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0 | The presence of a rotator cuff tear interferes with age-dependent muscle atrophy of intact shoulder muscles. An MRI study with 3yearsâ?? follow-up | Glenohumeral Joint OA | Rotator cuff muscle atrophy is frequently studied, but it is unknown whether redistribution of mechanical load in the presence of a rotator cuff tear influence muscle atrophy that is observed in patients. We hypothesized that in the presence of a supraspinatus tear, redistribution of mechanical load towards teres minor and deltoid slows down atrophy of these muscles over time. In this retrospective observational study of 129 patients, we measured the cross-sectional surface-areas on MRI of shoulder muscles in an intact rotator cuff (n = 92) and in a supraspinatus-tear group (n = 37) with a mean follow-up of 3 ± 1.8 years. Mixed models were applied to evaluate changes in surface-area of the rotator cuff and deltoid with adjustments for age, sex and follow-up time. In patients with an intact rotator cuff, the mean surface-area of the teres minor decreased 6 mm2/year (95% CI 0.7â??11.1, P = 0.026) and the mean deltoid surface-area decreased 75 mm2/year (95% CI 24.5â??124.8, P = 0.004). The presence of a rotator cuff tear was associated with less reduction of teres minor and deltoid surface-area in patients <50 years, with an effect of a tear of 22 mm2/year (95% CI 1.7â??41.7, P = 0.034) and 250 mm2/year (95% CI 75.8â??424.3, P = 0.006), respectively. Whereas the surface-area of teres minor and deltoid decrease over time in patient with an intact rotator cuff, the decline in surface-area of these muscles was substantially less in the presence of a rotator cuff tear. Our findings indicate that atrophy may be reduced if an increase in mechanical load is exerted onto the muscle. |
0 | Preoperative Hypoalgesia after Cold Pressor Test and Aerobic Exercise is Associated with Pain Relief 6 Months after Total Knee Replacement | AAHKS (4) Acetaminophen | Objectives: Chronic pain after total knee replacement (TKR) is not uncommon. Preoperative impaired conditioning pain modulation (CPM) has been used to predict chronic postoperative pain. Interestingly, exercises reduce pain sensitivity in patients with knee osteoarthritis (KOA). This pilot study investigated the association between exercise-induced hypoalgesia (EIH) and CPM on post-TKR pain relief. Methods: Before and 6 months post-TKR, 14 patients with chronic KOA performed the cold pressor test on the nonaffected leg and 2 exercise conditions (bicycling and isometric knee extension), randomized and counterbalanced. Before and during the cold pressor test and after exercises test stimuli were applied to extract the pain sensitivity difference: computer-controlled cuff inflation on the affected lower leg until the participants detected the cuff pain threshold (cPPT) and subsequently the cuff pain tolerance (cPTT) and manual pressure pain thresholds (PPTs) at the legs, arm, and shoulder. Clinical pain intensity (numerical rating scale [NRS]) and psychological distress (questionnaires) were assessed. Results: Clinical pain intensity, psychological distress, cPPT, and PPT at the affected leg improved post-TKR compared with pre-TKR (P<0.05). Preoperatively, the CPM and bicycling EIH assessed by the increase in cPTT correlated with reduction in NRS pain scores post-TKR (P<0.05). Improved CPM and EIH responses after TKR were significantly correlated with reduction in NRS pain scores post-TKR (P<0.05). Discussion: In KOA patients, hypoalgesia after cold pressor stimulation and aerobic exercise assessed preoperatively by cuff algometry was associated with pain relief 6 months after TKR. EIH as a novel preoperative screening tool should be further investigated in larger studies. |
1 | Outcomes of Routine Use of Antibiotic-Loaded Cement in Primary Total Knee Arthroplasty | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | The routine use of antibiotic-loaded bone cement (ALBC) in primary total knee arthroplasty (TKA) is controversial. Outcomes were recorded in patients who underwent primary TKA from May 2003 to March 2007 using a community-based total joint registry. Infection rates were compared in patients undergoing TKA with ALBC and regular cement. A total of 22 889 primary TKA were performed, with 2030 cases (8.9%) using ALBC. Two thousand four hundred forty-nine patients were diabetic (10.7%), with ALBC used in 295 cases (12%). The rate of deep infection was 1.4% for ALBC TKA (28 cases) and 0.7% (154 cases) with regular cement (P = .002). Among patients with diabetes, the infection rate was 1.7% (5 cases) with ALBC and 0.9% (19 cases) with regular cement (P = .199). In patients whom surgeons considered higher risk for infection, ALBC did not appear to reduce TKA infection rates. The routine use of antibiotic-laden cement warrants further investigation. (copyright) 2009 |
0 | O(2)-O(3) therapy in tendinopathies and entrapment syndromes | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | We compare the results obtained after local administration of oxygen-ozone (O(2)-O(3)) with those of anti-inflammatory mesotherapy in patients with painful shoulder, tendinopathies and entrapment syndromes. O(2)-O(3) was significantly more effective than mesotherapy in relieving painful shoulder and pubic pain without side effects which did occur in patients treated by mesotherapy. Oxygen-ozone therapy is a valid treatment for inflammatory and degenerative diseases of the musculoskeletal apparatus |
0 | Requests for electromyography in Rome: a critical evaluation | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | To date, there exist no data reporting the level of suitability of requests for electromyography examinations (EMGs) in Rome. The records of 1,220 consecutive patients (age: 57.6+/-15.0 years; 400 M, 820 F) in two neurophysiology laboratories were collected and analyzed. In total, 1,317 EMGs were requested, mainly by general practitioners (GPs) (57%) and orthopedic specialists (18%). The most common diagnoses were L4-L5 radiculopathy (22%) and carpal tunnel syndrome (21%); 332 examinations (25%) were normal. 68% of requests were not accompanied by any specific query. The concordance between initial hypothesis/final post-EMG diagnosis was low (<20%). When a specific query was indicated, the initial suspicion was confirmed by EMG in 54% of GP requests and 64% of requests by specialists (p=0.03). No difference in diagnostic ability was found between specialists (p>0.05). In 17% of cases, the EMG was deemed diagnostically useless by the neurophysiologist, which seems to indicate potentially suboptimal prescription of EMGs |
0 | Identifying comorbid conditions that affect the 6 month recovery pattern of total knee arthroplasty | Surgical Management of Osteoarthritis of the Knee CPG | Background/Purpose: Cormorbid conditions can affect the recovery of total knee arthroplasty (TKA), yet aside from counting the number of comorbid conditions, the identification of which conditions have the most impact on pain relief and functional recovery is not clearly understood. We looked at the pattern of recovery for pain and function of TKA to determine what comorbid conditions had the most impact on the recovery following TKA in terms of pain relief and functional improvement. Methods: Longitudinal prospective inception cohort of 405 patients receiving elective primary TKA were followed within a month prior to surgery, and 1, 3, 6 months after surgery. The outcome measures, knee pain and function were measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Comorbid conditions were extracted from the chart and reported by the patient using a list generated from the Charlson Comorbidity Index and National Population Health Survey. The Center for Epidemiologic Studies-Depression (CES-D) was used to screen for depression. Measurements were repeated at each of the follow-up interviews. Linear mixed models were developed for pain and functional recovery to evaluate changes over time while adjusting for covariates. Results: The mean age was 68 (SD10) yrs; 249(61.5%) were female. Mean pre-operative pain improved from 49.0 (SD 17.0) to 17.9 (SD 17.1) over the 6 months (p<0.001). The mean pre-operative function improved from 44.7 (SD 17.3) to 19.8 (SD 16.2) over this time (p<0.001). At baseline, mean depression score was 8.7 (SD 8.4), 90 (22%) had chronic respiratory disease, 156 (39%) back pain, 60 (15%) diabetes and 114 (28%) urinary incontinence. After controlling for age, sex, baseline pain and time, depression score (coeff 0.2, p<0.001), back pain (2.7, p<0.01), chronic respiratory disease (4.1, p<0.001), and diabetes (2.8, p=0.03) had a deleterious effect on pain relief. For instance, the coefficient of diabetes in this model implies diabetic patients have 2.8 units less pain relief over the 6 months than non-diabetic patients. Depression score (0.2, p<0.01), chronic respiratory disease (4.0, p<0.001), and urinary incontinence (2.1, p=0.04) affected functional improvement. No interactions were found between depression and diabetes, chronic respiratory disease or urinary incontinence. Conclusion: Patients with higher depression scores or chronic respiratory disease are likely to have slower pain relief and functional improvement over a 6 month recovery. Active pain management and rehabilitation should target these patient subgroups given the slower recovery patterns seen. Managing these conditions before surgery may also help patients attain more favourable outcomes |
0 | Topical NSAIDs for chronic musculoskeletal pain in adults | SR for PM on OA of All Extremities | Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly taken orally, but they are also available in topical preparations to be applied to or rubbed onto the skin of a painful joint, typically one affected by arthritis, with the aim of relieving pain locally. Topical NSAIDs are widely used in some parts of the world for acute and chronic painful conditions, but have not been universally accepted until recently. One of the problems has been that older clinical studies were generally short, lasting four weeks or less, and short duration studies are not regarded as adequate in ongoing painful conditions.Objectives: To examine the use of topical NSAIDs in chronic musculoskeletal pain, focusing on studies of high methodological quality, and examining the measured effect of the preparations according to study duration. The principal aim was to estimate treatment efficacy in longer duration studies of at least 8 weeks.Search methods: A series of electronic searches, together with bibliographic searches, and searches of in-house databases were combined with electronic searches of clinical trial registers and manufacturers of topical NSAIDs, or companies known to be actively researching topical NSAIDs. There had to be at least 10 participants in each treatment arm, with application of treatment at least once daily.Selection criteria: Randomised, double blind studies with placebo or active comparators, where at least one treatment was a topical NSAID product, in any topical formulation (cream, gel, patch, solution), in studies lasting at least two weeks.Data collection and analysis: Two review authors independently assessed study quality and validity, and extracted data. Numbers of participants achieving each outcome were used to calculate relative risk (RR) and numbers needed to treat (NNT) or harm (NNH) compared to placebo or other active treatment.Main results: Information was available from 7688 participants in 34 studies from 32 publications; 23 studies compared a topical NSAID with placebo. Topical NSAIDs were significantly more effective than placebo for reducing pain due to chronic musculoskeletal conditions. The best data were for topical diclofenac in osteoarthritis, where the NNT for at least 50% pain relief over 8 to 12 weeks compared with placebo was 6.4 for the solution, and 11 for the gel formulation. There were too few data of good quality to calculate NNTs for other individual topical NSAIDs compared with placebo. Direct comparison of topical NSAID with an oral NSAID did not show any difference in efficacy. There was an increase in local adverse events (mostly mild skin reactions) with topical NSAIDs compared with placebo or oral NSAIDs, but no increase in serious adverse events. Gastrointestinal adverse events with topical NSAID did not differ from placebo, but were less frequent than with oral NSAIDs.A substantial amount of data from unpublished studies was unavailable. Much of this probably relates to formulations that have never been marketed.Authors' conclusions: Topical NSAIDs can provide good levels of pain relief; topical diclofenac solution is equivalent to that of oral NSAIDs in knee and hand osteoarthritis, but there is no evidence for other chronic painful conditions. Formulation can influence efficacy. The incidence of local adverse events is increased with topical NSAIDs, but gastrointestinal adverse events are reduced compared with oral NSAIDs |
0 | Bone transport in the management of posttraumatic bone defects in the lower extremity | DoD LSA (Limb Salvage vs Amputation) | BACKGROUND: The aim of this study was to evaluate the clinical and functional outcomes of traumatic bone defects of the lower extremity managed by internal bone transport using the Ilizarov technique. METHODS: We retrospectively reviewed 19 patients who underwent internal bone transport for traumatic bone defects in the lower extremity. Mean follow-up was 68.7 months (5.7 years). Eighteen cases were open: grade IIIA, 10 cases; grade IIIB, 4 cases; and grade IIIC, 4 cases. RESULTS: Clinical outcome was 2 excellent, 11 good, 4 fair, and 2 poor. Eighteen of 19 patients reported being satisfied. The results of the SF-36 Health Survey showed a significant difference between the population norm and the mean of the study group in Physical Functioning, Bodily Pain, and Role-Emotional. The mean length of time in external fixation for all patients was 13.8 months. The mean length of regenerate was 5.7 cm (range, 0.8-20.4 cm). The total number of complications was 39 (20 minor and 19 major). Major complications included two transtibial amputations and four fractures at the docking site. CONCLUSION: Although the number of complications was high, the patients in this study were satisfied to have their limbs preserved. The SF-36 Health Survey showed that patients suffer mainly from physical and emotional consequences after these major injuries. Their general, social, and mental health is usually not affected. Infection significantly increased the healing index. The limb should be protected for a long time, with careful evaluation to avoid fracture at the docking site after fixator removal. |
0 | Interposition Arthroplasty of the Elbow Utilizing a Lateral Epicondyle Osteotomy | Pediatric Supracondylar Humerus Fracture 2020 Review | Management of severe elbow arthritis in young or active patients presents a challenging problem. Interposition arthroplasty is a useful salvage procedure for these patients but has a significant failure rate associated with postoperative instability. Previous studies have sought to preserve the integrity of the medial elbow ligament complex to decrease postoperative instability and the need for external fixation. Our lateral epicondylar osteotomy technique preserves the native lateral elbow ligament complex. Potential advantages include bone-to-bone healing of the osteotomy, decreased postoperative instability, and the decreased need for and associated costs and potential complications of supplemental external fixation. |
1 | Clinical outcome of conventional versus biological fixation of subtrochanteric fractures by proximal femoral locked plate | DoD SSI (Surgical Site Infections) | Introduction Surgical fixation is the standard management of the subtrochanteric fractures. Proximal femoral locked plating (PF-LCP) provides a strong construct for fixation with a high success rate. However, some studies reported implant failure due to loss of the postero-medial bone support and recommended an anatomical reduction. Other studies reported excellent to good results with indirect (biological) fixation without anatomical reduction. In this study, we reviewed the short-term clinical results of PF-LCP fixation for subtrochanteric fractures using both conventional and biological fixation. Materials and methods Forty six patients (34 males and 12 females) with comminuted subtrochanteric fractures were included aged between 18 and 74 (mean 44.3 years). They were treated in a single-blind random manner by either conventional (open, direct) or biological (indirect) reduction method and internal fixation with PF-LCP. Intra-operative variables including; duration of surgery, blood loss, fluoroscopy time and any complications were recorded. Post-operative differences including; duration of healing, implant failure, complications and the final clinical outcome by Harris Hip Score (HHS) were documented. Results 44 cases continued to the final follow-up (23 of the open fixation group and 21 of the biological fixation group). Patients of open group demonstrated greater blood loss (756 ± 151 vs. 260 ± 39 ml; P < 0.0001), longer operative times (129 ± 16.9 vs. 91 ± 8 min; P < 0.0001) and incisions (s) length (20.4 ± 3 vs. 13.4 ± 1 cm; P < 0.0001). More patients needed blood transfusion in open group (11 patients vs. six in closed group; P < 0.0001). Patients of biological group demonstrated longer fluoroscopy time (80.9 ± 7.3 vs. 47.2 ± 5.8 sec.; P < 0.0001). For each group, one case of implant failure was recorded. Low patient compliance was a detrimental factor for the implant failure in both cases. No much difference was demonstrated for the healing rate (open group; 18.3 ± 3.7 vs. biological group16.5 ± 4 weeks; P < 0.058) and for the functional outcome (open group; excellent/good: 54%/37%, biological group; excellent/good: 57%/33%; P = 0.766). Conclusion PF-LCP provided a strong construct for fixation of the comminuted subtrochanteric fractures either by open or biological techniques. Low patient compliance is an influential factor for implant failure in both types. |
0 | Comparison of broadband ultrasonic attenuation of the os calcis and quantitative computed tomography of the distal radius | Distal Radius Fractures | The measurement of broadband ultrasonic attenuation (BUA) in the os calcis, which consists of predominantly trabecular bone, has been compared by others with single photon absorptiometry of forearm cortical bone. We have compared BUA in 24 female subjects with the separate measurement of trabecular and cortical bone in the distal radius using quantitative computed tomography (QCT). BUA was highly significantly correlated with each of the measurements in the radius (P less than 0.001). Paradoxically, BUA was found to be best correlated with the bone mass per unit length in the radial shaft (r = 0.85) rather than with radial trabecular bone (r = 0.66). The degree of correlation was not sufficient to predict radial bone mass accurately in individuals. Broadband ultrasonic attenuation, however, appears to be a useful measurement of bone in the appendicular skeleton. |
0 | Breast cancer cell line MDA-MB 231 exerts a potent and direct anti-apoptotic effect on mature osteoclasts | MSTS 2022 - Metastatic Disease of the Humerus | Cancer cells metastasized to bone stimulate osteoclastogenesis resulting in bone destruction. However, the influence of tumor cells on fully differentiated osteoclasts is much less known. We postulated that breast cancer cells directly stimulate the survival of mature osteoclasts. We thus tested the effect of conditioned media (CM) prepared from MDA-MB-231 cells on the activity and apoptosis of osteoclasts isolated from 10-day-old rabbit long bones. First, we demonstrated that CM increased the bone resorbing activity in our cell model of rabbit mature osteoclasts. Using a highly purified osteoclast cell population, we found that MDA-MB-231 CM dramatically inhibited osteoclast apoptosis. In the presence of 20% CM, apoptosis was decreased by approximately 60%. LY294002, a PI3 kinase inhibitor, strongly prevented the CM anti-apoptotic effect. Neutralizing experiments with human antibody revealed that macrophage-colony stimulating factor originating from MDA-MB 231 cells was possibly involved in the CM anti-apoptotic effect. These results suggest that breast cancer cells, in addition to stimulating osteoclastogenesis, potently inhibit mature osteoclast apoptosis, a mechanism which may greatly contribute to their osteolytic potential. |
0 | Constant connections: piloting a mobile phone-based peer support program for Nuer (southern Sudanese) women | DoD PRF (Psychosocial RF) | Refugee women have poor psychosocial health as a result of past trauma and difficulties associated with settlement. This study was a pilot to find out how to use mobile phone-based peer support to improve the psychosocial health of, and facilitate settlement in a group of nine Nuer refugee women in Melbourne, Australia. Nine participants recruited by a community leader received peer support training over two five-week periods. They were further provided with mobile phone recharge vouchers to call one another to practice peer support techniques. The fifth and final sessions were focus groups to evaluate the intervention. Notes from the focus groups were thematically analysed. The women reported greater confidence and empowerment as they received more support, had better connections within the group and better access to information. Relationships with friends, family and the community became richer as they adopted and experienced more functional communication patterns. Using mobile phones for peer support helped to re-create community by bridging the geographical distance that separates refugee women. It allowed the women, from similar backgrounds and with similar experiences, to provide mutual support and exchange information through a verbal channel, the form of communication they are most comfortable with. The program demonstrates the positive psychosocial effect of peer support in a refugee community, and provides a viable model for using mobile phones in health promotion interventions. The successful outcomes, as perceived by the participants, are indicative of the potential of using technology to bridge health inequities in a marginalised group. |
0 | Physical therapists collect different outcome measures after total joint arthroplasty as compared to most orthopaedic surgeons: a New England study | OAK 3 - Non-arthroplasty tx of OAK | Background: Following total knee and hip arthroplasty, patient progress can be assessed with patient-reported outcome measures (PROMs) and performance-based outcome measures (PBOMs). The American Joint Replacement Registry 2016 guide recommends collecting several measures, including Patient Reported Outcome Measure Information System Global, Knee Injury and Osteoarthritis Outcome Score Jr, and Hip Injury and Osteoarthritis Outcome Score Jr. This study aimed to assess the current and anticipated use of PROMs and PBOMs by New England physical therapists. Methods: An online survey was conducted in July and August of 2015 asking physical therapists in New England to rate their current and anticipated future use of PROMs and PBOMs in terms of clinical decision making associated with the treatment and care of patients after total hip and knee replacement. Results: There were 122 responses. The most often used and recommended PROMS were the Numeric Pain Rating Scale (99.2% and 97.5%, respectively) and Lower Extremity Function Scale (76.2% and 77.0%). There was significant variability in the use of different PBOMs, but the most often used and recommended were the Timed Up and Go (93.4% and 85.2%) and the Single Leg Balance Test (90.2% and 87.7%). Conclusions: This study suggests that orthopaedic surgeons and physical therapists use different PROMs and PBOMs for postoperative assessment of total joint patients and highlights the need for more collaboration and consistency between these disciplines. |
0 | Rotational mismatch of self-align technique in posterior-stabilized total knee arthroplasty | OAK 3 - Non-arthroplasty tx of OAK | Background: Rotational malalignment of a femoral component may lead to chronic pain, patellar maltracking, knee instability, and early failure of a total knee arthroplasty [TKA]. The transepicondylar axis of the femur is widely accepted as a good reference for rotational alignment of a tibial component, although it is more controversial for a tibial component. Objective: This study aimed to determine the degree of rotational mismatch between femoral and tibial components implanted using the center-post self-align technique. Materials and Methods: Patients who underwent TKA for osteoarthritis of the knee were enrolled to have postoperative CT scans for determination of the rotational alignment. The study included 51 patients (60 knees), 5 males and 46 females, with a mean age of 64.0 years (range 58 to 73). The posterior cruciate ligament substituting tibial component position was set using the center-post self-align technique. CT digital images in the supine position with the knee at full extension were evaluated. Results: Of the 60 TKAs, the mean rotational mismatch between tibial and femoral prostheses was 2.00° (SD±O.340, range 0.1° to 5.8°). The femoral component was rotated externally and internally within 1.5° while the tibial component was within 2.59° relative to the transepicondylar axis. All knees had good patellar tracking intraoperatively without any lateral release procedure. Conclusion: The center-post self-align technique can achieve good compatibility of rotational alignment between the femoral and tibial components with low variability, particularly with the knee in the extended position. |
0 | The Current State of Screening and Decolonization for the Prevention of Staphylococcus aureus Surgical Site Infection After Total Hip and Knee Arthroplasty | PJI DX Updated Search | The most common pathogens in surgical site infections after total hip and knee arthroplasty are methicillin-sensitive Staphylococcus aureus (MSSA), methicillin-resistant S. aureus (MRSA), and coagulase-negative staphylococci. Patients colonized with MSSA or MRSA have an increased risk for a staphylococcal infection at the site of a total hip or knee arthroplasty. Most colonized individuals who develop a staphylococcal infection at the site of a total hip or total knee arthroplasty have molecularly identical S. aureus isolates in their nares and wounds. Screening and nasal decolonization of S. aureus can potentially reduce the rates of staphylococcal surgical site infection after total hip and total knee arthroplasty |
0 | Accuracy of self-reported diagnosis of hip replacement | Management of Hip Fractures in the Elderly | OBJECTIVE: To examine the accuracy and validity of self-report of hip replacement for osteoarthritis (OA). METHODS: We compared self-reported hip replacement and the reason for surgery in elderly, white women age > or =65 years from the Study for Osteoporotic Fractures cohort with medical records and pelvis radiographs. Women, followed for an average of 8 years at the fifth clinic visit, were asked about any hip replacements since baseline. RESULTS: Among 7,421 women attending the fifth clinic visit, 347 reported 387 hip replacements. Radiographs and/or medical records were available for 316 self-reported hip replacements. Participants accurately reported that hip replacements were for arthritis or fracture, with 94.5% and 97.2% of these self-reported diagnoses, respectively, confirmed from medical records. However, 1 in 8 self-reported hip replacements were not attributed by participants to either arthritis or a fracture; of these, medical records indicated that 88% were for OA. Overall, 302 self-reported hip replacements (95.6%) were confirmed as hip replacements (for agreement with self-report, kappa = 0.95 [95% confidence interval 0.92-0.96]). Under-reporting of hip replacements compared with hip replacements seen on radiographs was minimal (0.28%). CONCLUSION: Elderly women accurately reported hip replacements and whether the surgery was for arthritis or a hip fracture, although a small number of hip replacements for arthritis were not attributed to this diagnosis by the women. Because hip OA and hip fracture have very different determinants, epidemiologic studies that use self-reported hip replacement as an indicator for the presence of hip OA or as an outcome of hip OA should verify the underlying cause by asking about the reason for surgery |
0 | Treatment of unstable distal ulna fractures associated with distal radius fractures in patients 65 years and older | Distal Radius Fractures | PURPOSE: To prospectively compare the clinical and radiological outcomes of 2 treatment methods for unstable distal ulna fractures associated with distal radius fractures in patients 65 years of age and older.
METHODS: From February 2008 to March 2010, the first 29 ulnas were treated surgically (group 1) and the next 32 ulnas were treated nonoperatively (group 2). The mean final follow-up period was 34 months (range, 24-56 mo). All radiuses were fixed internally, in both groups. Clinical outcomes were compared between groups using a visual analog scale for postoperative pain; Disabilities of the Arm, Shoulder, and Hand scores; active range of motion; grip strength; and the modified system of Gartland and Werley. Radiological outcomes, including ulnar variance, were evaluated. Arthrosis was evaluated at the radiocarpal joint or distal radioulnar joint (DRUJ) according to the system of Knirk and Jupiter.
RESULTS: There were no significant differences between the groups in any of the clinical outcomes. No significant differences were observed for radiological outcomes including ulnar variance, distal radius, and union rate. There were no patients in either group with symptomatic arthritic changes in the radiocarpal joint or DRUJ at the final follow-up. In group 2, 1 patient had malunion (angulated, 14degree) on the anteroposterior view without evidence of arthrosis in the DRUJ, and functional outcomes were good.
CONCLUSIONS: In this population distal ulna fractures can be successfully managed nonoperatively when they occur in combination with distal radius fractures. |
0 | Longitudinal Assessment of Vascular Function With Sunitinib in Patients With Metastatic Renal Cell Carcinoma | MSTS 2018 - Femur Mets and MM | BACKGROUND: Sunitinib, used widely in metastatic renal cell carcinoma, can result in hypertension, left ventricular dysfunction, and heart failure. However, the relationships between vascular function and cardiac dysfunction with sunitinib are poorly understood.
METHODS AND RESULTS: In a multicenter prospective study of 84 metastatic renal cell carcinoma patients, echocardiography, arterial tonometry, and BNP (B-type natriuretic peptide) measures were performed at baseline and at 3.5, 15, and 33 weeks after sunitinib initiation, correlating with sunitinib cycles 1, 3, and 6. Mean change in vascular function parameters and 95% confidence intervals were calculated. Linear regression models were used to estimate associations between vascular function and left ventricular ejection fraction, longitudinal strain, diastolic function (E/e'), and BNP. After 3.5 weeks of sunitinib, mean systolic blood pressure increased by 9.5 mmHg (95% confidence interval, 2.0-17.1; P=0.02) and diastolic blood pressure by 7.2 mmHg (95% confidence interval, 4.3-10.0; P<0.001) across all participants. Sunitinib resulted in increases in large artery stiffness (carotid-femoral pulse wave velocity) and resistive load (total peripheral resistance and arterial elastance; all P<0.05) and changes in pulsatile load (total arterial compliance and wave reflection). There were no statistically significant associations between vascular function and systolic dysfunction (left ventricular ejection fraction and longitudinal strain). However, baseline total peripheral resistance, arterial elastance, and aortic impedance were associated with worsening diastolic function and filling pressures over time.
CONCLUSIONS: In patients with metastatic renal cell carcinoma, sunitinib resulted in early, significant increases in blood pressure, arterial stiffness, and resistive and pulsatile load within 3.5 weeks of treatment. Baseline vascular function parameters were associated with worsening diastolic but not systolic function. |
0 | Familial influence on tibiofemoral alignment | AMP (Acute Meniscal Pathology) | BACKGROUND: Tibiofemoral alignment has a role in knee osteoarthritis (OA), but which factors contribute to alignment is unknown.
OBJECTIVE: To investigate familial aggregation of tibiofemoral alignment in participants of the GARP (Genetics ARthrosis and Progression) study.
METHODS: The tibiofemoral anatomical angle on semiflexed knee radiographs was measured in sibling pairs (mean age 60 years, 81% women) with primary OA with multiple joint involvement. Radiographic OA was assessed according to the Kellgren-Lawrence (KL) method. Heritability estimates of the tibiofemoral angle were calculated by comparing twice the between-sibling variance with the total variance; adjustments were made for age, gender, body mass index, history of meniscectomy, lower limb fracture and in analyses including all knees, for KL score.
RESULTS: 360 subjects representing 180 families were studied. The mean (SD) tibiofemoral angle of right and left knees in the probands was 182.7 (2.9) degrees and 182.8 (2.6) degrees , respectively; similar angles were measured in the siblings. Radiographic knee OA (KL score > or =2) was present in 27% of the knees. Stratified analyses in sib pairs with non-osteoarthritic right or left knees showed adjusted heritability estimates of the tibiofemoral angle of the right and left knees of 0.42 (95% CI 0.02 to 0.82) and 0.56 (95% CI 0.19 to 0.93). In addition, adjusted heritability estimates of the tibiofemoral angle in all right and left knees were calculated, being 0.48 (95% CI 0.18 to 0.78) and 0.50 (95% CI 0.21 to 0.79), respectively.
CONCLUSION: The alignment of the tibiofemoral joint is influenced by familial factors, implying that tibiofemoral malalignment may add to the genetic predisposition for knee OA development. These results need to be confirmed in other study populations. |
0 | Step test performance and risk of stress fractures among female Army trainees | DoD PRF (Psychosocial RF) | Background: Stress fractures and other musculoskeletal injuries are major sources of morbidity among female military trainees. Several risk factors have been postulated, particularly pre-existing fitness, usually assessed with post-entry run time for â?¥ 1.0 mile. Purpose: Physical fitness is not formally evaluated prior to Army entry. If a valid and simple test that identified women at increased risk of stress fracture were available and could be applied prior to entry, it would facilitate costâ??benefit studies of deferral or interventions. These analyses were undertaken to determine if a 5-minute step test conducted before entry identified women at increased risk. Methods: A prospective study was conducted of weight-qualified women entering the Army in 2005â??2006, with analyses completed in 2011. At the pre-entry examination, information was collected on age, BMI, smoking, race, and activity level. Everyone took the step test. All outpatient medical encounters were captured, and stress fractures and other musculoskeletal injuries identified. Women with stress fractures and those with other musculoskeletal injuries were evaluated separately. Results: 1568 women were included in the study; 109 developed stress fractures and 803 other musculoskeletal injury. Women who failed the step test had a 76% higher stress fracture incidence and a 35% higher incidence of other musculoskeletal injuries. There was effect modification between age and test failure for stress fracture. Conclusions: A step test that can be administered before military entry identifies women with increased incidence of stress fracture and other musculoskeletal injury. This test could be used pre-entry to defer or target high-risk recruits for tailored fitness training before or after military entrance. (PsycINFO Database Record (c) 2016 APA, all rights reserved) |
0 | BACTERIAL ENDOCARDITIS DUE TO AN ACTINOBACILLUS | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | A case of subacute bacterial endocarditis due to Actinobacillus actinomycetemcomitans followed dental extraction under penicillin cover. Isolation of the organism was only achieved by incubating blood cultures in a CO(2)-enriched atmosphere. The patient was successfully treated with streptomycin |
0 | Distribution of substance-P nerve fibers in intact and ruptured human anterior cruciate ligament: a semi-quantitative immunohistochemical assessment | Surgical Management of Osteoarthritis of the Knee CPG | Numerous studies have reported qualitative and quantitative analysis of nerve supply in the anterior cruciate ligament; however, as yet relatively little is known about the distribution of substance-P nerve endings in the human anterior cruciate ligament. The objective of this work was to evaluate the distribution of substance-P nerve fibers in intact human anterior cruciate ligament, and determine if rupture of the ligament has any influence on occurrence of these receptors. The intact anterior cruciate ligament group (group 1) of osteoarthritis knee, undergoing total knee arthroplasty, consisted of nine patients (eight females) with a mean age of 65.3 years at surgery. The anterior cruciate ligament rupture group (group 2) consisted of 20 patients (18 males and 2 females) with a mean age of 27.8 years at reconstruction. Healing time of the torn ligament in vivo, determined by the time period between the rupture and reconstruction, lasted from 1 to 40 months and the patients were divided into 3 groups (I, II and III) embracing diverse time periods. All harvested anterior cruciate ligaments were sectioned in thirds so that there was a proximal, middle and distal third for each ligament. The distribution of nociceptive receptors was studied by immunohistochemistry with monoclonal antibody to substance-P, including the semi-quantitative assessment. No significant difference was found between the number of substance-P nerve fibers in the proximal, middle and distal third of the intact anterior cruciate ligament (p>0.05). During the first 4 months after injury (group I) the mean number of neuropeptide-containing fibers was greater in the proximal than in the distal third (p=0.048996). The number of SP-positive nerve fibers in the proximal third decreased between 5 and 12 months after rupture, in a statistically significant manner (p=0.045864). This study showed that distribution of the nociceptive nerve supply, positively stained for substance-P, is equal among the intact anterior cruciate ligament. The substance-P nerve ending density was significantly affected by the injury as well as by the time since rupture. The results of this study provide immunohistochemical evidence suggesting that between 1 to 4 months after rupture the site of the injury undergoes neurogenic inflammation, which could have an influence on the healing course of the torn ligament |
0 | Nationwide surveillance of 6 otorhinolaryngological infectious diseases and antimicrobial susceptibility pattern in the isolated pathogens in Japan | Patrick’s pharmacoepidemiology project | The Japanese Three Academic Societies Joint Antimicrobial Susceptibility Surveillance Committee has conducted a nationwide surveillance on antimicrobial susceptibility patterns and rates of isolation in 6 otolaryngological diseases. The surveillance program was conducted in the otorhinolaryngological departments of 29 universities, and their 26 affiliated hospitals. Patients suffering from acute otitis media, chronic otitis media, acute nasal sinusitis, chronic nasal sinusitis, acute tonsillitis, and peritonsillar abscess between January 2011 and June 2012 were investigated. The collected swab or incision samples were cultivated for microbial identification, and the drug susceptibility of detected bacteria was measured at the Kitasato University Research Center for Infections and Antimicrobials. The surveillance focused on three gram-positive bacteria (Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus), three gram-negative bacteria (Haemophilus influenzae, Moraxella Catarrhalis, and Pseudomonas aeruginosa), and three anaerobic bacteria (Peptostreptococcus spp., Prevotella spp., and Fusobacterium spp.). Bacterial susceptibility to 39 antimicrobial drugs was investigated. We compared bacterial isolation ratio of each disease in this surveillance from those of past 4 times surveillance which we performed formerly, and we also compared percentage of main drug resistant strains from those of past 4 times surveillance. The age composition between this time and former surveillances was not statistically significant by student-t test.We were unable to completely resolve the rise in resistant bacteria, such as methicillin-resistant S. aureus, penicillin-resistant S. pneumoniae, penicillin-intermediate resistant S. pneumoniae, beta-lactamase non-producing ampicillin-resistant H. influenzae, beta-lactamase producing ampicillin-resistant H. influenzae, and beta-lactamase producing amoxicillin clavulanic acid-resistant H. influenzae. We suggest promoting the proper usage of antimicrobial drugs in order to avoid the spread of these bacteria |
0 | Norepinephrine from synovial tyrosine hydroxylase positive cells is a strong indicator of synovial inflammation in rheumatoid arthritis | AAHKS (2) Corticosteroids | Objective. Density of sympathetic nerve fibers in synovial tissue was lower in patients with rheumatoid arthritis (RA) compared to those with osteoarthritis (OA). This was accompanied by norepinephrine (NE) release from synovial tyrosine hydroxylase positive cells (TH+ cells). We investigated the role of TH+ cells and NE in synovial inflammation. Methods. Synovial tissue of 34 patients with RA and 36 with OA who underwent knee joint replacement surgery was characterized using immunohistochemistry and a synovial tissue superfusion technique, respectively. In culture experiments with mixed synoviocytes, the effect of NE on secretion of interleukin 6 (IL-6), IL-8, tumor necrosis factor (TNF), and matrix metalloproteinase-3 (MMP-3) was investigated. Results. Tissue density of TH+ cells was higher in RA compared to OA (63.9 vs 34.2 cells/mm2; p = 0.017). Basal NE release from synovial tissue correlated highly significantly with density of TH+ cells in RA (Rrank = 0.573, p = 0.001) but not in OA (Rrank = 0.102, NS). Basal NE release correlated with the degree of inflammation in RA (Rrank = 0.420, p = 0.021) but not in OA (Rrank = 0.174, NS), and with spontaneous IL-8 secretion in RA (Rrank = 0.581, p = 0.001) but not in OA (Rrank = 0.160, NS). Only in RA, density of TH+ cells correlated positively with spontaneous secretion of IL-6, IL-8, and MMP-3. We confirmed the extensive loss of sympathetic nerve fibers in RA compared to OA (0.32 vs 3.1 nerve fiber/mm2; p < 0.001). The ratio of sympathetic to sensory nerve fibers was 1 to 5 in RA and 2 to 1 in OA. A ratio of 1.0 separates almost all patients into 2 diseases groups (RA vs OA). Prior prednisolone treatment of RA patients was related to decreased spontaneous cytokine secretion, a lower density of T cells, CD163+ macrophages and TH+ cells, a lower degree of inflammation, and reduced synovial NE secretion. NE was able to inhibit secretion of IL6 (in OA), IL-8 (in RA), and TNF (in RA and OA) in culture experiments. Conclusion. TH+ cells and release of NE are strongly linked to a higher degree of synovial inflammation. Culture experiments indicate that NE has antiinflammatory properties at higher concentrations (10-5 M). NE secretion of TH+ cells may be an antiinflammatory mechanism to counteract local inflammation. Thus, TH+ cell derived NE can be an important local factor of immunomodulation in synovial inflammation. |
0 | Translation and cultural adaptation of the Turkish lysholm knee scale: Ease of use, validity, and reliability knee | AMP (Acute Meniscal Pathology) | Background: The Lysholm knee scale, first published in 1982, is an eight-item questionnaire designed to evaluate patients after knee ligament injury. However, as a tool developed in English, its use as a validated instrument has been limited to English-language populations. Questions/purposes: The objectives of this study were to test the ease of use, reliability, and validity of a Turkish-language, culturally adapted version of the Lysholm knee scale. Methods: The Lysholm knee scale was translated into Turkish according to Guillemin's recommendations. Seventy patients (mean age, 36 years; range, 17-72 years) with different knee complaints were included, and the scale was completed twice by each participant at 3- to 14-day intervals to assess test-retest reliability based on the interrater correlation coefficient, whereas Cronbach's alpha evaluated internal consistency. External validity was evaluated with correlations between the Lysholm knee scale, Kujala Anterior Knee Pain Scale, and SF-36. The distribution of floor and ceiling effects was determined. Results: Patients completed the Turkish-language Lysholm questionnaire in approximately 3 minutes. The test-retest reliability was 0.82, with a Cronbach's alpha coefficient of 0.68. The Lysholm knee score was strongly correlated with the Kujala Anterior Knee Pain Scale (r = 0.78). The Turkish Lysholm knee scale showed high correlations with the SF-36 physical component score (r = 0.61) and a low association with the mental component domain (r = 0.14). Conclusions: The Turkish version of the Lysholm knee scale is quickly administered, valid, and reliable, and can be used for patients with various knee disorders. Level of Evidence: Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence. © 2013 The Author(s). |
0 | Altered gait mechanics and elevated serum pro-inflammatory cytokines in asymptomatic patients with MRI evidence of knee cartilage loss | AMP (Acute Meniscal Pathology) | OBJECTIVE: To test if sagittal plane gait mechanics parameters and serum inflammation levels differ between healthy asymptomatic subjects and asymptomatic subjects with magnetic resonance imaging (MRI) evidence of cartilage loss.
DESIGN: Gait mechanics and resting serum tumor necrosis factor-alpha (TNFalpha) concentrations were measured for two groups of asymptomatic subjects recruited for a previous study: Pre-Osteoarthritis (OA) subjects had MRI evidence of partial- or full-thickness knee cartilage loss in at least one compartment (n = 52 (30 female), 1.7 +/- 0.1 m, 85.3 +/- 18.9 kg, 44 +/- 11 years); Control subjects had no MRI features of cartilage loss, osteophytes, bone marrow lesions, nor meniscal pathology in either knee (n = 26 (13 female), 1.7 +/- 0.1 m, 74.6 +/- 14.9 kg, 34 +/- 10 years). Discrete measures of sagittal plane gait kinematics and kinetics were compared between subject groups and adjusted for age and body mass index (BMI) using analysis of covariance (ANCOVA). Serum TNFalpha concentrations were compared between groups using bootstrap t-test.
RESULTS: The Pre-OA group had less extended knees (P = 0.021) and decreased maximum external knee extension moment (P = 0.0062) in terminal stance during gait, as well as increased resting serum TNFalpha concentration (P = 0.040) as compared to Control subjects. There were no group differences in heel strike flexion angle (P = 0.14), in maximum knee flexion moment (P = 0.91), nor in first peak knee adduction moment (KAM) (post-hoc analysis, P = 0.39).
CONCLUSIONS: The finding that asymptomatic subjects with cartilage loss had gait and inflammatory characteristics similar to those previously reported in symptomatic OA patients supports the idea that there are specific mechanical and biological factors that precede the onset of knee pain in the pathogenesis of OA. |
1 | Negative pressure wound therapy in grade IIIB tibial fractures: fewer infections and fewer flap procedures? | DoD LSA (Limb Salvage vs Amputation) | BACKGROUND: Grade IIIB open tibia fractures are devastating injuries. Some clinicians advocate wound closure or stable muscle flap coverage within 72 hours to limit complications such as infection. Negative pressure wound therapy was approved by the FDA in 1997 and has become an adjunct for many surgeons in treating these fractures. Opinions vary regarding the extent to which negative pressure wound therapy contributes to limb salvage. Evidence-based practice guidelines are limited for use of negative pressure wound therapy in Grade IIIB tibia fractures. This systematic literature review of negative pressure wound therapy in Grade IIIB tibia fractures may substantiate current use and guide future studies. QUESTIONS/PURPOSES: We sought to answer the following: (1) Does the use of negative pressure would therapy compared with gauze dressings lead to fewer infections? (2) Does it allow flap procedures to be performed safely beyond 72 hours without increased infection rates? (3) Is it associated with fewer local or free flap procedures? METHODS: We conducted a systematic review of six large databases (through September 1, 2013) for studies reporting use of negative pressure wound therapy in Grade IIIB open tibia fractures, including information regarding infection rates and soft tissue reconstruction. The systematic review identified one randomized controlled trial and 12 retrospective studies: four studies compared infection rates between negative pressure wound therapy and gauze dressings, 10 addressed infection rates with extended use, and six reported on flap coverage rates in relation to negative pressure wound therapy use beyond 72 hours. None of the 13 studies was eliminated owing to lack of study quality. RESULTS: Negative pressure wound therapy showed a decrease in infection rates over rates for gauze dressings in two of four studies (5.4% [two of 35] versus 28% [seven of 25], and 8.4% [14 of 166] versus 20.6% [13 of 63]), an equivalent infection rate in one study (15% [eight of 53] versus 14% [five of 16]), and an increased infection rate in the fourth study (29.5% [23 of 78] versus 8% [two of 25]). In terms of the second question regarding infection rates with negative pressure wound therapy beyond 72 hours, eight of 10 studies concluded there was no increase in infection rates, whereas two of 10 reported an increase in infection rates associated with negative pressure wound therapy use beyond 72 hours. Infection rates varied from 0% to 57% in these 10 studies. Five studies reported low infection rates of 0% to 7% and five reported rates of 27% to 57%. The third question (addressed by six studies) regarded the potential decreased use of a soft tissue flap in patients treated with extended negative pressure wound therapy. Flap rates were reduced by 13% to 60% respectively compared with those of historical controls. Grade IIIB tibia fractures by definition required soft tissue procedures. The patients in these six studies had Grade IIIB tibia fractures after the first debridement. However, after extended negative pressure wound therapy, fewer patients required flaps than grading at the first debridement would have predicted. CONCLUSIONS: There is an increasing body of data supporting negative pressure wound therapy as an adjunctive modality at all stages of treatment for Grade IIIB tibia fractures. There is an association between decreased infection rates with negative pressure wound therapy compared with gauze dressings. There is evidence to support negative pressure wound therapy beyond 72 hours without increased infection rates and to support a reduction in flap rates with negative pressure wound therapy. However, negative pressure wound therapy use for Grade IIIB tibia fractures requires extensive additional study. LEVEL OF EVIDENCE: Level III, therapeutic study. |
0 | Surgery in nonagenarians: Morbidity, mortality, and functional outcome | DoD LSA (Limb Salvage vs Amputation) | Background. There are few studies that document the outcomes experienced by very old patients who undergo major surgery. Methods. This is a case series and 7-year follow-up of 116 consecutive patients who were aged 90 years or older and underwent major surgery at a large university-affiliated community hospital. We describe the functional status, short- and long-term mortality, and predictors of mortality in this group of frail elders. Results. The 116 nonagenarians in this study underwent 134 major operations. Sixty-three patients were admitted to the hospital from a nursing home. The most common surgical procedures were for hip fracture, lower extremity amputation, and abdominal problems. Nineteen patients died in the hospital following surgery, and 23 patients died within 30 days of operation. Follow- up at 7 years revealed that all but three patients had died. Survival was worse for patients admitted from nursing homes, those who were nonambulatory before surgery, and those with major or complete functional impairment. Conclusions. Major surgery in nonagenarians is associated with a 20% perioperative mortality. Functional status and ambulatory ability are maintained in most patients. Whether to operate on these frail eiders is a complex decision. |
0 | MiR-1 is a tumor suppressor in thyroid carcinogenesis targeting CCND2, CXCR4, and SDF-1alpha | MSTS 2018 - Femur Mets and MM | CONTEXT: Micro-RNA have emerged as an important class of short endogenous RNA that act as posttranscriptional regulators of gene expression and are constantly deregulated in human cancer. MiR-1 has been found down-regulated in lung, colon, and prostate cancer.
OBJECTIVES: In this study, we investigated the possible role of miR-1 in thyroid carcinogenesis.
DESIGN: We have analyzed miR-1 expression in a panel of thyroid neoplasias including benign and malignant lesions and searched for miR-1 targets.
RESULTS: Our results show that miR-1 expression is drastically down-regulated in thyroid adenomas and carcinomas in comparison with normal thyroid tissue. Interestingly, miR-1 down-regulation was also found in thyroid hyperproliferative nonneoplastic lesions such as goiters. We identified the CCND2, coding for the cyclin D2 (CCND2) protein that favors the G1/S transition, CXCR4, and SDF-1alpha genes, coding for the receptor for the stromal cell derived factor-1 (SDF-1)/CXCL12 chemokine and its ligand SDF-1/CXCL12, respectively, as miR-1 targets. An inverse correlation was found between miR-1 expression and CXC chemokine receptor 4 (CXCR4) and SDF-1alpha protein levels in papillary and anaplastic thyroid carcinomas. Consistent with a role of the CCND2 protein in cell proliferation and CXCR4 and SDF-1alpha proteins in cell invasion and metastasis, functional studies demonstrate that miR-1 is able to inhibit thyroid carcinoma cell proliferation and migration.
CONCLUSIONS: These results indicate the involvement of miR-1 in thyroid cell proliferation and migration, validating a role of miR-1 down-regulation in thyroid carcinogenesis. |
0 | Complementary and alternative medicine in the treatment of prostate cancer | Reduction Mammoplasty for Female Breast Hypertrophy | Treatments based on complementary medicine have gained significant ground in oncology. Patients are mainly interested in adequate support, reduction of the side effects of clinical medicine, strengthening their immune system and enhancing quality of life both during and after chemotherapy and irradiation treatments. In the last few years, a number of complementary strategies for the treatment of prostate cancer have been evaluated and published in international journals. These studies allow us to present today, with scientific accuracy, the initial results of complementary treatment methods, describe their contraindications and interactions, and discuss a safe individualized therapy with the patient. In Western Europe and the USA, immunomodulatory, anti-oxidative and herbal therapies, in particular, have been investigated and published. Of these, we discuss mistletoe therapy, enzyme therapy, carotinoids, lycopene, vitamin A, C, E, selenium, phytoestrogens, PC-SPES, physical therapy and relaxation techniques and psychological therapy. Several studies have demonstrated the improvement in quality of life and the value of complementary medicine as an adjunct to chemotherapy or radiotherapy. Based on fruitful communication and cooperation with the treating oncological urologist, internist/oncologist or radiotherapist, complementary therapy might serve as a valuable and useful supportive measure for prostate cancer patients. © 2006. |
0 | Ten-year results with the Morscher press-fit cup: An uncemented, non-modular, porous-coated cup inserted without screws | PJI DX Updated Search | Total hip arthroplasty (THA) with well designed cementless acetabular implants has shown excellent results. The purpose of this study was to assess our clinical and radiological outcomes using an uncemented cup. We conducted a prospective cohort study including all consecutive primary THAs performed with the Morscher press-fit cup, an uncemented non-modular acetabular component, between March 1996 and December 1998. Patients were evaluated at ten years with clinical and radiological follow-up, patient satisfaction and questionnaire assessment using the Harris hip score (HHS), Merle d'Aubigné and Postel score, the UCLA score, the 12-item short-form health survey (SF-12) and a visual analog scale. Five hundred sixty-one THAs were performed in 518 patients. At 120 months (ñ 7.3 months), 303 patients with 335 THAs were still available for follow-up. None of the patients had required cup revision for aseptic loosening. At ten years, the cup survivorship was 98.8% (95% CI 97.4-99.5) with cup revision for any cause as an endpoint. No radiolucencies were seen around the cups, but osteolytic defects involved 21 stems (8.3%). Mean total linear polyethylene wear was 0.9 mm. The Morscher acetabular replacement cup provides excellent results at ten years. There were no revisions for aseptic loosening of the cup, and no osteolytic defects were found around the cup. Patient satisfaction was high and the clinical results were very good. é 2010 Springer-Verlag |
1 | Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip | Management of Hip Fractures in the Elderly | We prospectively studied 367 patients who had a fracture of the hip, to determine the effect of an operative delay on postoperative complications and on the one-year mortality rate. All of the patients were at least sixty-five years old, cognitively intact, living at home, and able to walk before the fracture. An operative delay was defined as an interval of three calendar days or more between the time of admission to the hospital and the operation. The operation was performed within two calendar days after admission in 267 (73 per cent) of the patients. When the factors of the patient's age and sex and the number of pre-existing medical conditions were controlled, it was found that an operative delay beyond this period approximately doubled the risk of the patient dying before the end of the first postoperative year. When the patient's age and sex and the severity of pre-existing medical conditions were controlled, there was also an increase in mortality associated with an operative delay, although this was not significant. With the numbers studied, an operative delay beyond two calendar days did not have a significant effect on the prevalence of complications during hospitalization. We concluded that an operative delay of more than two calendar days after admission is an important predictor of mortality within one year for elderly patients who have a fracture of the hip and who are cognitively intact, able to walk, and living at home before the fracture. Optimally, such patients should have the operation within two calendar days after admission to the hospital |
0 | Symptomatic torn discoid lateral meniscus in adults | AMP (Acute Meniscal Pathology) | The purposes of this study were to report degenerative changes that coexist with a symptomatic torn discoid lateral meniscus in adults and to analyze the factors associated with the accompanied degenerative changes. From 1997 to 2008, 329 knees in the 305 patients were included. Associations between the status of the meniscus and the coexisting degenerative changes on the images and the arthroscopic findings were statistically analyzed. Marginal osteophyte was seen on conventional radiography in 118 patients (36%). Ninety patients (27%) had arthroscopically confirmed chondral lesion. Age, duration of symptoms, the type of meniscus, the type of tear and the magnetic resonance image classification were associated with the formation of the marginal osteophyte and chondral lesion on univariate analysis (P < 0.05). After conducting multivariate analysis, the type of tear and magnetic resonance image classification had a statistically significant association with the severity of marginal osteophyte and chondral lesion (P < 0.05). |
0 | Fate of Free Fat Grafts with or without Adipogenic Adjuncts to Enhance Graft Outcomes | Panniculectomy & Abdominoplasty CPG | BACKGROUND: Free fat grafting is popular, but it is still unclear how it works. Although focusing on graft survival seems an obvious direction for improving clinical results, the authors' research suggests that long-term volume retention is in part attributable to new fat regeneration. Measures to facilitate adipogenesis may therefore be equally important. METHODS: To investigate the relative roles of survival and regeneration of fat grafts, the authors measured the fate of human lipoaspirate implanted into the scalps of immunodeficient mice, with and without stromal vascular fraction and a porcine extracellular matrix (Adipogel). Specifically, the authors were interested in volume retention, and the composition of implanted or regenerated tissue at 6 and 12 weeks. RESULTS: Free fat grafts exhibited poor volume retention and survival. Almost all of the injected human adipocytes died, but new mouse fat formed peripheral to the encapsulated fat graft. Adipogel and stromal vascular fraction improved proliferation of murine fat and human vasculature. Human CD34 stromal cells were present but only in the periphery, and there was no evidence that these cells differentiated into adipocytes. CONCLUSIONS: In the authors' model, most of the implanted tissue died, but unresorbed dead fat accounted substantially for the long-term, reduced volume. A layer of host-derived, regenerated adipose tissue was present at the periphery. This regeneration may be driven by the presence of dying fat, and it was enhanced by addition of the authors' adipogenic adjuncts. Future research should perhaps focus not only on improving graft survival but also on enhancing the adipogenic environment conducive to fat regeneration. |
1 | Interlocking intramedullary nailing of pathological fractures of the shaft of the humerus | MSTS 2022 - Metastatic Disease of the Humerus | We performed a retrospective study of thirteen patients who had had sixteen pathological fractures of the shaft of the humerus secondary to metastatic disease. All but one fracture was stabilized with interlocking intramedullary nailing with use of a closed technique. The mean operative time for the sixteen procedures was ninety-two minutes (range, fifty to 180 minutes), the mean blood loss was 116 milliliters (range, fifty to 200 milliliters), and the mean duration of hospitalization was five days (range, two to ten days). Fourteen extremities had a return to nearly normal function within three weeks after nailing. Relief of pain was rated as good or excellent in all but one patient. Eleven patients (fourteen humeri) received radiation therapy at a mean of seven days (range, three to fourteen days) after the operation. Nine patients died at a mean of four months (range, one to twelve months) postoperatively; the remaining four patients were still alive at a mean of ten months (range, nine to fifteen months). There were no problems related to the wound, deep infections, nerve palsies, or failures of the implant. The fracture was united in all seven of the eleven extremities in patients who survived for at least three months and had radiographs available. Interlocking intramedullary nailing of the humerus for pathological fractures provides immediate stability and can be accomplished with a closed technique, brief operative time, and minimum morbidity, with a resultant early return of function to the extremity. |
0 | Injection Therapy in the Management of Musculoskeletal Injuries: The Elbow | PRPs for Lateral Epicondylitis/Elbow Tendinopathies | Elbow injuries are common both in the general population and in the athlete. Given the repetition and forces that the elbow is exposed to during daily activities and sport, it is a site of several different pathologies. Tendinopathy or epicondylitis, both lateral and medial, are a common cause of elbow pain secondary to these repetitive loads. Complicating matters, ligamentous injuries can be mistaken for tendinopathies, making the clinical and radiological diagnoses important before treatment. Other pathologies such as bursitis, arthritis, osteochondritis dissecans, radial tunnel syndrome, and tendonitis can be causes of pain in the elbow. Furthermore, other sites of pathology can cause referred pain to the elbow, such as cervical radiculopathy. Treatment of elbow pathologies with injection therapies has been studied extensively in the literature. Some diagnoses, such as elbow tendinopathy/epicondylitis, ligamentous injuries, bursitis, and arthritis, are more commonly treated with injection therapies. This article reviews some of these common diagnoses in the elbow, including both the clinical symptoms and physical examination findings. We will discuss the indications for injection treatment and the literature supporting or refuting their use, as well as demonstrate some of the techniques used while administrating these treatments. Oper Tech Sports Med 20:124-131. © 2012 Elsevier Inc.. |
0 | Hemiarthroplasty: To cement or not to cement? A preliminary report | Management of Hip Fractures in the Elderly | Two hundred hemiarthroplasties were studied to compare uncemented Austin Moore and cemented Thompson's prostheses. The following variables were compared: preoperative mobility, ASA grade, Abbreviated Mental test scores, surgeon grade, peri-operative mortality, infection rate, operation time, intra-operative fractures, dislocation rate, thigh pain and revision rate to total hip replacement. Both groups were comparable in all respects. The incidence of intra-operative fractures, infection, postoperative dislocation and conversion to Girdlestone arthroplasty was higher in the uncemented group. The mortality remained the same in both groups. The incidence of significant thigh pain was higher in the uncemented group (13%), of whom half (6%) had to undergo a conversion to a total hip replacement within the 24 months follow-up period. Our current study of changed practice concluded that cemented Thompson's prosthesis performs better than uncemented Austin Moore when the incidence of hip pain and subsequent conversion to a total hip replacement were considered. (copyright) Wichtig Editore, 2004 |
0 | Investigation of Growth Factor and Tenocyte Proliferation Induced by Platelet Rich Plasma (PRP) in a 3-Chamber Co-Culture Device | PRP (Platelet-Rich Plasma) | The platelet-rich plasma (PRP) has become an attractive topic for soft tissue healing therapy recently. While some clinical reports revealed the effective treatments for knee osteoarthritis, lateral epicondylitis, and rotator cuff tears, other case studies showed that there was no statistically significant healing improvement. The efficacy of the PRP therapy is still unclear clinically. Thus, a significant amount of basic studies should be conducted to optimize the preparation procedure and the platelet concentration of the PRP. In this work, a 3-chamber co-culture device was developed for the PRP study in order to reduce the usage of primary cells and to avoid the PRP gelation effect. The device was a culture, well partitioning into 3 sub-chambers. Tenocytes and PRP could be respectively loaded into the sub-chambers and co-cultured under the interlinked medium. The results showed that a higher platelet number in the PRP could diffuse higher concentration of the growth factors in the medium and induce higher tenocyte proliferation. The 3-chamber co-culture device provides a simple and practical tool for the PRP study. It is potentially applied for optimizing the preparation procedure and platelet concentration of the PRP therapy. |
0 | Diagnosis and management of infection after tibial intramedullary nailing | DoD LSA (Limb Salvage vs Amputation) | A series of 20 patients with infection after intramedullary nailing of the tibia is discussed. The most common pathogen was Staphylococcus aureus, which was found in 14 patients (64%). Eleven nails were originally inserted without reaming, and 9 were reamed. Treatment protocols were based on the time of onset of infection (acute, subacute, and chronic) and the status of bone healing. In eight patients, the fractures (6) and nonunions (2) were healed at diagnosis of infection and were treated by debridement, nail removal, and antibiotics. Twelve patients had fractures (8) and nonunions (4) that were not healed. Four were treated with debridement, nail removal, and external fixation, and four with debridement and nail retention. The overall success rate for eradicating infection was 90%. Infection after unreamed nailing had fewer complications and a higher success rate for infection control than did reamed nailing. Risk factors identified in this study for infection are previous external fixation, severe open fracture, and substance abuse. |
0 | Comparative multicenter trial of teicoplanin versus cefazolin for antimicrobial prophylaxis in prosthetic joint implant surgery | Management of Hip Fractures in the Elderly | A randomized multicenter study was carried out in 12 centers in ItaIy to compare administration of a single dose of teicoplanin (400 mg i.v. bolus at time of anesthesia) versus that of five doses of cefazolin over a 24-h period (2 g at induction of anesthesia and 1 g every 6 h postoperatively, i.v. bolus) as antimicrobial prophylaxis in patients undergoing hip or knee arthroplasty. Of 860 patients enrolled, 427 received teicoplanin and 433 cefazolin. A total of 846 patients (422 teicoplanin and 424 cefazolin) were evaluable for safety and 826 patients for efficacy. Six patients (1.5%) in the teicoplanin group and seven patients (1.7%) in the cefazolin group developed a surgical wound infection during their postoperative hospital stay: this difference was not significant. Proven or suspected infections involving other body systems occurred in 114 patients (57 in each group). Seven hundred ninety-two patients completed a 3-month evaluation and 738 patients a 12-month evaluation; the success rates in evaluable patients at these observation times were 99.2% and 99.7% for teicoplanin and 99.2% and 99.7% for cefazolin, respectively. Adverse events occurred in three (0.7%) teicoplanin patients and nine (2.1%) cefazolin patients (P = 0.083). A single preoperative dose of teicoplanin ensures adequate surgical antisepsis, with results comparable to a standard multiple-dose regimen of cefazolin. Number of References 43. Copyright © 2011 Elsevier B. V., Amsterdam. All Rights Reserved |
0 | Determination of clinical decision rule for estimation of bone mineral density in women | DoD PRF (Psychosocial RF) | Objective: This study assessed the relative risk factors for osteoporosis in women referring to the Bone Densitometry Center during 2007, with the aim of designing a formula to estimate the severity of osteoporosis.Subjects andMethods: Data of outpatients (n = 1,047) who visited the Bone Densitometry Center of Chamran Hospital were gathered by administering a questionnaire to subjects before a dual-energy X-ray absorptiometry (DXA) densitometry test of the hip and vertebrae. Results: Of the 1,047 subjects, 764 (73%) were menopausal. The average (± SD) age and weight were 54.5 ± 10.3 and 69.5 ± 10.8, respectively. The average (± SD) T score of hip and lumbar spine were -1.88 ± 1.08 and -1.04 ± 1.05, respectively. After assessment, the precipitating factors of osteoporosis of the hip were age, menopause, duration of menopause, history of fracture, history and dosage of calcium supplementation, parity and duration of breastfeeding. Protective factors were weight, history of oral contraceptive pill consumption, and exercise, being significant (p < 0.05). Precipitating factors in osteoporosis of vertebrae were age, menopause and duration of menopause, diabetes, history of fracture, history and dosage of calcium supplementation, parity and duration of breastfeeding, with weight as a protective factor (p = <0.05). Using stepwise regression analysis, a minimal mathematical model for prediction of bone density of the hip and lumbar spine was formulated. Conclusion: Using the mathematical model, along with clinical findings and history, persons at risk of osteoporosis may be identified and early prevention and treatment made possible. Unnecessary expenses of diagnostic procedures for people without the risks of osteoporosis can also be prevented. Copyright © 2011 S. Karger AG, Basel. |
0 | The clinical outcome of minimally invasive Phase 3 Oxford unicompartmental knee arthroplasty: a 15-year follow-up of 1000 UKAs | OAK 3 - Non-arthroplasty tx of OAK | There have been concerns about the long-term survival of unicompartmental knee arthroplasty (UKA). This prospective study reports the 15-year survival and ten-year functional outcome of a consecutive series of 1000 minimally invasive Phase 3 Oxford medial UKAs (818 patients, 393 men, 48%, 425 women, 52%, mean age 66 years; 32 to 88). These were implanted by two surgeons involved with the design of the prosthesis to treat anteromedial osteoarthritis and spontaneous osteonecrosis of the knee, which are recommended indications. Patients were prospectively identified and followed up independently for a mean of 10.3 years (5.3 to 16.6). At ten years, the mean Oxford Knee Score was 40 (standard deviation (sd) 9; 2 to 48): 79% of knees (349) had an excellent or good outcome. There were 52 implant-related re-operations at a mean of 5.5 years (0.2 to 14.7). The most common reasons for re-operation were arthritis in the lateral compartment (2.5%, 25 knees), bearing dislocation (0.7%, seven knees) and unexplained pain (0.7%, seven knees). When all implant-related re-operations were considered as failures, the ten-year rate of survival was 94% (95% confidence interval (CI) 92 to 96) and the 15-year survival rate 91% (CI 83 to 98). When failure of the implant was the endpoint the 15-year survival was 99% (CI 96 to 100). This is the only large series of minimally invasive UKAs with 15-year survival data. The results support the continued use of minimally invasive UKA for the recommended indications. |
0 | The impact of traumatic events on emergency room nurses: findings from a questionnaire survey | DoD PRF (Psychosocial RF) | BACKGROUND: Emergency Nurses are routinely confronted with work related traumatic events and hectic work conditions. Several studies report a high prevalence of post-traumatic stress disorder (PTSD) in these nurses. Coping and social support seem to play an important role in the development of PTSD.
OBJECTIVES: This study examines (1) the frequency of exposure to and the nature of traumatic events in Emergency Nurses, (2) the percentage of nurses that report symptoms of PTSD, anxiety, depression, somatic complaints and fatigue at a sub-clinical level, and (3) the contribution of traumatic events, coping and social support to PTSD symptoms, psychological distress, somatic complaints, fatigue and sleep disturbances.
DESIGN: Cross-sectional data from 248 Emergency Nurses, from 15 Flemish (Belgian) general hospitals, were analyzed.
RESULTS: Emergency Nurses were found to be confronted frequently with work related traumatic events. Death or serious injury of a child/adolescent was perceived as the most traumatizing event. Almost one out of three nurses met sub-clinical levels of anxiety, depression and somatic complaints and 8.5% met clinical levels of PTSD. Levels of fatigue were high but not directly related to the frequency of exposure to traumatic events. Emotional coping was related to an increase in all outcomes; avoidant coping was related to more somatic complaints; problem focused coping was related to a decrease in psychological distress and perceived fatigue. Social support from colleagues and supervisor (head nurse) was found to have a protective effect on the occurrence of PTSD symptoms.
CONCLUSION: Emergency Nurses are especially vulnerable to post-traumatic stress reactions due to repetitive exposure to work related traumatic incidents. This not only personally affects the nurses, but can also impact quality of care. Hospital management should act on the findings of this study and invest in supportive, communicative, empathic and anticipatory leadership, and provide time-out facilities, cognitive-behavioral interventions and psychological counseling for Emergency Nurses on demand. |
0 | Management of multiple myeloma in asia: Resource-stratified guidelines | MSTS 2018 - Femur Mets and MM | Treatment of multiple myeloma has undergone substantial developments in the past 10 years. The introduction of novel drugs has changed the treatment of the disease and substantially improved survival outcomes. Clinical practice guidelines based on evidence have been developed to provide recommendations on standard treatment approaches. However, the guidelines do not take into account resource limitations encountered by developing countries. The huge disparities in economy, health-care infrastructure, and access to novel drugs in Asian countries hinder the delivery of optimum care to every patient with multiple myeloma in Asia. In this Review we outline the guidelines that correspond with different levels of health-care resources and expertise, with the aim to unify diagnostic and therapeutic guidelines and help with the design of future studies in Asia. © 2013 Elsevier Ltd. |
0 | Addition of epidural Clonidine enhances postoperative analgesia: A double-blind study in total knee- replacement surgeries | AAHKS (8) Anesthetic Infiltration | BACKGROUND: This study was undertaken to evaluate the analgesic effect of the combination of epidural Clonidine with Bupivacaine versus epidural Bupivacaine alone in patients undergone knee replacement surgery.
MATERIALS AND METHODS: A randomized double-blind design was used, and 60 adult patients (40-60 years) of ASA grade I and II scheduled for post-operative pain relief in total knee replacement surgeries by epidural Clonidine were studied. Patients received either an epidural Clonidine (1mug/kg) with Bupivacaine (1.5mg/kg) group CL (n=30) or Bupivacaine alone group CT (n=30) for Knee replacement surgeries. The pain score, blood pressure, heart rate, respiratory rate were measured at fixed times during the first 24 h after operation. Onset and duration of sensory and motor blockade, duration of analgesia, and analgesic requirement were compared.
RESULTS: The onset of sensory anesthesia was faster (493.8+/-31.66 in sec.) and the duration was significantly longer in Clonidine group (334.2 min). Requirement of supplementary analgesia (Inj. diclofenac) was markedly decreased in Clonidine group as evident from the findings that in control group 18 patients required 3 supplemental analgesic doses in first 24 hours as compared to only 3 patients in Clonidine group. Epidural Clonidine produced a significant decrease (P less than 0.05) in heart rate and blood pressure, whereas the respiratory rate was not affected. We also observed for side effects in both the groups. Incidence of significant hypotension was higher, 8 patients (26%) in Clonidine group compared to 2 patient (6%) in control group. Incidence of dryness of mouth was higher, 12 patients (48%) in Clonidine group compared to 5 (18%) in control group.
CONCLUSION: The addition of Clonidine to Bupivacaine epiduraly prolongs motor and sensory block and analgesia, without an increased incidence of side effects. |
0 | A randomised controlled trial comparing Kirschner wire stabilisation versus manipulation under anaesthesia (MUA) plaster treatment for displaced radial fractures | Distal Radius Fractures | INTERVENTION: 1. Kirschner wire stabilisation 2. Manipulation under anaesthesia (MUA) plaster treatment Please note, this trial was stopped due to poor recruitment. CONDITION: Injury, Occupational Diseases, Poisoning: Displaced radial fractures ; Injury, Occupational Diseases, Poisoning ; Displaced radial fractures PRIMARY OUTCOME: Not provided at time of registration SECONDARY OUTCOME: Not provided at time of registration INCLUSION CRITERIA: 1. Isolated injury in distal third radius greater than 50% shaft diameter displacement 2. Plus or minus distal ulnar fracture 3. Injury less than 24 hours 4. Above 12 years old |
0 | Transcriptome analysis of injured human meniscus reveals a distinct phenotype of meniscus degeneration with aging | AMP (Acute Meniscal Pathology) | OBJECTIVE: Meniscus tears are associated with a heightened risk of osteoarthritis. This study aimed to advance our understanding of the metabolic state of injured human meniscus at the time of arthroscopic partial meniscectomy through transcriptome-wide analysis of gene expression in relation to the patient's age and degree of cartilage chondrosis.
METHODS: The degree of chondrosis of knee cartilage was recorded at the time of meniscectomy in symptomatic patients without radiographic osteoarthritis. RNA preparations from resected menisci (n = 12) were subjected to transcriptome-wide microarray and QuantiGene Plex analyses. Variations in the relative changes in gene expression with age and chondrosis were analyzed, and integrated biologic processes were investigated computationally.
RESULTS: We identified a set of genes in torn menisci that were differentially expressed with age and chondrosis. There were 866 genes that were differentially regulated (>=1.5-fold difference and P < 0.05) with age and 49 with chondrosis. In older patients, genes associated with cartilage and skeletal development and extracellular matrix synthesis were repressed, while those involved in immune response, inflammation, cell cycle, and cellular proliferation were stimulated. With chondrosis, genes representing cell catabolism (cAMP catabolic process) and tissue and endothelial cell development were repressed, and those involved in T cell differentiation and apoptosis were elevated.
CONCLUSION: Differences in age-related gene expression suggest that in older adults, meniscal cells might dedifferentiate and initiate a proliferative phenotype. Conversely, meniscal cells in younger patients appear to respond to injury, but they maintain the differentiated phenotype. Definitive molecular signatures identified in damaged meniscus could be segregated largely with age and, to a lesser extent, with chondrosis. |
1 | Complex Medial Meniscus Tears Are Associated With a Biconcave Medial Tibial Plateau | AMP (Acute Meniscal Pathology) | PURPOSE: To determine whether an association exists between a biconcave medial tibial plateau and complex medial meniscus tears.
METHODS: A consecutive series of stable knees undergoing arthroscopy were evaluated retrospectively with the use of preoperative magnetic resonance imaging (MRI), radiographs, and arthroscopy documented by intraoperative videos. Investigators independently performed blinded reviews of the MRI or videos. Based on the arthroscopy findings, medial tibial plateaus were classified as either biconcave or not biconcave. A transverse coronal plane ridge, separating the front of the tibial plateau from the back near the inner margin of the posterior body of the medial meniscus, was defined as biconcave. The medial plateau slope was calculated with MRI sagittal views. General demographic information, body mass index, and arthroscopically confirmed knee pathology were recorded.
RESULTS: A total of 179 consecutive knees were studied from July 2014 through August 2015; 49 (27.2%) biconcave medial tibial plateaus and 130 (72.8%) controls were identified at arthroscopy. Complex medial meniscus tears were found in 103. Patients with a biconcave medial tibial plateau were found to have more complex medial meniscus tears (69.4%) than those without a biconcavity (53.1%) (P = .049) despite having lower body mass index (P = .020). No difference in medial tibial plateau slope was observed for biconcavities involving both cartilage and bone, bone only, or an indeterminate group (P = .47).
CONCLUSIONS: Biconcave medial tibial plateaus were present in 27.4% of a consecutive series of patients undergoing knee arthroscopy. A biconcave medial tibial plateau was more frequently associated with a complex medial meniscus tear.
LEVEL OF EVIDENCE: Level III, case-control study. |
0 | Osteoarthritis and osteoporosis: What is the overlap? | OAK 3 - Non-arthroplasty tx of OAK | Osteoarthritis (OA) and osteoporosis (OP) are highly prevalent health problems, associated with considerable morbidity. In the past, attention was focused on a supposed inverse relationship between OA and OP, since both disorders usually affect the elderly, but were regarded to rarely coexist in a single person. However, recent studies have revealed several factors which contribute to the pathogenesis of both disorders. These insights might contribute to the development of shared new treatment options in the near future. Increased subchondral bone loss is a characteristic feature of OP and the early stage of OA, and this finding is the rationale for studies on the effect of anti-osteoporotic drugs in OA. In addition, inflammation and unfavourable body composition have been recognized as contributing factors for both disorders. Underweight is a risk factor for OP, while obesity stimulates the development of OA, by mechanical overloading of weight-bearing joints but also by supposed unfavourable effects of adipokines. © 2013 Springer Science+Business Media New York. |
1 | Knee Dislocation in the Morbidly Obese Patient | DoD LSA (Limb Salvage vs Amputation) | Though a relatively rare orthopedic injury, knee dislocation in the morbidly obese population has been increasingly reported in the literature. These injuries are often referred to as "ultralow-velocity knee dislocations" since they commonly occur after a seemingly trivial injury, such as a ground level fall. As a result, these injuries are often underappreciated and initially misdiagnosed. Even though these injuries are low-velocity, they should still be regarded as a high energy injury because of the large amount of mass contributing to the dislocating force. Knee dislocations in the morbidly obese are associated with a particularly high rate of neurovascular injury. A timely and accurate diagnosis is crucial to avoid serious limb-threatening complications, including the need for amputation. Therefore, evaluating physicians should maintain a high suspicion for a knee dislocation in any morbidly obese patient who presents with knee pain following a seemingly innocuous injury. Management of these injuries is controversial. Associated vascular injuries must be identified promptly and appropriately managed by a vascular surgery team. There is no consensus on the ideal orthopedic treatment of knee dislocations in the morbidly obese patient. Operative treatment can be fraught with complications, including a higher rate of neurovascular injury, increased surgical complications, and poor subjective patient outcome scores compared with nonobese patients sustaining a high-velocity knee dislocation. It is paramount that treating physicians are familiar with the unique challenges of treating knee dislocations in the morbidly obese patient when discussing risks and benefits of treatment options. This article presents a review of the existing literature on knee dislocations in the morbidly obese population, including diagnosis, management, and outcomes. |
0 | Unilateral humeral lengthening in children and adolescents | The Treatment of Pediatric Supracondylar Humerus Fractures AUC | This study evaluates our early experience with unilateral humeral lengthening in children and adolescents. From 1995 till 2001, 16 cases with unilateral humeral shortening ranging from 5.5 to 15 cm were referred to our center. The cause was Erb's palsy in eight cases, epiphyseal injury in five cases and infection in three cases. The average age at operation was 13 years (range 8.5-17 years). Hybrid fixation using wires and half pins were applied to all cases to minimize the risk of operative neurovascular complications. Osteotomy was performed in the middle third of the humerus through a posterior approach. After a latent period of 5-7 days lengthening started at a rate of 0.33 mm every 8 h. At an average follow up of 3 years and 2 months (range 1 year and 4 months to 5 years and 6 months) there were 10 excellent and six good results. The average healing index was 28 days/cm. Complications included pin tract infection in all cases; radial nerve palsy in one patient whose humerus overlengthened by 2 cm but improved completely after compression; fracture of the regenerate in two cases |
0 | Thumb in cheek? Sensory reorganization and perceptual plasticity after limb amputation | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | We describe a patient who initially suffered from carpal tunnel syndrome that was alleviated by surgery. Subsequently, the patient's right arm was amputated and a phantom limb emerged. Stimuli applied to different areas of the face gave rise to sensations that were referred to the phantom by precise topographic mapping. This perceptual mapping of the (phantom) hand onto the face area modelled the form of prior pathology due to carpal tunnel syndrome. The findings have implications for the relief of phantom pain |
1 | Incidence and Extent of Graft Extrusion following Meniscus Allograft Transplantation | AMP (Acute Meniscal Pathology) | BACKGROUND: The incidence and extent of graft extrusion after meniscus allograft transplantation (MAT) may differ in patients undergoing medial and lateral meniscus transplantation due to the use of different surgical techniques. This meta-analysis was therefore designed to quantify the extent and incidence of graft extrusion after meniscus allograft transplantation.
METHODS: Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, all studies reporting absolute extrusion, relative percentage of extrusion (RPE), or frequency of major extrusions (>3 mm) on magnetic resonance imaging in patients undergoing medial or lateral MAT were included.
RESULTS: The pooled mean absolute extrusion following all MATs was 3.15 mm but was significantly greater following medial than lateral MAT (3.26 versus 3.01 mm; p = 0.001). The pooled mean RPE following all MATs was 32.79% and was significantly greater after medial than lateral MAT (32.69% versus 28.81%; p < 0.001). The pooled mean proportion of knees with major (>3 mm) extrusion was 53% (95% CI: 49% to 58%) and was significantly greater after medial than lateral MAT (61% versus 39%; p < 0.001).
CONCLUSION: Mean graft extrusion after arthroscopic assisted MAT using bony fixation was 3.2 mm, with major graft extrusion > 3 mm occurring in about 50% of transplanted menisci. Graft extrusion was significantly greater after medial than lateral MAT. |
0 | Risk factors for hip fractures. A review | Management of Hip Fractures in the Elderly | Risk factors for hip fracture have been reviewed based on case-control and prospective follow-up studies. Falls with impact to the hip, the capacity of energy absorption in soft tissue, and bone strength are closely linked to the risk of hip fracture. Consistently documented risk factors are age, sex, race, low bone mass, low body weight, estrogen deficiency and earlier fracture. Other risk factors are tendency to fall, disability and immobilisation, low physical activity, use of psychotropic/anxiolytic/hypnotic drugs, use of corticosteroid, low calcium intake in the elderly, osteomalacia, thyreotoxicosis, cigarette smoking, chronic alcoholism, diabetes mellitus, insufficient sunlight exposure and a protective effect from thiazide diuretics. Evidence is lacking for risk factors such as heredity, nutrition and medical conditions. No information is available on the combined effects of the different risk factors. Risk estimation of hip fractures should focus on the risk of falls, the capacity of energy absorption and the bone strength. Recent studies indicate that the prevention of hip fractures is realistic, even in the elderly and definitely osteoporotic population when these fundamental risk factors are modified, which has been shown in controlled trials in nursing homes by vitamin D and calcium supplementation or by wearing external hip protectors |
0 | Trends in incidence of subtrochanteric fragility fractures and bisphosphonate use among the US elderly, 1996-2007 | HipFx Supplemental Cost Analysis | Increasing numbers of atypical hip fractures have been reported among patients with bisphosphonate use. However, the nature and extent of the problem are unknown despite recent investigations. To analyze national trends in hip fractures and medication use in the elderly US population, we respectively used the Nationwide Inpatient Sample (NIS) and the Medical Expenditure Panel Survey (MEPS) from 1996 to 2007. In NIS, subtrochanteric fragility fractures were compared with typical hip fractures in femoral neck and intertrochanteric regions. Between 1996 and 2007, age-adjusted rates for typical hip fractures decreased by 31.6% among women (from 1020.5 to 697.4 per 100,000 population) and 20.5% among men (from 424.9 to 337.6 per 100,000 population). In contrast, overall trends in age-adjusted rates for subtrochanteric fragility fractures remained unchanged among men (p = .34) but increased 20.4% among women from 28.4 (95% confidence interval [CI] 27.7-29.1) in 1999 to 34.2 (95% CI 33.4-34.9) per 100,000 population in 2007. The annual percentage increase was 2.1% (95% CI 1.3-2.8, p < .001) based on joinpoint regression analysis. In MEPS, bisphosphonate use increased predominantly in women (from 3.5% in 1996 to 16.6% in 2007) compared with men (2.3% in 2007). In the context of declining typical hip fractures among the US elderly, we observed small but significant increases in the incidence of subtrochanteric fragility fractures from 1999 among postmenopausal women. Using age-adjusted rates, we estimated that for every 100 or so reduction in typical femoral neck or intertrochanteric fractures, there was an increase of one subtrochanteric fragility fracture |
0 | An Unusual Fracture in Arm Wrestling | Distal Radius Fractures | In brief: Previous reports of arm wrestling fractures have involved the distal third of the humerus. What makes this case unique is that the fracture occurred at the radial neck. The mechanism of injury probably involved extreme pronation where the radial head is locked into the capitellum-an area of potential weakness. Treatment was conservative, consisting of keeping the elbow flexed, 90degree in a sling. |
0 | Evolution of the hip fracture population: Time to consider the future? A retrospective observational analysis | Hip Fx in the Elderly 2019 | Objective: To examine how the population with fractured neck of femur has changed over the last decade and determine whether they have evolved to become a more physically and socially dependent cohort. Design: Retrospective cohort study of prospectively collected Standardised Audit of Hip Fractures of Europe data entered on to an institutional hip fracture registry. Participants: 10 044 consecutive hip fracture admissions (2000-2012). Setting: A major trauma centre in the UK. Results: There was a generalised increase in the number of admissions between 2000 (n=740) and 2012 (n=810). This increase was non-linear and best described by a quadratic curve. Assuming no change in the prevalence of hip fracture over the next 20 years, our hospital is projected to treat 871 cases in 2020 and 925 in 2030. This represents an approximate year-on-year increase of just over 1%. There was an increase in the proportion of male admissions over the study period (2000: 174 of 740 admissions (23.5%); 2012: 249 of 810 admissions (30.7%)). This mirrored national census changes within the geographical area during the same period. During the study period there were significant increases in the numbers of patients admitted from their own home, the proportion of patients requiring assistance to mobilise, and the proportion of patients requiring help with basic activities of daily living (all p<0.001). There was also a twofold to fourfold increase in the proportion of patients admitted with a diagnosis of cardiovascular disease, renal disease, diabetes and polypharmacy (use of >4 prescribed medications; all p<0.001). Conclusions: The expanding hip fracture population has increasingly complex medical, social and rehabilitation care needs. This needs to be recognised so that appropriate healthcare strategies and service planning can be implemented. This epidemiological analysis allows projections of future service need in terms of patient numbers and dependency. |
0 | Management of infants and young children with fever without source | Patrick’s pharmacoepidemiology project | There is considerable variation in the clinical management of infants and children with FWS. Community pediatricians generally do not follow clinical practice guidelines that are taught and used at academic training institutions. These guidelines are presented in Sidebar 1 (see page 677) and Sidebar 2. In general, the guidelines provided that all febrile neonates (>38.0Ã?°C) should have a "full sepsis evaluation", including lumbar puncture, and be admitted for parenteral antibiotic therapy. Non-toxic appearing infants 29-90 days of age with FWS >38.0Ã?°C can be managed using low risk laboratory and clinical criteria. Non-toxic appearing infants >90 days of age who have received Hib and PCV-7 vaccines are at low risk for occult bacteremia and meningitis. Therefore, the only laboratory tests necessary in this age group with FWS >39.0Ã?°C are a urinalysis and urine culture for circumcised males <6 months of age and uncircumcised males and females <24 months of age |
0 | Long-term outcomes of ultrasonic scalpel treatment in giant cell tumor of long bones | MSTS 2022 - Metastatic Disease of the Humerus | Giant cell tumors (GCTs) are generally benign, locally aggressive lesions with the potential to metastasize and a tendency of local recurrence. The present study aimed to investigate the advantages and long-term outcomes of application of ultrasonic scalpel in the treatment of GCT of long bones. This study retrospectively analyzed 32 cases of GCT of long bones, including 24 males and eight females. The age range was from 8 to 34 years old (mean age, 23.5 years old). The 32 cases were randomly divided into an observation group (n=10) and a control group (n=22). Patients in the observation group received curettage by ultrasonic scalpel combined with local methotrexate gelfoam adjuvant treatment, and then the cavity was filled with allograft and/or homograft bone. Patients in the control group eceived curettage by local methotrexate gelfoam adjuvant treatment and bone grafting. No local recurrence or pulmonary metastases were observed among patients in the observation group, however, six patients in the control group exhibited recurrence following surgery, although none of the patients demonstrated distant metastasis (P<0.05). Additionally, all 10 patients showed good bone knitting and rehabilitation without deformity and functional issues. The segmental bone graft was perfectly incorporated without obvious immune rejection, collapse and fracture. Curettage by ultrasonic scalpel with local methotrexate gelfoam adjuvant treatment and filling the site by allograft and/or homograft bone showed satisfactory results. |
0 | Intercondylar fractures of the distal humerus treated with the triceps-reflecting anconeus pedicle approach | The Treatment of Pediatric Supracondylar Humerus Fractures AUC | INTRODUCTION: Treatment choice for displaced, intercondylar fractures of the distal humerus is open reduction and internal fixation (ORIF) through a posterior approach. The triceps-reflecting anconeus pedicle (TRAP) approach, combination of modified Kocher and Bryan-Morrey has been described as a conservative surgical exposure for fixation of the complex intercondylar fractures. MATERIALS AND METHODS: Eleven patients with intercondylar fractures of the humerus operated with this approach were reviewed. The mean follow-up was 26 (14-40) months. The aetiology of injuries was mostly fall on the elbow. There were five females and six males and the average age of the patients was 58.3 years (range 16-70 years). RESULTS: According to Muller et al.'s classification; five were Type C1, four were Type C2 and, two were Type C3. At the final follow-up; Type C1 and C2 fractures had a ROM of 116 degrees (range 95 degrees-140 degrees) and, Type C3 fractures had a ROM of 85 degrees which showed limitation of elbow motion. Average humerotrochlear angle is 93.4 degrees (range 90 degrees-98 degrees). Two patients had transient n. ulnaris paraesthesia and one had heterotopic ossification. CONCLUSION: Our results demonstrate that TRAP approach is extensile enough in treating these complex fractures however both articular reconstruction and fixation can be easily managed without creating an olecranon fracture. No significant triceps weakness and dysfunction was observed after TRAP approach in the treatment of the intercondylar fractures of the humerus |
0 | Fractures of the tibial pilon treated by open reduction and internal fixation (locking compression plate-less invasive stabilising system): Complications and sequelae | OAK 3 - Non-arthroplasty tx of OAK | Background: The aim of this study was to evaluate variables that could be related to complications and sequelae in fractures of the tibial pilon treated by open reduction and internal fixation (ORIF) with a locking compression plate-less invasive stabilising system (LCP-LISS). Patients and methods: A total of 137 fractures treated by ORIF in a 7-year period were analysed. The mean follow-up was 3.3 years. We analysed the following variables: age, sex, side, type of fracture, energy of the injury, use of provisional external fixation (EF), time until ORIF, stages of treatment (one or two), surgical approach, type of bone fixation, quality of reduction, use of bone graft, hardware removal, associated fractures (fibula and others), functional results (AOFAS scale), early complications (infection, skin necrosis) and late complications (nonunion, early post-traumatic ankle osteoarthritis [AOA]). Results: According to the AOFAS scale, 30.5% of the results were excellent, 46.7% good, 13.1% fair and 9.7% poor. The rate of infection was 8.7%, and the rate of skin necrosis requiring flap coverage was 15.2%. Furthermore, type 43C3 fractures of the AO classification had a higher rate of skin necrosis and flap coverage. The rate of nonunion was 16.3% (22 cases, 4 aseptic, 18 infected), and the use of a medial plate was related to a higher rate of nonunion than the use of a lateral plate. The rate of early post-traumatic AOA was 13.1%, and open fractures were related to a higher prevalence of nonunion and flap coverage. Both infection and a suboptimal anatomic reduction were related to a higher prevalence of fair and poor results. The anteromedial approach was associated with a higher prevalence of skin necrosis and early post-traumatic AOA than the anterolateral approach. Conclusion: Optimal reduction and stable fixation is paramount to diminishing the rate of complications and sequelae after ORIF (LCP-LISS) of these fractures. |
0 | Osteopontin as a biochemical marker and severity indicator for idiopathic hip osteoarthritis | OAK 3 - Non-arthroplasty tx of OAK | INTRODUCTION: A diagnostic evaluation of the severity and progression of hip osteoarthritis (OA) using biochemical markers is lacking in the current medical literature. Osteopontin (OPN) has been proved to correlate with the progression and severity of knee OA. Therefore, the examination of plasma OPN levels in patients with idiopathic hip OA and its correlation with disease severity and progression was necessary.
METHODS: Our study included 21 patients displaying symptomatic severe idiopathic hip OA; the diagnosis of the disease was based on the checklist of the American College of Rheumatology and the severity was evaluated according to the K-L grading (Kellgran and Lawrence score).
RESULTS: 14 patients showed radiological changes according K-L grade 3 (66.66%), and 7 patients showed radiological changes according K-L grade 4 (33.33%). We observed a highly statistically significant increase of plasma OPN levels in comparison with normal referenced values, the cut off value for differentiating between normal people and patients with hip OA was 193.6 ng/ml. Furthermore, the mean of plasma OPN levels in idiopathic hip osteoarthritis patients with K-L grade 4 (362.51 +/- 83.31 ng/mL) was greater than those with K-L grade 3 (283.41 +/- 56.31 ng/mL), the difference being statistically significant.
CONCLUSIONS: plasma OPN levels are increased in idiopathic hip OA and are correlated with the severity of the disease. |
0 | Left-shifted Nav channels in injured bilayer: Primary targets for neuroprotective Nav antagonists? | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | Mechanical, ischemic, and inflammatory injuries to voltage-gated sodium channel (Nav)-rich membranes of axon initial segments and nodes of Ranvier render Nav channels dangerously leaky. By what means? The behavior of recombinant Nav1.6 (Wang et al., 2009) leads us to postulate that, in neuropathologic conditions, structural degradation of axolemmal bilayer fosters chronically left-shifted Nav channel operation, resulting in E(Na) rundown. This "sick excitable cell Nav-leak" would encompass left-shifted fast- and slow-mode based persistent I(Na) (i.e., Iwindow and slow-inactivating I(Na)). Bilayer-damage-induced electrophysiological dysfunctions of native-Nav channels, and effects on inhibitors on those channels, should, we suggest, be studied in myelinated axons, exploiting I(Na)(V,t) hysteresis data from sawtooth ramp clamp. We hypothesize that (like dihydropyridines for Ca channels), protective lipophilic Nav antagonists would partition more avidly into disorderly bilayers than into the well-packed bilayers characteristic of undamaged, healthy plasma membrane.Whereas inhibitors using aqueous routes would access all Navs equally, differential partitioning into "sick bilayer" would co-localize lipophilic antagonists with "sick-Nav channels," allowing for more specific targeting of impaired cells. Molecular fine-tuning of Nav antagonists to favor more avid partitioning into damaged than into intact bilayers could reduce side effects. In potentially salvageable neurons of traumatic and/or ischemic penumbras, in inflammatory neuropathies, in muscular dystrophy, in myocytes of cardiac infarct borders, Nav-leak driven excitotoxicity overwhelms cellular repair mechanisms. Precision-tuning of a lipophilic Nav antagonist for greatest efficacy in mildly damaged membranes could render it suitable for the prolonged continuous administration needed to allow for the remodeling of the excitable membranes, and thus functional recovery. (copyright) 2012 Morris, Boucher and Joos |
0 | Digital flexion contracture and severe carpal tunnel syndrome due to tophaceus infiltration of wrist flexor tendon: first manifestation of gout | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | The authors report an unusual case of flexor tenosynovitis, severe carpal tunnel syndrome, and triggering at the carpal tunnel as the first manifestation of gout. A 69-year-old man presented with digital flexion contracture and severe carpal tunnel syndrome of his right hand and was treated surgically. A flexor tenosynovectomy and a median nerve neurolysis were performed through an extended carpal tunnel approach. The sublimis and the profundus tendons were involved. Partial ruptures and multiple whitish lesions suggestive of tophacceous infiltration of the flexor tendons were seen. Macroscopically, the removed synovial tissue was involved by multiple whitish nodules that were milimetric in size and was suggestive of monosodium urate crystals deposits. By light microscopy examination, numerous nonnecrotizing granulomas of different sizes were observed that were compounded by large aggregations of acellular nonpolarized material, surrounded by epithelioid histiocytes, mononuclear cells, and foreign body multinucleated giant cells. Postoperatively, the patient recovered with resolution of the median nerve symptoms and a near-to-full range of motion of the affected digits.To the authors' knowledge, this patient is the first case report with flexor tendons tophacceous infiltration as the first clinical sign of gout. Gouty flexor tenosynovitis can occur in the absence of a long history of gout. A high index of suspicion is paramount to the initiation of proper management. Operative treatment of gouty flexor tenosynovitis is mandatory to debulk tophaceous deposits, improve tendon gliding, and decompress nerves. Routine uric acid determination could be helpful in the preoperative evaluation of patients with flexor tenosynovitis |
0 | Endoscopically assisted nerve decompression of nerve nerve compression syndromes at the upper extremity | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | Besides carpal tunnel and cubital tunnel syndrome, other nerve compression or constriction syndromes exist at the upper extremity. Using the technique of endoscopically assisted decompression such rare nerve compression syndromes of the upper extremity can be treated. The technique of endoscopical decompression is presented in six patients with rare compression or hour-glass-like constriction syndromes at the upper extremity. According to the classification of Roles and Maudsley in 5 of 6 cases excellent results were recorded. All but one patient considered the results excellent. The poorest responder developed a CRPS II and refused postoperative physiotherapy. Endoscopically assisted decompression in rare compression syndrome of the upper extremity is highly appreciated by patients and provides excellent functional results. (copyright) 2014 Verlag Hans Huber, Hogrefe AG, Bern |
0 | Elite firefighter/first responder mindsets and outcome coping efficacy | DoD PRF (Psychosocial RF) | The present study examined coping strategies used by firefighters, the relationship between appraisals and coping strategies used, and the relationship between transitional coping strategies used and outcome coping efficacy for mental preparedness. Firefighter coping strategies of problem focused coping and seeking social support were found to have positive significant relationships to outcome coping efficacy, after transitioning from one critical incident to a second. The coping strategies of blamed self wishful thinking, and avoidance appear to have a negative significant relationship to outcome coping efficacy. Additionally, the appraisals of challenge and positive reappraisal to meet the challenge appear to have a positive significant relationship to problem focused coping and seeking social support. These findings on outcome coping efficacy may be of help to firefighters for rehabilitative efforts after traumatic incidents when used in the Peer Support Review intervention model. |
1 | Diagnosis of COVID-19 Based on Symptomatic Analysis of Hospital Healthcare Workers in Belgium: Observational Study in a Large Belgian Tertiary Care Center during Early COVID-19 Outbreak | Coronavirus Disease 2019 (COVID-19) | OBJECTIVE: To identify early symptoms allowing rapid appraisal of infection with SARS-CoV-2 among healthcare workers of a large Belgian hospital. METHODS: Healthcare workers with mild symptoms of an acute respiratory tract infection were systematically screened on clinical characteristics of corona virus disease 2019 (COVID-19). A nasopharyngeal swab was taken and analyzed by real-time Reverse-Transcription-Polymerase-Chain-Reaction (rRT-PCR). RESULTS: Fifty percent of 373 workers tested COVID-19 positive. The symptoms cough (82%), headache (78%), myalgia (70%), loss of smell or taste (40%), and fever =37.5°C (76%) were significantly higher among those infected. CONCLUSION: Where each individual symptom contributes to the clinical evaluation of possible infection, it is the combination of COVID-19 symptoms that could allow for a rapid diagnostic appraisal of the disease in a high prevalence setting. Early transmission control is important at the onset of an epidemic. |
0 | Nuclear binding of the estrogen receptor: a potential predictor for hormone response in metastatic breast cancer | MSTS 2018 - Femur Mets and MM | We have previously described an in vitro immunohistochemical test employing anti-receptor antibodies, for demonstrating the nuclear binding characteristics of estrogen receptors (ER) in breast carcinomas. Based on a retrospective analysis of twenty-five patients with estrogen receptor-positive (ER+) breast cancer who were treated with hormone therapy and whose clinical responses were evaluable, we were able to demonstrate that this test may be valuable to predict which, among the ER+ tumors (whether or not they are progesterone receptor positive, PR+), are likely to respond to hormone therapy and which may fail. While tumors in which ER exhibited abnormalities in nuclear binding behavior (ligand-independent nuclear binding or no nuclear binding) failed hormone therapy (16 out of 19 patients), those in which nuclear binding of ER appeared normal (ligand-dependent) in the in vitro test, responded to hormone therapy (5/6 patients). While our previous report dealt with the procedural details, specificity of the reagents, and the design of the study, this report addresses the clinical aspects of this study and response correlation. |
1 | Early diagnosis of carpal tunnel syndrome: comparison of digit 1 with wrist and distoproximal ratio | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | Our objective in this study was to compare the sensitivity and specificity of the median sensory nerve conduction velocity (SNCV) from digit 1 to wrist with those of the distoproximal (D/P) ratio of the median SNCV from palm to digit 3/palm to wrist in the diagnosis of mild carpal tunnel syndrome (CTS) by using a receiver operating characteristic (ROC) curve. To achieve this objective, we studied prospectively (January 1997-October 1998) 370 patients referred for CTS. One hundred forty-two patients (38.4%) with moderate to severe CTS and 15 patients (4.1%) with multiple (> or = 3) compressive neuropathies in upper limbs with subclinical peripheral neuropathy were excluded. The remaining 213 patients (302 hands with mild CTS; 167 women; mean age, 50 y +/- 12 y) and 38 controls (71 hands; 25 women; mean age, 47 y +/- 13 y) had median and ulnar nerve conduction studies. ROC curves were constructed for median SNCV digit 1 to wrist and median SNCV D/P ratio from the patients' and controls' data. The median SNCV at < or = 45.9 m/s, corresponding to an optimal cutoff point on ROC curve, discriminated 89.5% of mild CTS from controls with specificity of 98.6%. The median D/P ratio at > or = 1.12, corresponding to an optimal cutoff point on ROC curve, discriminated 67.2% of mild CTS from controls with specificity of 97.2%. Of the 10.3% (31/302) of hands in which digit 1 to wrist was within normal limits at the selected optimal cutoff value (< or = 45.9 ms), 7% (21/302) had an abnormal D/P ratio (> or = 1.12), and 3.3% (10/302) had a normal electrophysiologic examination. The likelihood ratio (true-positive ratio to false-positive ratio, assessing the discriminative power of a test) of the median SNCV digit 1 to wrist, at an optimal point on ROC curve (63.9), was higher than that of the median SNCV D/P ratio (23.9, chi2 = 36.9, P < .001). These findings suggest that the median SNCV digit 1 to wrist is more sensitive than the median SNCV D/P ratio in the diagnosis of mild CTS |
0 | Computed tomography measurement of acetabular cup anteversion and retroversion in total hip arthroplasty | Management of Hip Fractures in the Elderly | In a clinical study conducted between March 1983 and July 1987, computed tomography of the hip was employed with specially designed software in 20 patients after 23 total hip arthroplasties (THAs). Three patients had bilateral THAs. Computed tomography was performed in the routine manner, except that the image was reconstructed utilizing software that eliminated the metallic artifacts. The angle of the acetabular cup is determined on a display console. The cursor is turned on, one pole of the cup is marked, and when the second moving cursor is positioned on the opposite pole, the angle is shown and measured on the console. This technique has been indispensable for accurate measurement of the angle of inclination of the acetabular cup and in treatment planning in patients with a dislocating total hip prosthesis |
0 | Towards a National Pediatric Musculoskeletal Trauma Outcomes Registry: the Pediatric Orthopaedic Trauma Outcomes Research Group (POTORG) experience | The Treatment of Pediatric Supracondylar Humerus Fractures AUC | This study is a pilot effort towards the broader implementation of a national pediatric musculoskeletal trauma outcomes registry. The primary goal of this project is to explore the feasibility of a web-based data acquisition and management platform and to identify catalysts and obstacles to multi-center collaboration. A prospective cohort of children presenting to the Pediatric Emergency Departments with ankle, femur, supracondylar humerus, tibial spine, or open fractures at five clinical centers between October 2001 and March 2003 comprised the study population. Patients were enrolled via the treating orthopaedic resident, using a web-based data acquisition and management system. Orthopaedic attendees were sent an automated reminder to complete a follow-up form one week after treatment, and parents of enrolled children were sent child and parent health questionnaires by e-mail and mail in order to capture health-related quality of life and post-traumatic stress symptoms. A total of 299 patients were enrolled in the study with an average age of 7.3 years. Post-treatment follow-up questionnaires were completed by 39% of the attending orthopaedic surgeons, and by 43% of the enrolled patients or patient's parents. Children old enough to complete health questionnaires scored lower in 5 of 12 functional domains including Physical Function, Role/Social Emotional/Behavioral, Parental Impact-Emotional, Family Activities, and Family Cohesion. Within the subset of patients sustaining femur fractures whose parents completed health questionnaires, 9.5% reported significant post-traumatic stress symptoms. This study demonstrates the potential of a multi-center web-based registry to facilitate the collection of a rich array of pediatric trauma, treatment and patient-based outcomes data, although new regulatory issues regarding patient privacy pose challenges to such an approach |
0 | Fusion rates of different anterior grafts in thoracolumbar fractures | Hip Fx in the Elderly 2019 | STUDY DESIGN: Retrospective CT analysis of anterior fusion in thoracolumbar trauma. OBJECTIVE: To compare fusion rates of different bone grafts and to analyse risk factors for pseudarthosis. SUMMARY OF BACKGROUND DATA: Interbody fusion is indicated in anterior column defects. Different grafts are used: autologous iliac crest, titanium mesh cages filled with cancellous bone, autologous ribs. It is not clear which graft offers the most reliable fusion. MATERIAL AND METHODS: Radiological data of 116 patients (71 males, 45 females) operated for type A2, A3, B or C fractures was analyzed. The average age was 44.6 (16-75) and follow-up was 2.7 (1-9) years. All patients were treated by posterior instrumentation followed by an anterior graft: 53 cases with iliac crest, 43 cases with mesh cages and 20 with rib grafts. Fusion was evaluated on CT and classified into complete fusion, partial fusion, unipolar pseudarthrosis and bipolar pseudarthrosis. RESULTS: Iliac crest fused in 66%, cages in 98%, and rib grafts in 90%. The fusion rate of cages filled with bone was significantly higher as the iliac graft fusion rate (P=0.002). The same applied to rib grafts compared to iliac crest (P=0.041). Additional bone formation around the main graft, bridging both vertebral bodies, was observed in 31/53 iliac crests grafts. Pseudarthrosis occurred more often in smokers (P=0.042). A relationship between fracture or instrumentation types, gender, age, BMI, and fusion could not be determined. CONCLUSION: Tricortical iliac crest grafts showed an unexpected high pseudarthrosis rate in thoracolumbar injuries. Their cortical bone is dense and their fusion surface is small. Rib grafts led to a better fusion when used in combination with cancellous bone from the fractured vertebral body. Titanium mesh cages filled with cancellous bone led to the highest fusion rate and built a complete bony bridge between vertebral bodies. Smoking seemed to influence fusion. LEVEL OF EVIDENCE: Case control study, Level III. |
0 | Clinical trials of vitamin and mineral supplements for cancer prevention | Developmental Dysplasia of the Hip 2020 Review | Approximately 20â?30% of Americans consume multivitamin supplements daily, indicating high public interest in the prevention of cancer and other chronic diseases through a nutritionâ?based approach. Although several bioactive food components, including vitamins and minerals, have been investigated for their ability to affect cancer risk, few large, randomized, placeboâ?controlled clinical trials of multivitamins with cancer as the primary endpoint have been performed. The results of most largeâ?scale trials of multivitamin supplements (combinations of â?¥2 vitamins and minerals) to prevent cancer have been mixed. The Linxian General Population and Dysplasia trials found a decreased risk of cancer, particularly stomach cancer, for participants taking a multivitamin supplement, but this was in a borderlineâ?deficient population in China. Two trials, the Alphaâ?Tocopherol, Betaâ?Carotene Cancer Prevention Study and the βâ?Carotene and Retinol Efficacy Trial, found an increased risk of lung cancer among male cigarette smokers or asbestosâ?exposed persons taking βâ?carotene â? a surprising result, considering that most epidemiologic studies have suggested that consumption of fruit and vegetables appears to lower cancer risk. To clarify the effects of multivitamin supplements, several large randomized clinical trials are underway, including the Physicians' Health Study II, the Selenium and Vitamin E Cancer Prevention Trial, and a European study, Supplémentation en Vitamines et Minéraux Antioxydants (SU.VI.MAX). Because epidemiologic studies generally evaluate foods rather than specific bioactive food components, a systematic approach to determining how combinations of vitamins and minerals may interact to ameliorate cancer risk is necessary to further our understanding of the potential benefits and risks of supplement use. © 2007 American Society for Nutrition. |
0 | Mechanical ventilation in neurocritical care patients: a systematic literature review | Coronavirus Disease 2019 (COVID-19) | INTRODUCTION: Neurocritical care (NCC) patients often require prolonged mechanical ventilation, and they are at high risk of respiratory complications. Therefore, the potential benefit role of protective lung ventilation (PLV), which demonstrated to reduce postoperative complications in patients with acute distress respiratory syndrome, has been suggested even on NCC patients. However, PLV can increase intracranial pressure as result of permissive hypercapnia and of high airway pressures during recruitment maneuvers. The aim of this review (PROSPERO registration number: CRD42015027011) is to describe the ventilatory strategies, and in particular PLV, commonly used in NCC patients. AREAS COVERED: We selected a total of 16 clinical studies, searching on PubMed and EMBASE databases, reporting original information on the MV on patients receiving NCC after acute brain injury, published in the last 10 years, in English language. Some of the included studies report data on a limited sample size. Expert commentary: The use of PLV techniques (PEEP, recruitment maneuvers, etc) in NCC patients is controversial. There is a wide variability among different centers in the treatment strategies and respiratory management of NCC patients, and there is the need for shared diagnostics and therapeutic studies, in order to improve the patients' outcome. |
1 | Treatment of primary osteoarthritis of the hip. A comparison of total joint and surface replacement arthroplasty | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | Of 285 total hip arthroplasties (260 patients) performed for primary osteoarthritis during a six-year period, 135 were resurfaced using a Tharies prosthesis (total hip articular replacement with internal eccentric shells) and 150 were treated with the Trapezoidal-28 total hip replacement. From each of these two groups 100 hips (ninety-one patients in the Tharies group and eighty-six in the Trapezoidal-28 group) that had been followed for two to seven years were evaluated at the time of follow-up in accordance with a predetermined protocol. The patients were younger in the Tharies than in the Trapezoidal-28 group (average ages, fifty-eight and sixty-six years), included more men (sixty compared with thirty-five), and were more active postoperatively. The average follow-up was forty-seven months for the total joint-replacement group and thirty-eight months for the surface replacement group. At follow-up the ratings for pain, walking, and function according to the University of California at Los Angeles 10-point scale and the clinical results were identical in the two groups. Heterotopic ossification (Brooker grade III or IV) developed after thirteen Trapezoidal-28 and twenty-two Tharies arthroplasties. Radiographs made at six and twelve months and at final follow-up showed that the incidence of radiolucencies about the acetabular component was higher in the resurfacing group: fifty-seven with complete radiolucent lines after an average follow-up of thirty-eight months compared with thirty-six with complete lines after an average follow-up of forty-seven months. There were three failures in the joint-replacement group: a hematogenous staphylococcal deep infection that required a Girdlestone procedure, a femoral stem fracture that required revision, and loosening of an acetabular component for which revision was performed. There was also one dislocation, successfully treated by closed reduction. Similarly, in the resurfacing group there were three failures: two loose acetabular components, revised successfully, and one loose femoral component that necessitated total joint arthroplasty. Multivariate stepwise regression analysis showed that the factors that affected the final extent and width of the acetabular radiolucencies adversely after resurfacing were: any radiolucent lines that were visible at six months, a high level of physical activity after arthroplasty, and a thin superior cement mantle.(ABSTRACT TRUNCATED AT 400 WORDS) |
0 | The fate of the oblique abdominal muscles after free TRAM flap surgery | Reduction Mammoplasty for Female Breast Hypertrophy | During recent years, clinical research on the donor site morbidity after free or pedicled transverse rectus abdominis myocutaneous (TRAM) flap surgery has been focusing on the reduced flexion capacity of the abdominal wall. However, the rectus abdominis muscles have close interactions with their synergists and antagonists and collaborate with their neighbouring muscles. The purpose of this study was to examine the consequences of partially resecting the rectus abdominis muscle on the different muscle groups of the abdominal wall. Twenty free TRAM flap patients, 12-61 months (mean 32.1 months) after surgery, were clinically examined, evaluated for curl-up performance and underwent isokinetic dynamometry for flexion, extension and rotation. The patients were compared with 20 non-operated controls. Nineteen patients answered a questionnaire. Abdominal wall abnormalities occurred in 10 patients: umbilical asymmetry (n = 3), abdominal wall asymmetry (n = 4), lower abdominal bulging (n = 2) and hernia (n = 1). Curl-up performance was less in the TRAM flap patients (P = 0.001, Mann-Whitney). Isokinetic flexion, extension and rotation were also less in the TRAM flap patients (Fisher's exact test). This study indicates that what has been believed to be 'limited' surgical damage to the abdominal wall leads to an important reduction in flexion strength but to an even more important reduction of rotation strength due to bilateral displacement and damage of the insertion of the oblique muscles. Partial compensation by synergists is variable and unpredictable on an individual basis. These functional disorders can potentially lead to important changes in activities of daily life. |
0 | Is pain and dissatisfaction after TKA related to early-grade preoperative osteoarthritis? | PJI DX Updated Search | BACKGROUND: There is growing evidence to suggest many patients experience pain and dissatisfaction after TKA. The relationship between preoperative osteoarthritis (OA) severity and postoperative pain and dissatisfaction after TKA has not been established. QUESTIONS/PURPOSES: We explored the relationship between early-grade preoperative OA with pain and dissatisfaction after TKA by (1) determining the incidence of early-grade preoperative OA in painful TKAs with no other identifiable abnormality; and (2) comparing this incidence with the incidence of early-grade OA in three other cohorts of patients undergoing TKA. METHODS: We evaluated all (n = 49) painful TKAs in a 1-year period that had no evidence of loosening, instability, malalignment, infection, or extensor mechanism dysfunction and classified the degree of preoperative OA according to the scale of Kellgren and Lawrence. For comparison, we identified three other cohorts of TKAs from the same center and classified their preoperative grade of OA: Group B (n = 100) was a consecutive series of primary TKAs performed for OA during the same year; Group C (n = 80) were asymptomatic TKAs from 1 to 4 years postoperatively; and Group D (n = 80) were TKAs with some degree of pain at 1 to 4 years postoperatively. RESULTS: Patients in Group A had a higher incidence of early-grade OA is preoperatively (49%) compared with any of the comparison groups: Group B, 5%; Group C, 6%; and Group D, 10%. CONCLUSIONS: A high percentage of patients referred for unexplained pain after TKA had early-grade osteoarthritis preoperatively. Patients undergoing TKA for less than Grade 3 or 4 OA should be informed that they may be at higher risk for persistent pain and dissatisfaction |
0 | FDG-PET imaging in hematological malignancies | MSTS 2018 - Femur Mets and MM | The majority of aggressive lymphomas is characterized by an up regulated glycolytic activity, which enables the visualization by F-18 FDG-PET/CT. One-stop hybrid FDG-PET/CT combines the functional and morphologic information, outperforming both, CT and FDG-PET as separate imaging modalities. This has resulted in several recommendations using FDG-PET/CT for staging, restaging, monitoring during therapy, and assessment of treatment response as well as identification of malignant transformation. FDG-PET/CT may obviate the need for a bone marrow biopsy in patients with Hodgkin's lymphoma and diffuse large B cell lymphoma. FDG-PET/CT response assessment is recommended for FDG-avid lymphomas, whereas CT-based response evaluation remains important in lymphomas with low or variable FDG avidity. The treatment induced change in metabolic activity allows for assessment of response after completion of therapy as well as prediction of outcome early during therapy. The five-point scale Deauville Criteria allows the assessment of treatment response based on visual FDG-PET analysis. Although the use of FDG-PET/CT for prediction of therapeutic response is promising it should only be conducted in the context of clinical trials. Surveillance FDG-PET/CT after complete remission is discouraged due to the relative high number of false-positive findings, which in turn may result in further unnecessary investigations. Future directions include the use of new PET tracers such as F-18 fluorothymidine (FLT), a surrogate biomarker of cellular proliferation and Ga-68 CXCR4, a chemokine receptor imaging biomarker as well as innovative digital PET/CT and PET/MRI techniques. |
0 | The biplane facelift: An opportunistic approach | Panniculectomy & Abdominoplasty CPG | The argument over what is the ideal facelift will not be resolved in the near future. There are too many variables to permit a totally scientific approach to this issue. It is yet to be proved that deep plane techniques actually add longevity to the results of facelifting. Those who advocate these procedures do so because they have an impression that they produce better and longer-lasting results, but this has not been proved and is disputed by many surgeons. This technique has been used by the senior author (H.T.) for over 12 years in several hundred cases, with excellent results. There have been few complications, and these have been limited to relatively minor problems, including unsatisfactory postoperative scars, delayed recovery related to hematoma formation, and unacceptable elevation of the temporal hair tuft in a few cases. Excessive preauricular scarring occurred in one patient, who developed pulmonary compromise after surgery that resulted in a period of significant hypoxia secondary to a pulmonary embolus. Fortunately, the patient recovered and had a satisfactory result after scar revision. There have been no cases of motor nerve injury despite the extensive dissection. Not all patients undergo the complete biplane dissection. Each patient's treatment plan is individualized. Sometimes a decision is made preoperatively to limit the dissection to the superficial plane. Patients who return for second facelifts often maintain a layer of scar tissue that seems to offer more holding power even if the surgery was several years earlier. They may not need the effect of the deeper lift if the dissection of their first lift was substantial. The decision may be modified during the actual surgery if more than average bleeding occurs or a thin musculofascial layer prevents adequate deep plane flap elevation. |
0 | New preoperative evaluation system of the physical findings of aged patients with femoral neck fracture | Management of Hip Fractures in the Elderly | We devised our own method of evaluating a patient's general condition at admission, and estimated the usefulness of this method for evaluating patients with femoral neck fractures and its relationship to prognosis, in particular, factors influencing poor functional and vital prognoses. We examined 83 patients between January 1992 and March 1996 who had been treated for more than 30 days after injury and had no malignant tumor as an underlying disease. The new criteria for systemic status evaluation at admission were chosen by reference to the preoperative status classification system of the American Society of Anesthesiologists. Three evaluation grades were established for each of eight items (pulmonary function, heart disease, hypertension, glucose tolerance impairment, renal function, hepatic function, anemia, and hypoproteinemia). Pulmonary function and heart disease were evaluated on a 20-point scale, and the other six items on a 10-point scale; the maximum possible score was 100 points. Scores were statistically analyzed in relation to functional and vital prognoses. Poor prognosis factors were determined and ranked. We found that the factors associated with a poor functional prognosis were heart disease, glucose tolerance impairment, and pulmonary dysfunction, and those associated with a poor vital prognosis were renal dysfunction and glucose tolerance impairment |
1 | How does reverse shoulder replacement change the range of motion in activities of daily living in patients with cuff tear arthropathy? A prospective optical 3D motion analysis study | Glenohumeral Joint OA | BACKGROUND: Reverse total shoulder arthroplasty (RSA) can improve function in cuff tear arthropathy (CTA) shoulders, but limited exact data are available about the maximum values in 3D motion analysis, and as to how improvements translate into the normal range of motion (ROM) in activities of daily living (ADLs).
METHODS: This study included nine consecutive patients (n = 9) who received RSA for CTA without muscle transfers. We measured shoulder movement by a novel 3D motion analysis using the Heidelberg upper extremity model (HUX) which can eliminate compensatory movements of the scapula, and the trunk. The measurement included active maximum values, and four ADLs.
RESULTS: Comparing the pre- to the 1-year postoperative status, RSA was associated with a significant increase in the mean maximum values for active flexion of about 43degree (SD +/- 31) from 66degree to 109degree (p = 0.001), for active abduction of about 37degree (SD +/- 26) from 57degree to 94degree (p = 0.001), and for the active adduction of about 28degree (SD +/- 10) from 5degree to 33degree (p = 0.002). Comparing the preoperative to the postoperative ROM in the ADLs in flexion/extension, ROM improved significantly in all ADLs, in abduction/adduction in three of four ADLs. No significant changes were observed in internal/external rotation in any ADLs.
CONCLUSION: RSA improves the active maximum ROM for flexion, abduction, and adduction. The patients are able to take advantage of this ROM increase in ADLs in flexion and in most ADL in abduction, but only in trend in internal and external rotation. |
0 | Fracture incidence in adults in relation to age and gender: A study of 27,169 fractures in the Swedish Fracture Register in a well-defined catchment area | Hip Fx in the Elderly 2019 | Studies on fracture incidence have mostly been based on retrospectively registered data from local hospital databases. The Swedish Fracture Register (SFR) is a national quality register collecting data prospectively on fractures, at the time of care-seeking. In the present study the incidence of all different fractures, regardless of location, in adults’ > 16 years treated at the only care provider for patients with fractures within a catchment area of approximately 550,000 inhabitants, during 2015–2018 are described. Age, gender, and fracture location (according to AO/OTA classification) was used for the analyses and presentation of fracture incidences. During the 4-year study period, 23,917 individuals sustained 27,169 fractures. The mean age at fracture was 57.9 years (range 16–105 years) and 64.5% of the fractures occurred in women. The five most common fractures accounted for more than 50% of all fractures: distal radius, proximal femur, ankle, proximal humerus, and metacarpal fractures. Seven fracture incidence distribution groups were created based on age- and gender-specific incidence curves, providing visual and easily accessible information on fracture distribution. This paper reports on incidence of all fracture locations based on prospectively collected data in a quality register. The knowledge on fracture incidence related to age and gender may be of importance for the planning of orthopaedic care, involving both in- and out-patients as well as allocating surgical resources. Further, this might be useful for organizing preventive measures, especially in countries with similar socioeconomic structure and fracture burden. |
0 | Risk factors for injury accidents among moped and motorcycle riders | DoD PRF (Psychosocial RF) | Objective: To study and quantify the effect of factors related to the riders of powered two-wheelers on the risk of injury accident involvement. Methodology: Based on national data held by the police from 1996 to 2005, we conducted a caseâ??control study with responsibility for the accident as the event of interest. We estimated the odds ratios for accident responsibility. Making the hypothesis that the non-responsible riders in the study are representative of all the riders on the road, we thus identified risk factors for being responsible for injury accidents. The studied factors are age, gender, helmet wearing, alcohol consumption, validity of the subject's driving licence and for how long it has been held, the trip purpose and the presence of a passenger on the vehicle. Moped and motorcycle riders are analyzed separately, adjusting for the main characteristics of the accident. Results: For both moped and motorcycle riders, being male, not wearing a helmet, exceeding the legal limit for alcohol and travelling for leisure purposes increased the risk of accident involvement. The youngest and oldest users had a greater risk of accident involvement. The largest risk factor was alcohol, and we identified a doseâ??effect relationship between alcohol consumption and accident risk, with an estimated odds ratio of over 10 for motorcycle and moped riders with a BAC of 2g/l or over. Among motorcycle users, riders without a licence had twice the risk of being involved in an accident than those holding a valid licence. However, the number of years the rider had held a licence reduced the risk of accident involvement. One difference between moped and motorcycle riders involved the presence of a passenger on the vehicle: while carrying a passenger increased the risk of being responsible for the accident among moped riders, it protected against this risk among motorcycle riders. Conclusion: This analysis of responsibility has identified the major factors contributing to excess risk of injury accidents, some of which could be targeted by prevention programmes. (PsycINFO Database Record (c) 2018 APA, all rights reserved) |
0 | Vasomotor dysfunction in carpal tunnel syndrome | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | Little attention has been paid to small-fiber dysfunction in carpal tunnel syndrome (CTS) although its symptoms are common. This study investigates vasomotor dysfunction, which is controlled by small nerve fibers, in patients with CTS compared with control subjects. Vasomotor function was quantified by measuring, with laser Doppler velocimetry, skin vasoconstriction induced by a eutectic mixture of local anesthetic (EMLA) cream over digit tips 3, 4, and 5. Hands with CTS (n = 32) compared with controls (n = 19) demonstrated significantly reduced vasoconstriction in digits 3 and 4, but not digit 5. A blood flow ratio (digit 3/5) of less than 0.73 identified CTS in 69% with 68% specificity. Testing for vasomotor dysfunction in CTS allows for more comprehensive neurophysiological testing, which is heavily biased towards large nerve fibers |
0 | The promise of γδT cells and the γδT cell receptor for cancer immunotherapy | MSTS 2018 - Femur Mets and MM | γδT cells form an important part of adaptive immune responses against infections and malignant transformation. The molecular targets of human γδT cell receptors (TCRs) remain largely unknown, but recent studies have confirmed the recognition of phosphorylated prenyl metabolites, lipids in complex with CD1 molecules and markers of cellular stress. All of these molecules are upregulated on various cancer types, highlighting the potential importance of the γδT cell compartment in cancer immunosurveillance and paving the way for the use of γδTCRs in cancer therapy. Ligand recognition by the γδTCR often requires accessory/co-stimulatory stress molecules on both T cells and target cells this cellular stress context therefore provides a failsafe against harmful self-reactivity. Unlike αβ T cells, γδT cells recognise their targets irrespective of HLA haplotype and therefore offer exciting possibilities for off-the-shelf, pan-population cancer immunotherapies. Here, we present a review of known ligands of human γδT cells and discuss the promise of harnessing these cells for cancer treatment. |
0 | Cellulitis and related skin infections | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | The location, appearance and clinical course of a skin infection can be used to make a reasonable assumption about its etiology. By carefully considering such factors as entry site and immunocompetence, the physician can make a rational decision about hospitalization and treatment. When appropriate, traditional antibiotics should be used initially, thereby avoiding the temptation to "overkill" the infection with newer, more expensive agents |
0 | Complications after 344 damage-control open celiotomies | DOD - Acute Comp Syndrome CPG | BACKGROUND: We reviewed our experience with the open abdomen and hypothesized that the known high wound complication rates were related to the timing and method of wound closure.
METHODS: All trauma admissions from 1995 through 2002 requiring an open abdomen and temporary abdominal coverage were included. The study group was then classified by three wound closure methods used in survivors: 1) primary (primary fascial closure); 2) temporizing (skin only, spit thickness skin graft and/or absorbable mesh), and 3) prosthetic (fascial repair using nonabsorbable prosthetic mesh).
RESULTS: In all, 344 patients required an open abdomen and temporary abdominal coverage either as part of a planned staged damage-control celiotomy (66%) or the development of the abdominal compartment syndrome (33%). Of these, 276 patients survived to wound closure. Sixty-nine of the 276 (25%) suffered wound complications (wound infection, abscess, and/or fistula). Thirty-four (12%) died after wound closure; seven of the deaths as a direct result of the wound complication. Complications increased significantly after 8 days (p < 0.0001) from the initial operative intervention to fascial closure. Primary fascial closure was achieved in 180 of 276 (65%) patients. Although there was no difference in the mean Injury Severity Score between the three groups, the primary group had significantly fewer mean transfusion requirements, shorter mean time to fascial closure, and a lower complication rate as compared with either the temporizing or prosthetic groups. The primary group thus incurred significantly less mean initial hospitalization charges.
CONCLUSION: Morbidity associated with wound complications from the open abdomen remains high (25%). Morbidity is associated with the timing and method of wound closure and transfusion volume, but independent on injury severity. Also, delayed primary fascial closure before 8 days is associated with the best outcomes with the least charges. |
1 | Advice on Standardized Diagnosis and Treatment for Spinal Diseases during the Coronavirus Disease 2019 Pandemic | Coronavirus Disease 2019 (COVID-19) | Coronavirus disease 2019 (COVID-19) outbreak started in December 2019 that caused difficulties for clinical work. Practical work experience in our spinal outpatient and emergency department during the COVID-19 pandemic is summarized in this article, with combined evidence-based medical evidence to explore a standardized process of diagnosis and treatment for spinal diseases. Outpatient reservation, continuous screening, triage, and isolation, first consultation accountability system, pandemic reporting system, and online revisit were strictly followed. We hope that our experience in prevention and control of COVID-19 can help spine surgeons globally in stopping the spread of COVID-19. Spine surgeons should collaborate with infection control specialists to avoid cross-infection in hospitals and optimize treatment. |
0 | No evidence of superiority in reducing outliers of component alignment for patient-specific instrumentation for total knee arthroplasty: a systematic review | OAK 3 - Non-arthroplasty tx of OAK | Patient-specific instrumentation (PSI) technology has been developed to improve alignment when implanting total knee arthroplasty (TKA) and is a new focus in the orthopaedic community. Current controversial data concerning PSI are discussed. A systematic review to compare PSI with conventional instrumentation and assess the radiographic outcomes was performed. Electronic databases (including PubMed, Medline, Embase, the Cochrane Library and the Science Citation Index database) and conference proceedings from 1950 to 2014 in the English language were searched. Data, including relevant patient characteristics, sample size, radiographic method, PSI system manufacturer and outliers of implant positioning and alignment on radiography were independently extracted from all eligible studies by two of the authors. A total of 2739 TKAs were included (1410 performed with PSI and 1329 with conventional instrumentation). There were more TCA outliers (malalignment >3°) and tibial slope outliers (malalignment >3°) in the PSI group than in the conventional group. The other radiographic outcomes assessed, including coronal, sagittal or rotational alignment outliers did not differ between the two groups. With regard to radiographic outcomes, our findings indicate that PSI technology is not superior in reducing outliers of component alignment. |
0 | A pilot study of surgical telementoring for leg fasciotomy | DoD LSA (Limb Salvage vs Amputation) | METHODS: Three anaethetists and one critical care physician were recruited as operators. They were directed to perform a two-incision leg fasciotomy on a Thiel-embalmed cadaver under the guidance of a remotely located orthopaedic surgeon. The operating physician and the surgeon (mentor) were connected through software that allows for real-time supervision and the use of a virtual pointer overlaid onto the surgical field. Two experienced orthopaedic traumatologists independently assessed the adequacy of compartment decompression and the presence of iatrogenic complications. RESULTS: 14 of 16 compartments (in four leg specimens) were felt to have been completely released. The first evaluator considered that the deep posterior compartment was incompletely released in two specimens. The second evaluator considered that the superficial posterior compartment was incompletely released in two specimens. The only complication was a large laceration of the soleus muscle that occurred during a period of blurred video signal attributed to a drop in bandwidth. CONCLUSIONS: This study suggests that surgical telementoring may enable physicians to safely perform two-incision leg fasciotomy in remote environments. This could improve the chances of limb salvage when compartment syndrome occurs far from surgical care. We found interobserver variation in the assessment of compartment release, which should be considered in the design of future research protocols. INTRODUCTION: Acute extremity compartment syndrome requires rapid decompression. In remote locations, distance, weather and logistics may delay the evacuation of patients with extremity trauma beyond the desired timeline for compartment release. The aim of this study was to establish the feasibility of performing telementored surgery for leg compartment release and to identify methodological issues relevant for future research. |
0 | Wrist arthroplasty for treatment of infected distal radius nonunion using free vascularised proximal fibular bone graft | DoD SSI (Surgical Site Infections) | Objective: Management of infected distal radius nonunion with a bone defect and radiocarpal and distal radio-ulnar joint arthritis is considered an orthopaedic challenge. Although several methods have been described but none provide a satisfactory solution. Free vascularised fibula bone graft constitutes a good option to eradicate the infection, correct the deformity, compensate for the shortening and maintain motion. Material and methods: This study included 15 cases with infected distal radius nonunion associated with bone defects. Nine cases were males and six were females. The average age of the patient was 20 years (range 8 - 60 years). The right wrist was involved in 10 patients and left was affected in 5 patients. Nine cases resulted from a motor vehicle accident, four cases after a firearm injury and two cases due to falling from a height. The average number of previous surgical procedures was three (range 2 -6). The principle of treatment was debridement, excision of distal radius and trimming of the proximal part of radius back to healthy bleeding bone, inserting the free vascularised proximal fibular bone graft to compensate the defect and fixation of the graft. Results: The procedure was successful in 13 of 15 cases. Bone union was achieved at an average of 4 months. No clinical evidence of osteomyelitis or or infection at final follow-up. Pain was completely relieved in all cases. Wrist joint range of motion averaged flexion 50°, extension 45° and handgrip was the same as the normal site. Twelve cases out of 15 returned to their daily activities. Conclusion: Free vascularised proximal fibula bone graft is a new indication for the treatment of an infected distal radius nonunion with a bone defect. |
0 | Modifiable factors associated with postoperative delirium after hip fracture repair: An age-stratified retrospective cohort study | Hip Fx in the Elderly 2019 | BACKGROUND: Postoperative delirium in hip fracture patients is common and is associated with substantial morbidity and consumption of resources. OBJECTIVE: Using data from the USA, we aimed to examine the relationship between postoperative delirium and (modifiable) peri-operative factors mentioned in the American Geriatrics Society Best Practice Statement on Postoperative Delirium in Older Adults, stratified by 'young old' (<80 years) and 'old-old' (â?¥80 years) categories. DESIGN: Retrospective cohort study from 2006 to 2016. SETTING: Population-based claims data from the USA. PARTICIPANTS: Patients undergoing 505â??152 hip fracture repairs between 2006 and 2016 as recorded in the Premier Healthcare Database. MAIN OUTCOMES AND MEASURES: The main outcome was postoperative delirium; modifiable factors of interest were peri-operative opioid use (high, medium or low; <25th, 25 to 75th or >75th percentile of oral morphine equivalents), anaesthesia type (general, neuraxial, both), use of benzodiazepines (long acting, short acting, both), pethidine, nonbenzodiazepine hypnotics, ketamine, corticosteroids and gabapentinoids. Multilevel models assessed associations between these factors and postoperative delirium, in the full cohort, and separately in those aged less than 80 and at least 80 years. Odds ratios (ORs) and Bonferroni-adjusted 95% confidence intervals (95% CIs) are reported. RESULTS: Overall, postoperative delirium incidence was 15.7% (nâ??=â??79â??547). After adjustment for relevant covariates, the use of long-acting (OR 1.82, CI 1.74 to 1.89) and combined short and long-acting benzodiazepines (OR 1.56, CI 1.48 to 1.63) and ketamine (OR 1.09, CI 1.03 to 1.15), in particular, was associated with increased odds for postoperative delirium, while neuraxial anaesthesia (OR 0.91 CI 0.85 to 0.98) and opioid use (OR 0.95, CI 0.92 to 0.98 and OR 0.88, CI 0.84 to 0.92 for medium and high dose compared with low dose) were associated with lower odds; all Pâ??<â??0.05. When analysing data separately by age group, effects of benzodiazepines persisted, while opioid use was only relevant in those aged less than 80 years. CONCLUSION: We identified modifiable factors associated with postoperative delirium incidence among patients undergoing hip fracture repair surgery. |
1 | Normal leg compartment pressures in adult Nigerians using the Whitesides method | DOD - Acute Comp Syndrome CPG | In Caucasians, the range of normal intracompartmental pressure of the leg is from 0 mmHg to 15 mmHg. In the literature, such measurements have not been done in Africa to identify normal leg intracompartmental pressures. We have sought to identify the normal range of pressures in such a population of Nigerians, and to demonstrate the reproducibility of the Whitesides injection technique with materials that are easily available in most hospitals so that compartment syndromes could be identified promptly and inexpensively in developing countries. We performed a 16-month hospital-based prospective study at Wesley Guild Hospital in Ilesa, Osun State, Nigeria, to measure the intracompartmental pressures in the anterior and deep posterior compartments of 49 contralateral uninjured legs of patients with closed contralateral tibial fractures, measured at presentation. The Whitesides infusion technique was used with the aim of determining the normal range of compartmental pressure in Nigerians. The anterior compartment pressures ranged from 3 mmHg to 18 mmHg with a mean 7.6 +/- 2.6 mmHg. The pressure in the deep posterior compartment ranged from 3 mmHg to 14 mmHg with mean of 7.4 +/- 2.7 mmHg. The values are similar to those reported in the literature. There was no statistically significant difference between the pressures in the two compartments (p = 0.668). |
0 | Effects of teriparatide [rhPTH (1-34)] treatment on structural geometry of the proximal femur in elderly osteoporotic women | Management of Hip Fractures in the Elderly | INTRODUCTION: We evaluated effects of teriparatide (rDNA origin) injection [teriparatide, rhPTH (1-34), TPTD] on hip structure among a subset 558 postmenopausal women enrolled in the Fracture Prevention Trial.METHODS: Patients were randomized to once-daily, self-administered subcutaneous injections of placebo (N = 189), teriparatide 20 mug (TPTD20; N = 186), or 40 mug (TPTD40; N = 183) for a median of 20 months. Repeated dual energy X-ray absorptiometry (DXA) hip scans were analyzed with the Hip Structure Analysis (HSA) program to derive structural geometry.RESULTS AND CONCLUSIONS: There were no significant differences in age or body size between groups at baseline, 1 year, or study termination. At the femoral neck, teriparatide increased bone mass and improved bone geometric strength in both treatment groups compared to the placebo group, with the response being dose-related. The mean difference (95% CI) in bone cross-sectional area (CSA) in the TPTD20 was 3.5% (1.8% to 5.3%), and 6.3% (4.5% to 8.2%) in TPTD40 at study termination, compared to placebo controls. Teriparatide treatment increased bending strength, with the mean difference in section modulus being 3.6% (1.4% to 5.8%) and 6.8% (4.6% to 9.1%) greater in the TPTD20 and TPTD40 groups, respectively. Compared to placebo, local cortical instability characterized by the buckling ratio decreased by 5.5% (3.5% to 7.5%) and 8.6% (6.6% to 10.5%) in the TPTD20 and TPTD40 groups, respectively, during the study period. The changes at the intertrochanteric region were comparable to those at the narrow neck although between-group differences were slightly smaller. Except for an inconsequential (1%) improvement in section modulus in TPTD20, teriparatide effects did not reach significance at the femoral shaft. In conclusion, teriparatide treatment improved axial and bending strength, and increased cortical thickness and stability at the femoral neck and intertrochanteric region. Teriparatide treatment effects were not apparent at the purely cortical femoral shaft |
0 | Using 3-dimensional ultrasound islice technology for the diagnosis of developmental dysplasia of the hip | Developmental Dysplasia of the Hip 2020 Review | OBJECTIVES: This study aimed to investigate the reliability of 3-dimensional (3D) ultrasound in screening for developmental dysplasia of the hip (DDH) by comparing the results with those of 2-dimensional (2D) ultrasound. METHODS: One hundred five infants who were younger than 6 months were enrolled in this study. All of the infants underwent 2D and 3D ultrasound scanning for DDH by novices and experts, and the images were graded by a lead expert. The scanning time and image grades were analyzed by Student t tests (Pâ??<â??.05). The consistency of the α angle measurement between the novices and experts was evaluated by the intraclass correlation coefficient (ICC). RESULTS: The 105 infants included 34 boys and 71 girls. On 2D scanning, there was agreement between the experts about the correct diagnosis, whereas in the novice group, 41 infants had misdiagnoses. There were no misdiagnoses with 3D scanning in either group. In the novice group, the mean image grades ± SD were 4.2â??±â??1.3 (2D ultrasound) and 8.1â??±â??0.7 (3D ultrasound; Pâ??<â??.05). In the expert group, the mean image grades were 7.4â??±â??1.0 (2D ultrasound) and 8.2â??±â??1.0 (3D ultrasound; Pâ??<â??.05). There was no statistically significant difference between the groups in the grades for 3D ultrasound (P = .83). The scanning time for 3D ultrasound was shorter than that for 2D ultrasound in both groups (Pâ??<â??.05). In the novice group, the ICC of the α angle between the 2D and 3D ultrasound results was 0.34, and in the expert group, it was 0.92. The ICCs were 0.35 and 0.84, respectively when comparing 2D and 3D ultrasound results in the groups. CONCLUSIONS: Three-dimensional ultrasound required less time and showed greater inter-rater reliability than 2D ultrasound for detecting DDH. |
0 | Experimental confirmation of the sheep model for studying the role of calcified fibrocartilage in hip fractures and tendon attachments | Management of Hip Fractures in the Elderly | Research has shown that there is a dramatic increase in the fractional area of calcified fibrocartilage from tendon and capsular insertions on the human femoral neck (Vajda and Bloebaum, 1999; Shea et al., 2001b). Additional information regarding the properties of the proximal femur's cortical shell, gained from the use of an animal model, may result in a better understanding of elderly hip fracture since the cortical shell is a significant contributor to the strength of the proximal femur. The objective of the present study was to determine if the greater trochanter's tendon insertions of the human, rat, and sheep differ in terms of morphology and mineralization. The tendons of the greater trochanter of the human, rat, and sheep were observed to insert via a fibrocartilage insertion. The mineral content of the human and sheep calcified fibrocartilage was significantly higher than that of the rat calcified fibrocartilage (P < 0.01). Additionally, the mineral content of the rat cortical bone was significantly higher than that of the human cortical bone (P < 0.01). The mineral content of the calcified fibrocartilage and bone of the human and sheep were not statistically different from each other. There were also more similarities between the bone structure and lacunae density of the human and sheep than between the human and the rat. This suggests that the tendon insertions of the sheep are a better model than the tendon insertions of the rat for the investigation of calcified fibrocartilage in elderly hip fractures |
0 | Complex Tears, Extrusion, and Larger Excision Are Prognostic Factors for Worse Outcomes 1 and 2 Years After Arthroscopic Partial Meniscectomy for Degenerative Meniscal Tears: A Secondary Explorative Study of the Surgically Treated Group From the Odense-Oslo Meniscectomy Versus Exercise (OMEX) Trial | AMP (Acute Meniscal Pathology) | BACKGROUND: Few studies have examined morphological findings from preoperative magnetic resonance imaging (MRI) and arthroscopic findings as prognostic factors for outcomes 1 and 2 years after arthroscopic partial meniscectomy (APM).
PURPOSE/HYPOTHESIS: The purpose was to evaluate prognostic factors of preoperative findings from MRI and arthroscopic evaluation on lower extremity performance at 1 year and patient-reported outcomes at 1 to 2 years after APM. The hypothesis was that medial compartment abnormalities would be prognostic for 1- and 2-year functional outcomes.
STUDY DESIGN: Cohort study; Level of evidence, 2.
METHODS: This secondary analysis from the OMEX (Odense-Oslo Meniscectomy Versus Exercise) trial included 40 patients treated surgically. Regression analyses with adjustments for age, sex, and body mass index explored associations between MRI findings (tear complexity and extrusion), arthroscopic findings (tear length, cartilage injury, and amount of excised meniscal tissue), and the following: lower extremity performance tests and thigh muscle strength at 1 year and the 5 Knee injury and Osteoarthritis Outcome Score (KOOS) subscales at 1 and 2 years.
RESULTS: A complex meniscal tear was a significant and clinically relevant prognostic factor for worse KOOS Symptoms subscores at 2 years (mean, 14.1 points [95% CI, 6.1-22.2]). Meniscal extrusion of at least 11%, 25%, and 20% were significant and clinically relevant prognostic factors for worse KOOS Activities of Daily Living (ADL) subscores at 1 year and worse KOOS Sports and Recreation (Sports/Rec) subscores at 1 and 2 years, respectively. Tear lengths of at least 7.0 mm, 6.7 mm, and 6.5 mm were significant and clinically relevant prognostic factors for better KOOS Symptoms subscores at 1 year and better KOOS Sports/Rec subscores at 1 and 2 years, respectively. A cartilage injury in the medial compartment was a significant and clinically relevant prognostic factor for worse KOOS ADL and Quality of Life (QoL) subscores at 2 years (mean, 10.4 and 19.4 points, respectively [95% CI, 3.4-17.4 and 7.7-31.1, respectively]). More than 20% meniscal tissue excised was a significant and clinically relevant prognostic factor for worse KOOS Pain, Symptoms, ADL, and Sports/Rec subscores at 1 and 2 years (mean, 8.9-41.5 points [95% CI, 2.2-15.5 to 21.0-62.0]) and worse KOOS QoL subscores at 2 years (mean, 25.3 points [95% CI, 13.6-37.0]).
CONCLUSION: Complex meniscal tears, larger extrusion, cartilage injuries, and larger meniscal excision were significant and clinically relevant prognostic factors for worse outcomes 1 and 2 years after APM.
REGISTRATION: NCT01002794 (ClinicalTrials.gov identifier). |
1 | Prevalence of Rotator Cuff Atrophy and Fatty Infiltration in Patients Undergoing Total Shoulder Arthroplasty | Glenohumeral Joint OA | Background: Rotator cuff fatty infiltration and atrophy are risk factors for worse outcomes after total shoulder arthroplasty (TSA). The purpose of this study is to evaluate the prevalence of preoperative fatty infiltration and atrophy in TSA patients compared to control patients without glenohumeral osteoarthritis. Methods: We retrospectively identified 30 patients undergoing TSA for primary glenohumeral arthritis who had preoperative magnetic resonance imaging. TSA patients were matched by age and sex with control patients without arthritis or full-thickness rotator cuff tears. Blinded observers graded fatty infiltration of the 4 rotator cuff muscles and measured supraspinatus atrophy by the occupation ratio. A multivariate analysis was used to correlate arthritis, age, sex, and body mass index with rotator cuff atrophy and fatty infiltration. Results: Goutallier grade � 2 fatty infiltration was seen in at least one muscle for 13/30 (43%) TSA patients and 1/30 (3%) control patients (P <.01). The average supraspinatus fossa occupation ratio was 0.72 ± 0.24 in the TSA group compared to 0.92 ± 0.23 for controls (P <.01). Moderate to severe supraspinatus muscle atrophy (occupation ration < 0.6) was observed in 10/30 (33%) TSA patients and 0/30 (0%) controls. Glenohumeral arthritis was an independent predictor of atrophy and fatty infiltration (P <.01). Age, sex, and body mass index were not significantly correlated with atrophy or fatty infiltration. Conclusion: Glenohumeral arthritis is associated with rotator cuff atrophy and fatty infiltration. In the absence of rotator cuff tendon tearing, glenohumeral arthritis may contribute to the pathophysiology of rotator cuff muscle degeneration. |
1 | Reduction mammaplasty by central pedicle flap with short submammary scar | Reduction Mammoplasty for Female Breast Hypertrophy | Reduction mammaplasty was performed in 30 patients by combining the central pedicle flap method with the short submammary scar (3-S) technique to avoid the common drawbacks of currently popular dermoglandular procedures. Reduction was accomplished by using perforating vascular branches from the pectoralis major muscle and its fascia supplying the nipple and breast parenchyme instead of the subdermal plexus. The central vascular pedicle supplying the nipple-areola complex was preserved. Only the periphery of the breast parenchyme was resected circumferentially, with the exception of the inferolateral portion, so as not to injure the sensory nerve. The remaining breast parenchyme was preserved in an inverted cone shape. The nipple-areola complex was safely transposed with great freedom, and the amount of resection was accurately adjusted for symmetry. No cases of nipple-areola complex sensory change occurred postoperatively, and lactation is possible because of preservation of the lactiferous ducts. The length of postoperative scars was reduced by using the short submammary scar technique. We believe this combined method is ideal in patients requiring resections ranging from 200 to 600 g per breast with good skin elasticity and moderate degree of ptosis. |
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