (OCLs), which respond to local osteoclast-activating factors (OAFs) produced by myeloma cells or by other cells in the local microenvironment. OAFs implicated in myeloma bone disease include tumor necrosis factor-beta (TNFbeta), RANK ligand (RANKL), interleukin-1 (IL-1), parathyroid hormone-related protein (PTHrP), hepatocyte growth factor (HGH), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNFalpha), and macrophage inflammatory protein-1-alpha (MIP-1alpha). To date, the leading candidates for OAFs are MIP-1alpha and RANKL. Adhesive interactions between marrow stromal cells and myeloma cells induce marrow stromal cells to secrete IL-6, a potent myeloma growth/survival factor that may contribute to the bone disease. Evaluation of myeloma bone disease includes plain radiographs, and newer methods, such as magnetic resonance imaging (MRI), positron emission tomography (PET) scans, technetium-99m-sestamibi (Mibi) scanning, and dual-energy x-ray absorptiometry (DEXA) scanning, may provide more complete information. In addition, biochemical markers of bone resorption are being evaluated, although the limited availability of these assays and lack of extensive testing in patients make their routine use premature. Treatment of myeloma bone disease includes radiation therapy, vertebroplasty, surgery, and bisphosphonates. New developments on the pathogenesis and treatment of myeloma bone disease present great opportunities to combat bone disease. [References: 98]
|
0 |
Failed joint unloading implant system in the treatment of medial knee osteoarthritis
|
Surgical Management of Osteoarthritis of the Knee CPG
|
In the setting of end-stage osteoarthritis of the knee, total knee arthroplasty is the gold-standard treatment. Recently, a minimally invasive, joint preserving treatment option in the treatment of medial osteoarthritis of the knee has been developed. It is called the KineSpring((R)) (Moximed((R)) International GmbH, Zurich, Switzerland). The goal of this novel device is to reduce medial compartment loading without significantly affecting the loading of the lateral compartment. In this context, the current authors present a case of device failure using these new implants, which at 7 months post-op necessitated revision surgery with complete removal of the device
|
0 |
Antimicrobial photodynamic therapy: photodynamic antimicrobial effects of malachite green on Staphylococcus, enterobacteriaceae, and Candida
|
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
OBJECTIVE: This study investigated in vitro the photodynamic antimicrobial effects of the photosensitizer malachite green on clinical strains of Staphylococcus, Enterobacteriaceae, and Candida. MATERIALS AND METHODS: Thirty-six microbial strains isolated from the oral cavity of patients undergoing prolonged antibiotic therapy, including 12 Staphylococcus, 12 Enterobacteriaceae, and 12 Candida strains, were studied. The number of cells of each microorganism was standardized to 10(6) cells/mL. Twenty-four assays were carried out for each strain according to the following experimental conditions: gallium-aluminum-arsenide laser and photosensitizer (n = 6, L+P+), laser and physiologic solution (n = 6, L+P-), photosensitizer (n = 6, L-P+), and physiologic solution (n = 6, L-P-). Next, cultures were prepared on brain-heart infusion agar for the growth of Staphylococcus and Enterobacteriaceae, and on Sabouraud dextrose agar for the growth of Candida, and incubated for 48 h at 37 degrees C. The results are reported as the number of colony-forming units (CFU/mL) and were analyzed with analysis of variance and the Tukey test. RESULTS: The Staphylococcus, enterobacterial, and Candida strains were sensitive to photodynamic therapy with malachite green (L+P+). A reduction of approximately 7 log(10) for Staphylococcus, 6 log(10) for enterobacteria, and 0.5 log(10) for the genus Candida. Significant statistical differences were observed between the L+P+ groups and the control groups (L-P-). CONCLUSION: The Staphylococcus, Enterobacteriaceae, and Candida strains studied were sensitive to photodynamic therapy with malachite green
|
0 |
Reconstruction of massive midfoot bone and soft tissue loss as a result of blast injury
|
DoD SSI (Surgical Site Infections)
|
Lower extremity blast injuries represent a unique challenge to surgeons and often involve complex, limb-threatening wounds with extensive soft tissue and bone loss. Surgical treatment of these injuries can be difficult because of limited autogenous resources for reconstruction of the defect. In this article, we describe a technique for medial column reconstruction using iliac crest bone graft and soft tissue coverage with an abductor hallucis rotational flap combined with a split-thickness skin graft. This method addresses the extensive bone and soft tissue defects that frequently characterize blast injuries to the foot, and may be applicable in other situations where trauma or infection has caused extensive destruction of the medial column.
|
1 |
Comparison of patellar resurfacing and nonresurfacing in total knee arthroplasty: A prospective randomized study
|
Surgical Management of Osteoarthritis of the Knee CPG
|
This study was conducted to evaluate the advantages and disadvantages of patellar resurfacing in total knee arthroplasty. One hundred consecutive total knee arthroplasties were performed by the authors. The knees were randomized into two groups of 50 knees, pre-operatively. Five patients (knees) dropped out during follow-up. There were 95 knees left for evaluation (47 in the resurfaced group, 48 in the nonresurfaced group). There were 71 women and 20 men. Seventy patients had osteoarthritis (72 knees) and 21 patients rheumatoid arthritis (23 knees). Clinical review was undertaken 2-3 years after operation. The mean follow-up time was 30 months. The patellofemoral joint was graded radiographically before operation. The state of the patellar cartilage was noted and staged intraoperatively. The PFC knee prosthesis was used in all knees. Clinical results related to subjective assessment, patellar pain (case history and observed), the Knee Society knee and function scores and range of movements. Patients with nonresurfaced patellae complained of anterior knee pain (all grades) in relation to 11 knees. Grinding and compression of the patella was painful in relation to 22 knees. The corresponding figures in the resurfaced group were one and four. The differences are statistically significant (p < 0.01 and 0.001 respectively). There were no significant differences between the groups assessed using the Knee Society scoring systems. No significant difference was found in the number of complications between the groups studied. The results of this prospective randomized study indicate that there was no significant difference in knee function after total arthroplasty whether or not the patella had been resurfaced at the time of operation, but that resurfacing guarantees a pain-free knee in most cases
|
0 |
Blood transfusion and cytokines' changes in total knee replacement
|
OAK 3 - Non-arthroplasty tx of OAK
|
INTRODUCTION: The aim of this prospective comparative study was to evaluate the serum levels of different cytokines and the frequency of adverse reactions and wound infections in patients who underwent total knee replacement (TKR) and were not transfused or received either allogeneic blood transfusion or postoperative auto-transfusion (PAT) with unwashed shed blood.
MATERIALS AND METHODS: A total of 248 patients were categorized into three groups; in Group 0 (n 85) patients received no blood transfusion, in Group 1 (n 92) patients received PAT and in Group 2 (n 71) patients received allogeneic blood transfusion. Patient's demographic and clinical data including age, gender, body mass index, preoperative haemoglobin value, adverse reactions and complications were documented. The serum levels of IL-1b, IL-6, IL-8, IL-10 and TNF were measured preoperatively, and on the first, third and fifth postoperative day. A statistical analysis of the results was performed.
RESULTS: A significant elevation of cytokine values were observed during the first five postoperative days in patients who received blood transfusion after TKR. Adverse reactions (chills and pyrexia) were also more common in patients who received blood transfusion, whereas superficial infections were more common in patients who received allogeneic blood transfusion.
CONCLUSION: The immunological status-as expressed by the measured cytokine levels-is altered in patients receiving blood transfusion compared to patients receiving no blood transfusion during the first five postoperative days. PAT is preferable to allogeneic blood transfusion in terms of the rate of adverse reactions and superficial wound infections.
|
0 |
The effect of femoral notching during total knee arthroplasty on the prevalence of postoperative femoral fractures and on clinical outcome
|
Surgical Management of Osteoarthritis of the Knee CPG
|
Background: The treatment of a supracondylar femoral fracture following total knee arthroplasty is complicated by the presence of the prosthetic components. Anterior femoral notching during arthroplasty has been implicated as a contributing risk factor for femoral fracture. We retrospectively reviewed the effect of anterior femoral notching on the subsequent occurrence of a periprosthetic supracondylar fracture of the distal aspect of the femur and the outcomes of primary total knee arthroplasty in such patients. Methods: The prevalence and depth of femoral notching were determined on a review of the lateral radiographs by observers blinded to the clinical results of 1089 consecutive total knee replacements performed in 1997 and 1998. Linear and logistic regression modeling was used to analyze the relationship between femoral notching and the prevalence of supracondylar femoral fracture, postoperative range of motion, the Knee Society score, and the Knee Society functional and pain scores. Results: Femoral notching was performed in 325 (29.8%) of the 1089 knees in our series. During an average follow-up period of 5.1 years, only two supracondylar femoral fractures occurred, both in femora treated without notching. Femoral notching was not associated with an increased rate of fracture (p = 1.000) or with significant differences in the measures of outcome (range of motion [p = 0.117], knee score [p = 0.967], functional score [p = 0.861], need for a lateral release [p = 0.234], or postoperative pain [p = 0.948]). Conclusions: This study demonstrated no difference in knees managed with or without notching of the anterior distal aspect of the femur with respect to the occurrence of a supracondylar fracture, range of motion, Knee Society score, Knee Society function, or pain. Level of Evidence: Therapeutic Level III. Copyright (copyright) 2005 By The Journal of Bone and Joint Surgery, Incorporated
|
0 |
Circular external fixator-assisted ankle arthrodesis following failed total ankle arthroplasty
|
PJI DX Updated Search
|
BACKGROUND: Failed total ankle arthroplasty (TAA) often results in significant bone loss and requires salvage arthrodesis. This study quantified the bone loss following failed TAA and reports the outcome of seven arthrodesis reconstructions using the Ilizarov method. METHODS: A retrospective review of ankle fusions was performed for failed TAA to collect the mode of implant failure, presenting limb length discrepancy (LLD), total bone defect, postarthrodesis LLD, and treatment type (shoe lift versus distraction osteogenesis) and amount (shoe lift or lengthening). RESULTS: Four mechanical failures and three infections were found. Four of seven cases had prior revision TAAs. Four of seven patients were treated with tibiotalar arthrodesis; three of the seven patients required talar resection and tibiocalcaneal arthrodesis. The mean presenting LLD was 2.2 (range, 1.2 to 3.5) cm. The mean time in frame was 197 (range, 146 to 229) days. With a mean postexplantation total bone defect of 5.1 (range, 3.7 to 8.5) cm, four of seven patients elected tibial lengthening following fusion [mean lengthening 4.6 (range, 2.5 to 8.0) cm; external fixation index (EFI) 42.6 (range, 16.5 to 55.6) days/cm)]. Three of seven patients were treated with a shoe lift [mean lift height 2.9 (range 2.5 to 3.2) cm]. There was no failure of fixation, refracture, or infection. All patients had a stable plantigrade foot and walked with minimal limp. Association for the Study and Application of the Method of Ilizarov (ASAMI) functional scores were six good and one fair. ASAMI bone scores were four excellent and three good. CONCLUSIONS: Ankle arthrodesis following failed TAA results in large LLDs secondary to bone loss during implant failure and subsequent explantation. External fixation can produce an excellent fusion rate in complex, possibly infected, failed TAAs. Limb length equalization (by either distraction osteogenesis or shoe lift) provides a means of obtaining good functional outcomes following failed TAA
|
1 |
A Review of State Guidelines for Elective Orthopaedic Procedures During the COVID-19 Outbreak
|
Coronavirus Disease 2019 (COVID-19)
|
BACKGROUND: The SARS-CoV-2 (COVID-19) pandemic has resulted in widespread cancellation of elective orthopaedic procedures. The guidance coming from multiple sources frequently has been difficult to assimilate as well as dynamic, with constantly changing standards. We seek to communicate the current guidelines published by each state, to discuss the impact of these guidelines on orthopaedic surgery, and to provide the general framework used to determine which procedures have been postponed at our institution. METHODS: An internet search was used to identify published state guidelines regarding the cancellation of elective procedures, with a publication cutoff of March 24, 2020, 5:00 P.M. Eastern Daylight Time. Data collected included the number of states providing guidance to cancel elective procedures and which states provided specific guidance in determining which procedures should continue being performed as well as to orthopaedic-specific guidance. RESULTS: Thirty states published guidance regarding the discontinuation of elective procedures, and 16 states provided a definition of "elective" procedures or specific guidance for determining which procedures should continue to be performed. Only 5 states provided guidelines specifically mentioning orthopaedic surgery; of those, 4 states explicitly allowed for trauma-related procedures and 4 states provided guidance against performing arthroplasty. Ten states provided guidelines allowing for the continuation of oncological procedures. CONCLUSIONS: Few states have published guidelines specific to orthopaedic surgery during the COVID-19 outbreak, leaving hospital systems and surgeons with the responsibility of balancing the benefits of surgery with the risks to public health.
|
1 |
Spinal narcotics for postoperative analgesia in total joint arthroplasty. A prospective study
|
Management of Hip Fractures in the Elderly
|
Sixty patients who were scheduled to have an elective total hip or knee arthroplasty were randomly assigned to one of three groups of twenty patients each before operation with spinal anesthesia. A double-blind technique was used throughout the study. The patients in Group I (control group) received hyperbaric 1 per cent tetracaine with epinephrine as the subarachnoid spinal anesthetic; the patients in Group II (morphine group), hyperbaric 1 per cent tetracaine with epinephrine and a single subarachnoid dose of Duramorph (morphine sulphate), 0.5 milligram; and those in Group III (Dilaudid group), hyperbaric 1 per cent tetracaine with epinephrine and a single subarachnoid dose of Dilaudid (hydromorphone hydrochloride), 0.002 milligram per kilogram of body weight. During the first twenty-four hours after the operation, the patients in Group II and Group III had significantly less pain compared with those in Group I. This was shown by the use of a visual linear-analog pain scale (p less than 0.05), the patients' ratings of the quality of relief of pain (p less than 0.02), and comparative measurements of the pain-altering medications that were used (p less than 0.05). The patients in Group II and Group III did not have any more complications or side effects than those in Group I. There was no significant difference in the quality and duration of analgesia between Group II and Group III
|
1 |
Phase II study of zoledronic acid combined with docetaxel for non-small-cell lung cancer: West Japan Oncology Group
|
MSTS 2018 - Femur Mets and MM
|
The aim of this open-label, multicenter, randomized phase II trial was to evaluate the efficacy and safety of zoledronic acid in combination with docetaxel in previously treated patients with non-small-cell lung cancer (NSCLC) and bone metastases. In this study, patients randomly received docetaxel (60 mg/m2) with (group DZ) or without (group D) zoledronic acid every 21 days. There were 50 patients in each group, and the primary endpoint was progression-free survival. In an efficacy analysis of 94 patients (DZ, 48; D, 46), the median progression-free survival was 2.7 months (95% confidence interval [CI], 1.5-3.5 months) for the DZ group and 2.6 months (95% CI, 1.5-3.4 months) for the D group (stratified log-rank test, P = 0.89). The median overall survival was 10.4 months (95% CI, 7.0-15.8 months) for the DZ group and 9.7 months (95% CI, 6.1-12.5 months) for the D group (stratified log-rank test, P = 0.62). There were no clinically relevant differences in the frequencies of grade 3 or 4 adverse events between the two groups. No treatment-related deaths occurred in the DZ group. Zoledronic acid combined with docetaxel was well tolerated but did not meet the primary endpoint of demonstrating a longer progression-free survival in advanced NSCLC patients with bone metastases compared with docetaxel alone. This trial was registered with the University Hospital Medical Information Network (UMIN000001098). A randomized phase II study was evaluate the efficacy and safety of zoledronic acid in combination with docetaxel in previously treated patients with non-small cell lung cancer (NSCLC) and bone metastases. This study demonstrated the safety and tolerability of the combination of zoledronic acid and docetaxel but did not meet the primary endpoint of PFS in advanced NSCLC patients with bone metastasis. © 2014 The Authors. Cancer Science published by Wiley Publishing Asia Pty Ltd on behalf of Japanese Cancer Association.
|
0 |
Device-associated infections: A macroproblem that starts with microadherence
|
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
Medical devices are responsible for a large portion of nosocomial infections, particularly in critically ill patients. Device-associated infections can cause major medical and economic sequelae. Bacterial colonization of the indwelling device can be a prelude to both infection and malfunction of the device. The pathogenesis of device-associated infection centers around the multifaceted interaction among the bacteria, the device, and the host. Bacterial factors are probably the most important in pathogenesis of infection, whereas device factors are the most amenable to modification with the objective of preventing infection. Some, but not all, of the studied bacterial receptors satisfy the proposed "adherence/infection" version of Koch's postulates. Traditional surface-modifying preventive approaches have largely focused on antimicrobial coating of devices and resulted in variable clinical success in preventing device-associated infections. The potential protective role of newer innovative approaches, such as biofilm modification and bacterial interference, ought to be further investigated
|
1 |
Kirschner wire pin tract infection rates: a randomized controlled trial between percutaneous and buried wires
|
Distal Radius Fractures
|
This prospective, randomized trial compares the infection rates of Kirschner wires left percutaneously and those buried deep to the skin in a group of patients with isolated distal radial fractures. Percutaneous wires had a significantly greater infection rate than wires which were buried deep to the skin.
|
0 |
[The manipulation and effects of continuous femoral nerve block after performing a combined spinal and epidural anesthesia]
|
Surgical Management of Osteoarthritis of the Knee CPG
|
OBJECTIVE: To evaluate the manipulation and effects of continuous femoral nerve block after performing a combined spinal and epidural anesthesia. METHODS: 60 patients, ASAI-II, scheduled for elective total knee arthroplasty were randomized to PRE group or POST group (n = 30 for the each). CFNB was implemented before CSEA in PRE group, while CFNB was completed after the anesthesia in POST group. After the surgery, 1% lidocaine 10 ml was injected in through the catheter as the priming dose following a continuous rate of 5 ml/h of 0.2% ropivacaine. The performance time of CFNB, VAS scores, patient satisfaction and adverse effects were recorded. RESULTS: The performance time of CFNB in POST group was significantly lower than it in PRE group ((10.5 +/- 2.5) min vs (13.4 +/- 3.0) min) (P < 0.05). The patient satisfaction was much higher (P < 0.05), while the VAS scores was significantly lower in POST group (0.8 +/- 0.2) than those in PRE group (3.4 +/- 0.5) (P < 0.05) during the performance of CFNB. There were no significant differences in VAS scores at postoperative 6, 12, 24, 36 and 48 h, total patient satisfaction and adverse effects. CONCLUSION: The effects of CFNB after CSEA were definitely fine with higher patient satisfaction during the manipulation. It was a better choice of performing CFNB after CSEA
|
0 |
Distribution of aromatase P450 transcripts and adipose fibroblasts in the human breast
|
Reduction Mammoplasty for Female Breast Hypertrophy
|
The fibroblast component of adipose tissue is the primary extraglandular site of aromatase P450 (P450arom) expression, which is responsible for the conversion of C19 steroids to estrogens. Previously, we have shown positive correlations between the level of P450arom transcripts and the ratio of fibroblasts to mature adipocytes in adipose tissue samples proximal to breast tumors. The present study was conducted to determine the distribution of P450arom messenger ribonucleic acid (RNA) levels and fibroblast to adipocyte ratios in disease-free breasts of premenopausal women. Adipose tissue samples were collected from 3 regions (outer, upper, and inner) of both breasts of 13 women undergoing reduction mammoplasty. The histological composition of adipose tissue (n = 12) was determined by morphometry using a computerized image analysis program. We used a competitive RT-PCR method employing rat P450arom complementary RNA as an internal standard to quantify adipose P450arom transcripts in tissue total RNA samples (n = 11). Overall, 67% of the highest fibroblast to adipocyte ratios and 64% of the highest P450arom transcript levels were detected in an outer breast region, whereas in only 1 patient were the highest values detected in an inner region. Parametric ANOVA showed significant differences between the fibroblast content of the regions [p(F) = 0.037]. This distribution pattern directly correlates with the most common or the least common sites of carcinoma in the breast, the outer and inner regions, respectively. Moreover, a direct relationship was demonstrated between adipose fibroblasts and P450arom transcripts within the breast, in that regions with the highest fibroblast to adipocyte ratios contained the highest P450arom transcript levels (by ANOVA of contrast variables, P = 0.0009). These results suggest that, similar to our previous findings in the breast bearing a tumor, adipose tissue aromatase expression in the disease-free breast is determined by the local ratio of fibroblasts to adipocytes.
|
0 |
Lateral patellofemoral ligament reconstruction using a free gracilis autograft
|
Surgical Management of Osteoarthritis of the Knee CPG
|
Medial patellofemoral instability is a rare, disabling condition that is often associated with the wrong indication for lateral retinacular release or overcorrection with medializing tibial tubercle osteotomy. It is an even less common complication after total knee arthroplasty (TKA). The lateral patellofemoral ligament is an important lateral stabilizer of the patella against medial subluxation or dislocation. Until now, no report in the literature has described lateral patellofemoral ligament reconstruction with a free gracilis tendon autograft. Furthermore, there has not been a single case report of lateral patellofemoral ligament reconstruction after TKA. The authors describe a novel technique for reconstruction of the lateral patellofemoral ligament in a symptomatic medial subluxated patella resulting from TKA and extended lateral release in a 62-year-old patient. The result 1 year postoperatively was deemed successful. Clinically, the patella was stable, with correct tracking, and radiologically the patella was correctly positioned. With a technique similar to that used for the medial patellofemoral ligament, the lateral patellofemoral ligament can be reconstructed with a gracilis tendon autograft to permit stabilization independent of resting scar tissue of the lateral retinaculum. This operation can be performed in a minimally invasive way, without opening the joint, therefore decreasing the risk of joint infection. The authors showed a successful clinical and radiologic outcome 1 year after lateral patellofemoral ligament reconstruction in a patient with medial patellar instability after TKA and lateral release. (Figure Presented)
|
1 |
The partial AlloDerm sling: reducing allograft costs associated with breast reconstruction
|
Acellular Dermal Matrix
|
BACKGROUND: Many surgeons now incorporate Acellular Dermal Matrix (ADM) into expander-based breast reconstruction. ADM is safe, provides full expander coverage, eliminates the need for additional muscular dissection and has improved aesthetic outcomes. However, its use increases surgical costs. Whether this cost is offset by decreased operative times or a reduced number of revision procedures is unknown. METHODS: We have developed a new technique that minimises the amount of ADM required in many patients. The 'partial sling' approach has been used for 145 consecutive patients (197 breasts) by a single surgeon from 2007 to 2010. After mastectomy, any portion of the pectoralis major insertion at, or <1 cm from, the planned inframmary fold is left intact and becomes the inferior margin of the expander pocket. The minimal size of ADM required is then determined by measuring from the pectoralis to the lateral breast margin. In this study, we exclusively used AlloDerm. Preoperative breast measurements, intra-operative fill volume, time to exchange procedure, number of expansion procedures and complications were recorded for all patients. RESULTS: Patients were grouped according to the surface area (cm(2)) of ADM required. Good aesthetic outcomes were obtained in all groups. Two groups had a significant difference in intra-operative fill volumes but this did not correlate to an increase in the number of expansion procedures required. Of 197 reconstructed breasts less than 64 cm(2) of ADM was used for 40 breasts (20%). CONCLUSIONS: The partial AlloDerm sling can minimise the costs associated with ADM use in breast reconstruction for many patients without increasing complications or altering aesthetic outcomes.
|
0 |
Minimally invasive periprosthetic plate osteosynthesis using the locking attachment plate
|
PJI DX Updated Search
|
OBJECTIVE: Stable fixation of periprosthetic or periimplant fractures with an angular stable plate and early weight bearing as tolerated. INDICATIONS: Periprosthetic femur fractures around the hip, Vancouver type B1 or C. Periprosthetic femur and tibia fractures around the knee. Periprosthetic fractures of the humerus. Periimplant fractures after intramedullary nailing. CONTRAINDICATIONS: Loosening of prosthesis. Local infection. Osteitis. SURGICAL TECHNIQUE: Preoperative planning is recommended. After minimally invasive fracture reduction and preliminary fixation, submuscular insertion of a large fragment femoral titanium plate or a distal femur plate. The plate is fixed with locking head screws and/or regular cortical screws where possible. If stability is insufficient, one or two locking attachment plates (LAP) are mounted to the femoral plate around the stem of the prosthesis. After fixing the LAP to one of the locking holes of the femoral plate, 3.5 mm screws are used to connect the LAP to the cortical bone and/or cement mantle of the prosthesis. POSTOPERATIVE MANAGEMENT: Weight bearing as tolerated starting on postoperative day 1 is suggested under supervision of a physiotherapist. RESULTS: In 6 patients with periprosthetic fractures and 2 patients with periimplant fractures, no surgical complications (e.g., wound infection or bleeding) were observed. The mean time to bony union was 14 weeks. No implant loosening of the locking attachment plate was observed. At the follow-up examination, all patients had reached their prefracture mobility level
|
0 |
The role of sarcopenia with and without fracture
|
Hip Fx in the Elderly 2019
|
INTRODUCTION: Bone and muscle tissues are in a close relationship. They are linked from a biological and functional point of view and both are related to an increased fracture risk in the elderly. The aging process is involved in the loss of functionality of both bones and muscles. In particular, aging-induced decline in muscle size and quality accompanies catabolic alterations in bone tissue; furthermore, age-related changes in bone alter its response to muscle-derived stimulation. The increased fracture risk in individuals with sarcopenia and osteoporosis is due to the decline of muscle mass and strength, the decrease in bone mineral density (BMD) and limited mobility. In this study, we investigated the role of sarcopenia and the main age-related bone diseases, osteoporosis (OP) and osteoarthritis (OA).
METHODS: Muscular performance status was evaluated using the Physical Activity Scale for the Elderly (PASE) test in 27 female patients with OP who underwent total hip arthroplasty for hip fracture, and in 27 age-matched female patients with OA who underwent total hip arthroplasty. Dual-energy X-ray absorptiometry (DEXA) was performed and the T-score values were used to discriminate between OP and OA patients. Body Mass Index (BMI) was calculated. As part of a multiparametric model of evaluation, biopsies of vastus lateralis muscle were analysed by immunohistochemical reaction to find a correlation with the above mentioned functional index.
RESULTS: The PASE test showed that the OP patients had a low or moderate level of physical activity before fracture occurred, whereas the OA patients had more intensive pre-fracture physical performances. Histological analysis showed that osteoporosis is characterised by a preferential type II fibre atrophy; in particular, data correlation showed that lower PASE test scores were related to lower diameter of type II fibres. No correlation was found between bone mineral density (BMD) and PASE test results.
DISCUSSION AND CONCLUSION: Osteoporosis is closely related to sarcopenia before and after fracture. Bone remodelling is influenced by muscle morphological and functional impairment and sarcopenia is considered one of the major factors for functional limitation and motor dependency in elderly osteoporotic individuals. Therefore, physical activity should be strongly recommended for OP patients at diagnosis.
|
0 |
Postoperative analgesia in patients older than 75 years undergoing intervention for per-trochanteric hip fracture: a single centre retrospective cohort study
|
Hip Fx in the Elderly 2019
|
The aim of this study was to compare the efficacy of four analgesia techniques on postoperative pain after per-trochanteric femur fracture. A retrospective cohort study was conducted on 131 consecutive patients older than 75 years enrolled in an 18-month period and who underwent per-trochanteric fracture repair under spinal analgesia. Patients received postoperative analgesia from: G1 (n = 36), intravenous analgesia on demand only; G2 (n = 28) administration of acetaminophen at fixed hours; G3 (n = 50) continuous morphine infusion; G4 (n = 17), preoperative echo-graphic guided femoral nerve block. Continuous opioid infusion failed to prevent the onset of pain at the end of the effects of subarachnoid anesthesia (rescue dose of analgesic in 48 % of patients in G3 vs. 22 % in G2 in the first day; p < 0.05). The greater effectiveness was achieved by preventing the onset of pain with drugs administered at time intervals (rescue dose of analgesic in 48 % of patients in G3, 58 % in G1 and 48 % in G4 vs. 22 % in G2 in the first day and rescue dose of analgesic in 32 % of patients in G3, 67 % in G1 and 76 % in G4 vs. 18 % in G2 in the second day; p < 0.05). Our study does not confirm the effectiveness of a single shot femoral nerve block on postoperative pain in per-trochanteric femur fracture (PAIN VAS score > 3 at t1 in 23 % of patients in G1 and 19 % in G4 vs. 10 % in G2 and G3; p < 0.05).
|
0 |
Management of soft-tissue injuries in distal radius fractures
|
DOD - Acute Comp Syndrome CPG
|
Distal radius fractures account for approximately 15% of all fractures in adults, and are the most common fractures seen in the emergency department. Soft-tissue injuries associated with distal radius fractures may influence strategies for the acute management of the fracture, but also may be a source of persisting pain and/or disability despite fracture healing. This article describes soft-tissue injuries and considerations for treatment associated with distal radius fractures, including injuries to the skin, tendon and muscle, ligaments, the triangular fibrocartilage complex, neurovascular structures, and related conditions such as compartment syndrome and complex regional pain syndrome.
Copyright © 2012 Elsevier Inc. All rights reserved.
|
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.