recall
int64 0
1
| article_title
stringlengths 5
500
| topic
stringlengths 21
84
| abstract
stringlengths 2
65.8k
|
|---|---|---|---|
0 | Hip dysplasia screening - epidemiological data from Valcea County | Developmental Dysplasia of the Hip 2020 Review | RATIONALE: :In its most severe form, developmental dysplasia of the hip (DDH) is one of the most common congenital malformations. Uncorrected developmental dysplasia of the hip is associated with long-term morbidity such as gait abnormalities, chronic pain, and degenerative arthritis. AIMS: (1) to identify the risks and predisposing factors involved in DDH (2) to define the incidence of the disease locally; (3) to emphasize the importance of ultrasonography in early diagnosis of DDH. METHODS AND RESULTS: 1021 newborns in the Neonatal Department of Valcea County Emergency Hospital were analyzed. The information contained in the observation sheets was collected and upon this, the ultrasound was performed accordingly to Graf's classification. The following parameters were analyzed: sex, area of origin, gestational age, birthweight, type of delivery, parturition. Out of 1021 newborns, 27 had an abnormal ultrasound examination. 20 infants were diagnosed with DDH. Regarding the risk factors: cephalic delivery was associated with a lower risk/ the lowest of DDH (with p=0.045 for the right hip and p=0.001 for the left hip). Increased gestational age and increased birthweight were incriminating factors in the occurrence of DDH. DISCUSSION: Ultrasound imaging has become an accepted tool for accurately diagnosing DDH. |
1 | Blueberries Improve Pain, Gait Performance, and Inflammation in Individuals with Symptomatic Knee Osteoarthritis | OAK 3 - Non-arthroplasty tx of OAK | Osteoarthritis (OA) is the most common joint disorder in the world and is the most frequent cause of walking related disability among older adults in the US, which brings a significant economic burden and reduces quality of life. The initiation and development of OA typically involves degeneration or progressive loss of the structure and function of articular cartilage. Inflammation is one of the major drives of the progression of OA. Dietary polyphenols have been studied for their antiâ?inflammatory properties and potential anabolic effects on the cartilage cells. Blueberries are widely consumed and are high in dietary polyphenols, therefore regular consumption of blueberries may help improve OA. The purpose of the present study was to examine the effect of freeze dried whole blueberries on pain, gait performance, and inflammation in individuals with symptomatic knee OA. In a randomized, doubleâ?blind trial, adults age 45 to 79 with symptomatic knee OA, were randomized to either consume 40 g freezeâ?dried blueberry powder (n = 33) or placebo powder (n = 30) daily for four months. Blood draws and assessment of pain and gait were conducted at baseline, two months, and four months. Western Ontario McMaster Osteoarthritis Index (WOMAC) questionnaires were used to assess pain and GAITRite® electronic walkway was used to evaluate gait spatiotemporal parameters. WOMAC total score and subâ?groups, including pain, stiffness, and difficulty to perform daily activities decreased significantly in the blueberry treatment group (p < 0.05), but improvement of WOMAC total score and difficulty to perform daily activities were not observed in the placebo group. Normal walking pace single support percentage for both limbs increased (p = or < 0.007), while double support percentage for both limbs decreased in the blueberry treatment group (p = or < 0.003). No significant changes were observed in plasma concentrations of tumor necrosis factor (TNF)â?α, interleukin (IL)â?1β, ILâ?6, ILâ?10, ILâ?13, matrix metalloproteinases (MMP)â?3, MMPâ?13, and monocyte chemoattractant proteinâ?1 (MCPâ?1) in both treatment groups. However, an increasing trend for ILâ?13 concentration and a decreasing trend in MCPâ?1 concentration were noted in the blueberry group. The findings of this study suggest that daily incorporation of whole blueberries may reduce pain, stiffness, and difficulty to perform daily activities, while improving gait performance, and would therefore improve quality of life in individuals with symptomatic knee OA. |
0 | Pain control after total hip arthroplasty: a randomized trial determining efficacy of fascia iliaca compartment blocks in the immediate postoperative period | AAHKS (8) Anesthetic Infiltration | INTRODUCTION: Pain control after total hip arthroplasty (THA) is an essential component of patient satisfaction. Published studies suggest postoperative fascia iliaca blocks provide additional benefit when used in conjunction with a multi modal pain regimen; however, there have been no studies that describe single shot fascia iliaca blocks after a miniâ?posterior surgical approach to the hip and their impact on postoperative function and pain. The purpose of this randomized trial was to identify if fascia iliaca blockade, when used in conjunction with a multimodal pain control regimen, reduces postoperative narcotic consumption and improves early functional outcomes in primary THA performed through the miniâ?posterior approach. METHODS: Patients were recruited during preoperative clinic visits starting in September 2017 and scheduled to end in September 2018. Eligible patients had to receive a primary THA with epidural anesthesia. All arthroplasties were performed using a miniâ?posterior approach to the hip without the use of periarticular injection. In the recovery room, patients were randomized to either receive a fascia iliaca compartment block with 40mL of 0.5% bupivacaine or a placebo block, performed by a regional anesthesiologist. The patients and surgical team were blinded to the procedure. Patients received the same multiâ?modal pain management and rapid recovery protocols postoperatively. VAS pain scores (0â?10) were recorded at 30 minute intervals initially after surgery, then at 4 hour intervals after the first 12 hours. The total narcotic requirement (milliequivalents of morphine) was calculated for each patient. Functional outcomes including distance walked during therapy, timedâ?upâ?andâ?go testing, and quadriceps strength were recorded for each patient. After discharge, the patients completed PROMIS pain and physical function surveys at 4 weeks postoperatively. The primary outcomes in this study were pain scores and narcotic consumption in the first 48 hours postoperatively. Secondary outcomes were distance walked with therapy during the first session, the timedâ?upâ?andâ?go test score on postoperative day 1, incidence of quadriceps weakness, and pain scores at the first postoperative visit. Tâ?tests were used to compare continuous variables between treatment groups, and Chi square tests were used to compare categorical variables between treatment groups (a = 0.05). RESULTS: Recruitment started in September 2017 and is estimated to end in September 2018. Fiftyâ?seven out of a target 120 patients were included in this analysis. There was no difference in the average pain scores at any time interval between the placebo and block groups (p = 0.1â?0.83), and there was no difference in pain scores during the week prior to the first postoperative visit (6.88 vs. 6.06, p =0.34). There was no difference between the preâ?block and postâ?block pain scores in the block group (4.26 vs. 4.23, p= 0.97). There was no difference in the morphine equivalents consumed between the placebo and block group during the first 4 hours (16.6 vs. 13.3, p = 0.3), 12 hours (38.2 vs. 36.9, p =0.81), or 24 hours (80.4 vs. 80.4, p = 1) postoperatively. Total morphine equivalents consumed was also the same between the placebo and block groups (90.0 vs. 86.0, p=0.77). Functional testing showed no difference between the two groups in regards to distance walked during the first therapy session (66.4 vs. 53.3 ft, P=0.29) and timedâ?upâ?andâ?go testing (50.5 vs. 56.9 sec, P = 0.52). There was an increased incidence of quadriceps weakness between the placebo and block groups (0/27 vs. 8/30, p = 0.004). DISCUSSION AND CONCLUSION: This preliminary analysis shows that the fascia iliaca compartment block does not improve functional performance and does not decrease pain levels or narcotic usage after miniâ?posterior THA and can increase the risk of quadriceps weakness postoperatively. Based on these results we do not recommend routine fascia iliaca compartment blocks in patients after THA performed using the miniâ?poster or approach. |
0 | Correlation between the rotational degree of the dial test and arthroscopic and physical findings in posterolateral rotatory instability | AMP (Acute Meniscal Pathology) | Diagnosing posterolateral rotatory instability (PLRI) is difficult because it occurs rarely, takes time to manifest, and no single definitive tool exists in diagnosing posterolateral corner injuries. We sought to evaluate the correlation between rotational degrees in the dial test and physical and arthroscopic findings that surgically verified PLRI in the knee joint. Patients (n = 67) who were diagnosed as having PLRI and received posterolateral reconstruction (n = 57) and repair (n = 10) from 1998 to 2006 were recruited. Preoperative physical findings were evaluated under anesthesia, and arthroscopic findings during surgeries were analyzed. A dial test with post-anesthesia (spinal or general) was conducted. We divided patients into three subgroups (A: <15 degrees, B: 15-20 degrees, and C: >20 degrees), according to differences in rotational degrees in the dial test. All tests showed significant differences among the three groups and positive findings increased as the rotational degrees increased. No test showed a statistically significant difference in the specific group. All tests except for popliteal hiatus widening showed significant differences among the three groups and positive findings also increased as the rotational degrees increased. The total incidence and positive rate of each physical examination and the popliteal hiatus arthroscopic findings in PLRI significantly increased as the rotational degree in the dial test increased. The number of positive findings on physical examination was larger than the number of positive findings by arthroscopy in all three groups. |
0 | Intrarticular infiltration of bupivacaine and magnesium sulfate in distal radius fractures. A pilot study | Distal Radius Fractures | BACKGROUND: The distal radius fracture represent until 15% of all bone injuries in adults. The key in the recovery of mobility and functional outcomes are rehabilitation. The intraâ?articular application of magnesium sulphate has been used for postoperative pain. The objective was to determinate the improvement in pain and functional outcome of patients with distal radius fracture using intraâ?articular magnesium sulphate. MATERIAL AND METHODS: Patients with distal radius fracture treated with percutaneous pinning and cast immobilization was included and randomized into two groups. The group 1 was applied 1.0 ml of magnesium sulphate and 1.5 ml of injectable water; meanwhile the group 2, the water was replaced with 1 ml of bupivacaine (5 mg/ml). The intraâ?articular infiltration was applied at the end of immobilization. Pain, functionality and movement of the wrist was evaluated for two weeks. RESULTS: Twenty patients, 8 male and twelve females, with a mean age of 53 years (± 17 SD) was evaluated. A significative reduction of pain during the first minute and at three minutes after intraâ?articular infiltration in group 2 (p 0.05). Both groups presented better articular outcomes at the two weeks (p 0.05), and a better articular movement at same point (p 0.05). CONCLUSIONS: The intraâ?articular infiltration of magnesium sulphate plus bupivacaine help to reduces the pain. |
0 | Novel therapies for metastatic castrate-resistant prostate cancer | MSTS 2018 - Femur Mets and MM | Recent advances in tumor biology have made remarkable achievements in the development of therapy for metastatic castrate-resistant prostate cancer. These advances reflect a growing appreciation for the role of the tumor microenvironment in promoting prostate cancer progression. Prostate cancer is no longer viewed predominantly as a disease of abnormally proliferating epithelial cells but rather as a disease of complex interactions between prostate cancer epithelial cells (epithelial compartment) and the surrounding tissues (stromal compartment) in which they reside. For example, prostate cancers frequently metastasize to bone, an organ that contains a microenvironment rich in extracellular matrix proteins and stromal cells including hematopoietic cells, osteoblasts, osteoclasts fibroblasts, endothelial cells, adipocytes, immune cells, and mesenchymal stem cells. Multiple signaling pathways provide crosstalk between the epithelial and the stromal compartments to enhance tumor growth, including androgen receptor signaling, tyrosine kinase receptor signaling, and immune surveillance. The rationale to disrupt this "two-compartment" crosstalk has led to the development of drugs that target tumor stromal elements in addition to the cancer epithelial cell. |
0 | Complications in posteromedial arthroscopic suture of the medial meniscus | AMP (Acute Meniscal Pathology) | INTRODUCTION: All-inside posteromedial suture for lesions of the posterior horn of the medial meniscus in anterior cruciate ligament (ACL) repair provides effective freshening and good healing.
HYPOTHESIS: The posteromedial portal provides satisfactory healing rates without increasing morbidity or complications rates.
MATERIAL AND METHODS: Intra- and postoperative complications were collected for a consecutive single-center series of 132 patients undergoing posteromedial hook suture of the medial meniscus in ACL repair. Meniscal healing was assessed as the rate of recurrence of symptomatic medial meniscus lesions (Barret criteria) and on revision surgery, if any, in terms of the aspect and extent of the iterative lesion. The severity of any sensory disorder was assessed by questionnaire.
RESULTS: The intraoperative complications rate was 1.5% (2 saphenous vein punctures). At a mean 31months (range, 28-35months), there was no loss to follow-up. Twelve patients (9%) showed symptomatic recurrence of the medial meniscus lesion, requiring 10 repeat surgeries. In 6 cases (4.5%), the iterative lesion involved a smaller, more central part of the meniscus anterior to the sutures, of "postage-stamp" effect, possibly implicating the suture hook and/or non-absorbable sutures. There were no cases of infection or fistula. Postoperative hematoma occurred in 7% of patients. In total, 1.8% reported dysesthesia areas equal to or greater than the size of a credit card (45cm<sup>2</sup>).
DISCUSSION: Some retears, or "partial failures", may implicate a new lesion caused by the suture hook and possibly prolonged by non-resorbable sutures. Hematoma and sensory disorder rates were comparable to those reported in isolated ACL repair without posteromedial portal.
CONCLUSION: The present results show that posteromedial arthroscopic hook suture in posterior medial meniscus tear provides good healing rates without increased morbidity due to the supplementary portal.
Level of evidence: Iv. |
0 | Vertical Continuous Meniscal Suture Technique | AMP (Acute Meniscal Pathology) | Meniscal injuries are common in the population, representing the major cause of functional impairment in the knee. Vertical longitudinal injuries of the meniscus can be stable or unstable. When extensive, they are commonly unstable and can lead to clinical signs of significant functional disability. Vertical longitudinal injuries have the best prognosis for repair, especially when occurring in the meniscal periphery, called the red-red zone. A recently developed type of meniscal suture device called Meniscus 4 A-II enables the surgeon to perform a meniscal suture from the inside-out continuously, reducing surgical time. Because it allows the surgeon to use a single and inexpensive device to repair the entire injury, costs are significantly reduced. Here, an approach to carry out continuous meniscal repair with vertical sutures is described. This technique warrants excellent stability to the meniscal repair, increasing the chances of a successful outcome. We believe that the popularization of the repair technique from the inside out using the Meniscus 4-All device will help many surgeons around the world save menisci that otherwise would have a great chance of being excised, since it is a cheap, reproducible, and easy-to-handle device. |
0 | Computer navigation for total knee arthroplasty reduces revision rate for patients less than sixty-five years of age | PJI DX Updated Search | Background: Computer navigation for total knee arthroplasty has improved alignment compared with that resulting from non-navigated total knee arthroplasty. This study analyzed data from the Australian Orthopaedic Association National Joint Replacement Registry to examine the effect of computer navigation on the rate of revision of primary total knee arthroplasty. Methods: The cumulative percent revision following all non-navigated and navigated primary total knee arthroplasties performed in Australia from January 1, 2003, to December 31, 2012, was assessed. In addition, the type of and reason for revision as well as the effect of age, surgeon volume, and use of cement for the prosthesis were examined. Kaplan-Meier estimates of survivorship were used to describe the time to first revision. Hazard ratios (HRs) from Cox proportional hazards models, with adjustment for age and sex, were used to compare revision rates. Results: Computer navigation was used in 44,573 (14.1% of all) primary total knee arthroplasties, and the rate of its use increased from 2.4% in 2003 to 22.8% in 2012. Overall, the cumulative percent revision following non-navigated total knee arthroplasty at nine years was 5.2% (95% confidence interval [CI] = 5.1 to 5.4) compared with 4.6% (95% CI = 4.2 to 5.1) for computer-navigated total knee arthroplasty (HR = 1.05 [95% CI = 0.98 to 1.12], p = 0.15). There was a significant difference in the rate of revision following non-navigated total knee arthroplasty compared with that following navigated total knee arthroplasty for younger patients (HR = 1.13 [95% CI = 1.03 to 1.25], p = 0.011). Patients less than sixty-five years of age who had undergone non-navigated total knee arthroplasty had a cumulative percent revision of 7.8% (95% CI = 7.5 to 8.2) at nine years compared with 6.3% (95% CI = 5.5 to 7.3) for those who had undergone navigated total knee arthroplasty. Computer navigation led to a significant reduction in the rate of revision due to loosening/lysis (HR = 1.38 [95% CI = 1.13 to 1.67], p = 0.001), which is the most common reason for revision of total knee arthroplasty. Conclusions: Computer navigation reduced the overall rate of revision and the rate revision for loosening/lysis following total knee arthroplasty in patients less than sixty-five years of age. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence |
0 | An Assessment of United States Dermatology Practices during the COVID-19 Outbreak | Coronavirus Disease 2019 (COVID-19) | Objectives: The COVID-19 outbreak is a serious threat to public health and social distancing on the part of individuals can help contain the epidemic. It is unknown if dermatologists are assisting with the public health officials' recommendations for social distancing by closing their practice or limiting their practice to the treatment of emergency conditions. This study examines the activity level of dermatology practices during the United States COVID-19 outbreak.Methods: We performed scripted phone calls to 60 dermatology practices in six different counties in the United Stated during the COVID-19 outbreak. We assessed if practices are open and if they are serving patients with urgent and non-urgent conditions.Results: Of the 60 dermatologists selected for the study, 55 were successfully contacted (92% contact rate). Of these practices, 29 (53%) were open, 17 (31%) were only seeing urgent patients and 9 (16%) were closed. New York, New York had 2 (20%) open offices which was the lowest proportion of any county (p=.04). Counties with higher prevalence had fewer open offices (p<.01, R(2)=.7).Conclusions: Many practices have restricted their level of operation especially in higher areas of COVID-19 prevalence, likely to help facilitate social distancing. |
0 | Mucopolysaccharidosis type VI in Spain | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | Background: Mucopolysaccharidosis VI is a progressive autosomal recessive lysosomal storage disorder. Since 2006 enzyme replacement therapy is available which has improved the prognosis of these patients. In Spain there are 11 patients withMPS VI, all under treatment with ERT. The aim of this review is to present Spanish patients and their evolution before and after therapy with ERT. Patients: A retrospective, descriptive study of 11 patients diagnosed with MPS VI confirmed by enzymatic and/or genetic studies Results: 11 patients have been diagnosed with actual ages from 2 to 22 years. Median age at diagnosis was 2 years and at the beginning of therapy 4.5 years. At the time of diagnosismost patients had characteristic phenotype (9/11), signs of skeletal spine involvement (7/11) and hepatomegaly (7/11). All patients started ERT between 18 months and 15 years of age. They have required several surgeries: Porth-a-cath, adenoidectomy, tympanic tubes, carpal tunnel surgery and VP shunt. Conclusions: All patients have presented a positive clinical course with ERT, with no severe side effects. Despite the benefits of therapy they still need amultidisciplinary follow-up because of the complications that are not reversible with ERT, some of which require various surgical interventions |
0 | Breast cancer (non-metastatic) | MSTS 2018 - Femur Mets and MM | INTRODUCTION: Breast cancer affects at least 1 in 10 women in the UK, but most present with primary operable disease, which has an 80% 5-year survival rate overall.
METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions after breast-conserving surgery for ductal carcinoma in situ? What are the effects of treatments for primary operable breast cancer? What are the effects of interventions in locally advanced breast cancer (stage IIIB)? We searched: Medline, Embase, The Cochrane Library and other important databases up to February 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS: We found 79 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: adding chemotherapy (cyclophosphamide/methotrexate/ fluorouracil and/or anthracycline and/or taxane-based regimens), or hormonal treatment to radiotherapy; adjuvant treatments (aromatase inhibitors, adjuvant anthracycline regimens, tamoxifen); axillary clearance; axillary dissection plus sentinel node dissection; axillary radiotherapy; axillary sampling; combined chemotherapy plus tamoxifen; chemotherapy plus monoclonal antibody (trastuzumab); extensive surgery; high-dose chemotherapy; hormonal treatment; less extensive mastectomy; less than whole breast radiotherapy plus breast conserving surgery; multimodal treatment; ovarian ablation; primary chemotherapy; prolonged adjuvant combination chemotherapy; radiotherapy (after breast-conserving surgery, after mastectomy, plus tamoxifen after breast-conserving surgery, to the internal mammary chain, and to the ipsilateral supraclavicular fossa, and total nodal radiotherapy); sentinel node biopsy; and standard chemotherapy regimens. |
0 | Success of meniscal repair at anterior cruciate ligament reconstruction | AMP (Acute Meniscal Pathology) | BACKGROUND: Meniscal repair is performed in an attempt to prevent posttraumatic arthritis resulting from meniscal dysfunction after meniscal tears. The socioeconomic implications of premature arthritis are significant in the young patient population. Investigations and techniques focusing on meniscus preservation and healing are now at the forefront of orthopaedic sports medicine.
HYPOTHESIS: Concomitant meniscal repair with anterior cruciate ligament reconstruction is a durable and successful procedure at 2-year follow-up.
STUDY DESIGN: Case series; Level of evidence, 4.
METHODS: All unilateral primary anterior cruciate ligament reconstructions entered in 2002 in a cohort who had meniscal repair at the time of anterior cruciate ligament reconstruction were evaluated. Validated patient-oriented outcome instruments were completed preoperatively and then again at the 2-year postoperative time point. Reoperation after the index procedure was also documented and confirmed by operative reports.
RESULTS: A total of 437 unilateral primary anterior cruciate ligament reconstructions were performed with 82 concomitant meniscal repairs (54 medial, 28 lateral) in 80 patients during the study period. Patient follow-up was obtained on 94% (77 of 82) of the meniscal repairs, allowing confirmation of meniscal repair success (defined as no repeat arthroscopic procedure) or failure. The overall success rate for meniscal repairs was 96% (74 of 77 patients) at 2-year follow-up.
CONCLUSION: Meniscal repair is a successful procedure in conjunction with anterior cruciate ligament reconstruction. When confronted with a "repairable" meniscal tear at the time of anterior cruciate ligament reconstruction, orthopaedic surgeons can expect an estimated >90% clinical success rate at 2-year follow-up using a variety of methods as shown in our study. |
0 | Evaluation of a Hospital at Home scheme for the early discharge of patients with fractured neck of femur | Management of Hip Fractures in the Elderly | The community health services in Southern Derbyshire, in conjunction with an acute hospital, established a pilot scheme for the early discharge of fractured neck of femur patients from hospital to their own homes. The scheme was evaluated by prospectively comparing a group of patients using Hospital at Home (HAH) and a group receiving hospital care only. The main outcomes measured were the proportion of hospital admissions for fractured neck of femur using HAH, length of stay, patient satisfaction, general health status at discharge as measured by the Nottingham Health Profile, and three-month mortality and readmission rates. Costs were calculated based on prices charged by providers of the services. In the first year of the scheme, 76 (18 per cent) of the 432 hospital admissions for fractured neck of femur fitted the selection criteria and agreed to admission to HAH. Thirty-four patients were identified who were suitable for HAH but not admitted to it. The comparison of the 76 HAH patients and 34 hospital patients revealed that HAH patients were discharged from hospital an average of 7 days earlier; patients in both groups were satisfied with the care they received; the general health status of the two groups at discharge was similar, with the exception that HAH patients had better emotional health on discharge from care; the three-month mortality rate was similar in both groups (5 per cent); the readmission rate for HAH patients appeared higher than for hospital patients but this difference was not statistically significant (15.8 per cent versus 8.8 per cent, Fisher's exact test, p = 0.187).(ABSTRACT TRUNCATED AT 250 WORDS) |
0 | Vitality and mental health in disability: Associations with social relationships in persons with spinal cord injury and their partners | DoD PRF (Psychosocial RF) | BACKGROUND: Various social relationship constructs have been proposed to affect mental health. However, these constructs have rarely been studied in a comprehensive way in persons with chronic disabilities and their partners, inhibiting researchers from evaluating their relative importance.
OBJECTIVE: To investigate 1) the variation in the quantity and quality of social relationships in persons with spinal cord injury (SCI) and their partners; 2) dyadic coherence within social relationship constructs; 3) the interrelationships between social relationship constructs; and 4) the associations of social relationship constructs with vitality and mental health.
METHODS: Cross-sectional survey data from 133 couples of persons with SCI and their partners was used. Quantitative (social networks) and qualitative aspects (social support, relationship quality, loneliness, and reciprocity in partnerships) of social relationships were assessed. Correlations were performed to analyse dyadic coherence and interrelationships of social relationship constructs and multivariable regressions were applied to examine associations with vitality and mental health.
RESULTS: Loneliness, larger social networks and higher relationship quality were more prevalent in SCI. All social relationship constructs, apart from loneliness, were more similar within couples than between couples and the interrelationships between different constructs were small. Qualitative aspects of relationships were more important than the quantitative aspects in their associations to vitality and mental health. These associations were most consistent for loneliness, reciprocity and relationship quality in both groups.
CONCLUSIONS: In the long-term management of community functioning in persons with SCI and their partners, the fostering of high quality intimate relationships should take priority. |
0 | Femoral head size is a risk factor for total hip luxation: A study of 42,987 primary hip arthroplasties from the Norwegian Arthroplasty Register | Management of Hip Fractures in the Elderly | On the basis of the Norwegian Arthroplasty Register, which has recorded nearly all primary hip prostheses and revisions in Norway since 1987, we studied risk factors for prosthesis luxation leading to revision. 7 prosthesis brand combinations used in 42,987 primary operations were included from 1987-2000. We found that femoral head size was an important risk factor; 28 mm heads led to revision more often than 32 mm ones (failure rate ratio (FRR) 4.0, 95% confidence interval (CI) 2.2-7.3). Charnley (22 mm head) performed equally well or better than the 28 mm heads. The Exeter stem and cup is the type of prosthesis on the Norwegian market with more than two femoral head sizes (26, 28, 30, 32 mm) and 26 mm heads led to revision due to luxation significantly more often than 30 mm heads (FRR 4.1, 95% CI 2.2-8.1). Old age, preoperative diagnosis, and choice of prosthesis brand combination were also important factors affecting the revision rate due to luxation. A posterior approach increased the risk of revision more than a lateral one (FRR 1.9, 95% CI 1.4-2.5). Gender, trochanteric osteotomy and duration of the operation did not affect the results |
0 | Adductor Canal Block After Total Knee Replacement - a Suture-method Catheter vs a Standard Catheter vs a Single Bolus | AAHKS (9/10) Regional Nerve Blocks | The aim of the study is to compare the clinical effects of three different administration forms for an ACB: repeated intermittent boluses through a Certa catheter (CC) versus repeated boluses through a standard catheter (through the needle) (SC) versus a single bolus (SB). Our dual hypothesis is that repeated boluses through a catheter (either Certa or standard catheter) reduces opioid consumption (primary outcome), as well as reduces pain scores, enhances ambulation and muscle strength compared with a single bolus, and that the Certa catheter is superior to a standard catheter. |
1 | Radiographs late in the follow up of uncomplicated distal radius fractures: are they worth it? Clinical outcome and financial implications | Distal Radius Fractures | Fractures of the distal radius are common. Displacement can quickly lead to secondary osteoarthritis. Early follow up radiographs are subsequently paramount to facilitate for early attempts at reduction. Developing callus eventually makes this impractical. In the absence of complications we propose that radiographs may become obsolete at the later stages of follow up. We investigate whether clinical deformity, range of wrist movement and grip strength are independent of radiographs taken later than 2 weeks into the follow up of uncomplicated cases. Local cases between May 2009 and December 2011 were reviewed. Devised criteria regulated case selection. Data was collected from radiological software and occupational therapy clinical notes. Fractures were placed in short or term follow up groups dependant on whether they were imaged later than 2 weeks into follow up. T-tests compared our outcomes measures between these groups. 138 cases were included; 77 short term; 61 long term. No cases reported visible clinical deformity. There were no significant differences between grip strength or range of wrist movement for the short and long term groups. No cases required intervention for late displacement. Although complications may justify delayed imaging, our results suggest radiographs late in the follow up of uncomplicated distal radius fractures have no impact on our outcome measures. Further studies are required to confirm this. Financial regulation means any potential benefits from the removal of these unnecessary radiographs should be recognised. Established radiological follow up regimes need to be devised. |
0 | Benign fibrous histiocytoma of bone: a report of ten cases and review of literature | MSTS 2022 - Metastatic Disease of the Humerus | The benign fibrous histiocytoma is a rare tumor with only a few descriptions. In order to better define the optimal therapeutic procedure and the necessity of surgery we retrospectively analyzed the patients of the orthopedic department. Benign fibrous histiocytoma occurred in the femur (n = 3), pelvis (n = 2), humerus, tibia, fibula, rib and spine. Pain as the cardinal symptom and a median age of 28 years are factors that differentiate benign fibrous histiocytoma from other metaphyseal fibrous lesions such as the nonossifying fibroma. Radiographic investigation of this entity showed osteolytic lesions with eccentric thinning of the cortex and small fissures. To a variable extent, sclerosis was found in the margin of the lesions. Computer tomography revealed dense soft tissue in the lesions, but one lesion was filled with fluid. The tumor was restricted to bone, with no periosteal or soft tissue reaction. Magnetic resonance imaging showed enhancement of the tumor after administration of contrast medium. All lesions had uniform histological findings. Although no pathologic fracture occurred in any case, local expansion of the tumor was indicated by cortical thinning, small fissures and pain. This implied that the patients needed prophylactic curettage and bone grafting. Surgery restricted to the osteolytic area was sufficient to prevent recurrence. |
0 | Legg-calvé-perthes disease an overview with recent literature | Developmental Dysplasia of the Hip 2020 Review | The evolving knowledge on Legg-Calvé-Perthes (LCP) demonstrates the utility of studying a rare disease systematically by piecing together the biology and mechanics of this condition and applying clinical observations to improve patient care. As treatments of less common diseases are hard to randomize and study in meaningful numbers, long-term study groups have been created to provide insight into this entity that remains an enigma in many aspects. These studies permit a more evidence-approached guide to prognosis and treatment. Meanwhile, basic science research contributes to our understanding of pathophysiology of the disruption and repair processes that lead to LCP, with the goal of clinical translation. This review of LCP aims to give an overview of the condition, with specific focus on recent literature. |
1 | Popliteal artery trauma. Systemic anticoagulation and intraoperative thrombolysis improves limb salvage | DoD LSA (Limb Salvage vs Amputation) | OBJECTIVE: This study was conducted to evaluate those factors associated with popliteal artery injury that influence amputation, with emphasis placed on those that the surgeon can control. SUMMARY BACKGROUND DATA: Generally accepted factors impacting amputation after popliteal artery injury include blunt trauma, prolonged ischemic times, musculoskeletal injuries, and venous disruption. Amputation ultimately results from microvascular thrombosis and subsequent tissue necrosis, predisposed by the paucity of collaterals around the knee. METHODS: Patients with popliteal artery injuries over the 10-year period ending November 1995 were identified from the trauma registry. Preoperative (demographics, mechanism and severity of injury, vascular examination, ischemic times) and operative (methods of arterial repair, venous repair-ligation, anticoagulation-thrombolytic therapy, fasciotomy) variables were studied. Severity of extremity injury was quantitated by the Mangled Extremity Severity Score (MESS). Amputations were classified as primary (no attempt at vascular repair) or secondary (after vascular repair). After univariate analysis, logistic regression analysis was performed to identify the independent risk factors for limb loss. RESULTS: One hundred two patients were identified; 88 (86%) were males and 14 (14%) were females. Forty injuries resulted from blunt and 62 from penetrating trauma. There were 25 amputations (25%; 11 primary and 14 secondary). Patients with totally ischemic extremities (no palpable or Doppler pulse) more likely were to be amputated (31% vs. 13%; p < 0.04). All requiring primary amputations had severe soft tissue injury and three had posterior tibial nerve transection; the average MESS was 7.6. Logistic regression analysis identified independent factors associated with secondary amputation: blunt injury (p = 0.06), vein injury (p = 0.06), MESS (p = 0.0001), heparin-urokinase therapy (p = 0.05). There were no complications with either heparin or urokinase. CONCLUSIONS: Minimizing ischemia is an important factor in maximizing limb salvage. Severity of limb injury, as measured by the MESS, is highly predictive of amputation. Intraoperative use of systemic heparin or local urokinase or both was the only directly controllable factor associated with limb salvage. The authors recommend the use of these agents to maximize limb salvage in association with repair of popliteal artery injuries. |
0 | TruFit CB bone plug: chondral repair, scaffold design, surgical technique and early experiences | Diagnosis and Treatment of Osteochondritis Dissecans AUC | The TruFit CB osteochondral scaffold plug is a commercially available and licensed scaffold implant for the treatment of chondral and osteochondral defects of the knee. A number of surgical techniques have been described that are designed to achieve neocartilaginous tissue cover of a chondral defect, but many result in fibrocartilage tissue, not type II collagen hyaline cartilage. This fibrocartilage layer can fail with high shear forces in the knee joint, and lead to ongoing articular surface irregularity and subsequent secondary arthritic change. Recent research and clinical interest has focused on employing tissue-engineering techniques utilizing scaffolds in an attempt to obtain cartilage repair tissue that is histologically and biomechanically superior. The TruFit CB implant is one such device. This article describes the techniques of attempted chondral repair and the problems that can be experienced. Current concepts in chondral scaffold design are discussed, and the surgical technique and early experiences with the TruFit CB implant are presented |
0 | Analysis of fractures of the proximal femur in the Jordanian population | Management of Hip Fractures in the Elderly | BACKGROUND: Proximal femur fractures represent a challenging medical problem worldwide. In recent years numerous reports have documented a progressive increase in the incidence of hip fractures. In Jordan, this problem has not received sufficient attention, and to my knowledge, this is the first study to address the problem. OBJECTIVE: To analyze the predisposing factors involved in the occurrence of proximal femur fractures seen at a major medical center in Jordan. METHODS: A retrospective analysis was conducted of all patients admitted with hip fractures to King Hussein Hospital and the Royal Jordanian Rehabilitation Center at the King Hussein Medical Center over a 2 year period (1 January 1995 to 31 December 1996). We determined the associated chronic diseases and medications, mechanisms of injury, types of fractures and other circumstances in order to suggest preventive measures to decrease the incidence of this clinical problem. RESULTS: We identified 216 cases of fracture: 43% occurred in people over the age of 80 years, 95% were due to low energy injuries (falls), and 69.5% occurred in females. Two or more co-morbid medical conditions were present in 70% of the cases. CONCLUSIONS: Since fractures of the hip in the study population in Jordan occurred predominantly as low energy injuries in the elderly, preventive measures should focus on fall avoidance |
1 | External Fixation Versus Hemiartroplasty In Unstable Intertrochanteric Hip Fractures Of The Elderly | Hip Fx in the Elderly 2019 | To compare two alternative methods : external fixation (EF) and hemiarthroplasty (HA) in elderly patients with unstable intertrochanteric hip fractures. Forty-two patients with Orthopaedic Trauma Association type 31A2-2 or 31A2-3 fractures treated between January 2007 and December 2010 were included. Twenty-two patients underwent hemiarthroplasty and twenty patients underwent external fixation. The mean length of stay in the operation room was 45 minutes and 108 minutes in the EF and HA groups, respectively (p<0.05). The mean postoperative length of hospital stay was 2.7 days in the EF group and 4.9 days in the HA group (p<0.05). The total length of hospital stay, functional scores and mortality rates were not different. Findings of the current study comparing EF and HA in a limited number of non-randomized elderly patients with unstable intertrochanteric fracture indicated that the EF method, when performed in a sufficiently stable manner, might be a valuable alternative to HA since it is less aggressive and cheaper. |
0 | Functional performance and inflammatory cytokines after squat exercises and whole-body vibration in elderly individuals with knee osteoarthritis | OAK 3 - Non-arthroplasty tx of OAK | OBJECTIVE: To investigate the effects of squat exercises combined with whole-body vibration on the plasma concentration of inflammatory markers and the functional performance of elderly individuals with knee osteoarthritis (OA).
DESIGN: Clinical, prospective, randomized, single-blinded study.
SETTING: Exercise physiology laboratory.
PARTICIPANTS: Elderly subjects with knee OA (N=32) were divided into 3 groups: (1) squat exercises on a vibratory platform (platform group, n=11); (2) squat exercises without vibration (squat group, n=10); and (3) the control group (n=11).
INTERVENTIONS: The structured program of squat exercises in the platform and squat groups was conducted 3 times per week, on alternate days, for 12 weeks.
MAIN OUTCOME MEASURES: Plasma soluble tumor necrosis factor-alpha receptors 1 (sTNFR1) and 2 (sTNFR2) were measured using immunoassays (the enzyme-linked immunosorbent assay method). The Western Ontario and McMaster Universities Osteoarthritis Index questionnaire was used to evaluate self-reported physical function, pain, and stiffness. The 6-minute walk test, the Berg Balance Scale, and gait speed were used to evaluate physical function.
RESULTS: In the platform group, there were significant reductions in the plasma concentrations of the inflammatory markers sTNFR1 and sTNFR2 (P<.001 and P<.05, respectively) and self-reported pain (P<.05) compared with the control group, and there was an increase in balance (P<.05) and speed and distance walked (P<.05 and P<.001, respectively). In addition, the platform group walked faster than the squat group (P<.01).
CONCLUSIONS: The results suggest that whole-body vibration training improves self-perception of pain, balance, gait quality, and inflammatory markers in elderly subjects with knee OA. |
1 | The refractory period of transmission in patients with carpal tunnel syndrome | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | In patients with the carpal tunnel syndrome (CTS) and in control subjects, pairs of shocks at intervals of 0.8 msec and 1.0 msec were used to stimulate the median nerve just above the wrist. Nerve action potentials were recorded at the elbow and from the index or middle finger. In patients but not in controls, recordings from the finger frequently showed loss of the second action potential of the pair, although a second action potential was present at the elbow. In these cases it seemed likely that impulse transmission through the carpal tunnel had failed because the damaged nerve at the level of the lesion had an increased refractory period of transmission (RPT) compared with its refractory period under the stimulating cathode. The possible diagnostic use of RPT measurement in CTS patients is discussed |
0 | Arthroscopic distal clavicle resection | Glenohumeral Joint OA | The acromioclavicular joint is a potential source of pain in the shoulder. There are a variety of disorders that can affect this joint, including distal clavicle osteolysis, posttraumatic arthritis, osteoarthritis, and rheumatoid arthritis. Nonoperative treatment for this condition with nonsteroidal medication and activity modification can alleviate the pain. When conservative treatment is exhausted, surgical resection of the distal clavicle is often necessary. Arthroscopic resection of the distal clavicle preserves the acromioclavicular ligaments to prevent postoperative distal clavicle instability. The procedure is performed in either the beach chair or lateral position and requires the use of a shaver, electrocautery, and a burr for soft tissue and debridement and bone resection. © 2004 Elsevier Inc. All rights reserved. |
0 | The fat pad sign following elbow trauma in adults: its usefulness and reliability in suspecting occult fracture | The Treatment of Pediatric Supracondylar Humerus Fractures AUC | OBJECTIVE: An elbow joint effusion with no fracture seen on radiographs after acute trauma has become synonymous with occult fracture. This study evaluates the incidence of fracture in such cases as determined by MR imaging and the predictive value of an elbow joint effusion. METHODS: Twenty consecutive patients whose posttrauma elbow radiographs showed an effusion but no fracture and who were suitable for MR imaging were recruited. The elbow effusion size, represented by anterior and posterior fat pad displacement, was measured from the initial lateral elbow radiograph. Suitable candidates underwent MR imaging using a bone marrow sensitive sequence. The time between injury and MR imaging ranged from 0 to 12 days (mean 4 days). RESULTS: Seventy-five percent of the 20 patients who underwent MR imaging had radiographically occult fractures identified. Some (86.6%) of these fractures were located in the radial head, 6.7% were in the lateral epicondyle, and 6.7% were in the olecranon. Ninety percent had evidence of bone marrow edema. Fifteen percent had collateral ligament disruption identified on MR imaging, and 5% had a loose body. There was no change in patient management as a result of the additional imaging. The anterior fat pad displacement ranged from 5 to 15 mm (mean 9.25), and the posterior fat pad was elevated from 1 to 6 mm (mean 3.2). CONCLUSION: Our data using MR imaging suggests that fat pad elevation in the presence of recent trauma is frequently associated with a fracture. The size of the effusion, anterior/posterior fat pad elevation, or a combination of both does not correspond to the likelihood of an underlying fracture. MR imaging reveals a broad spectrum of bone and soft tissue injury beyond that recognizable on plain radiographs as demonstrated by all patients in this study |
0 | Interventions for the management of temporomandibular joint osteoarthritis | SR for PM on OA of All Extremities | Background: Osteoarthritis (OA) is the most common form of arthritis of the temporomandibular joint (TMJ), and can often lead to severe pain in the orofacial region. Management options for TMJ OA include reassurance, occlusal appliances, physical therapy, medication in addition to several surgical modalities.Objectives: To investigate the effects of different surgical and non-surgical therapeutic options for the management of TMJ OA in adult patients.Search methods: We searched the following databases: the Cochrane Oral Health Group Trials Register (to 26 September 2011); CENTRAL (The Cochrane Library 2011, Issue 3); MEDLINE via OVID (1950 to 26 September 2011); EMBASE via OVID (1980 to 26 September 2011); and PEDro (1929 to 26 September 2011). There were no language restrictions.Selection criteria: Randomised controlled trials (RCTs) comparing any form of non-surgical or surgical therapy for TMJ OA in adults over the age of 18 with clinical and/or radiological diagnosis of TMJ OA according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) guideline or compatible criteria.Primary outcomes considered were pain/tenderness/discomfort in the TMJs or jaw muscles, self assessed range of mandibular movement and TMJ sounds. Secondary outcomes included the measurement of quality of life or patient satisfaction evaluated with a validated questionnaire, morphological changes of the TMJs assessed by imaging, TMJ sounds assessed by auscultation and any adverse effects.Data collection and analysis: Two review authors screened and extracted information and data from, and independently assessed the risk of bias in the included trials.Main results: Although three RCTs were included in this review, pooling of data in a meta-analysis was not possible due to wide clinical diversity between the studies. The reports indicate a not dissimilar degree of effectiveness with intra-articular injections consisting of either sodium hyaluronate or corticosteroid preparations, and an equivalent pain reduction with diclofenac sodium as compared with occlusal splints. Glucosamine appeared to be just as effective as ibuprofen for the management of TMJ OA.Authors' conclusions: In view of the paucity of high level evidence for the effectiveness of interventions for the management of TMJ OA, small parallel group RCTs which include participants with a clear diagnosis of TMJ OA should be encouraged and especially studies evaluating some of the possible surgical interventions |
0 | Management of postoperative complications: anemia | HipFx Supplemental Cost Analysis | Anemia is extremely common following hip fracture. Consistent data from randomized trials show that transfusion of less blood, with a transfusion threshold around 8 g/dL hemoglobin concentration, is preferable to a traditional threshold of 10 g/dL. Adoption of a lower threshold leads to at least equivalent clinical outcomes, with much less exposure to transfusion costs and risks. The most common complication of transfusion is circulatory overload. Future research may elucidate the optimal transfusion threshold for these elderly patients and address the specific needs of subgroups of patients, including those with acute coronary syndrome or chronic kidney disease |
0 | No Disparity for American Indians in Surgery for Pelvis/Lower Extremity Fractures: a Cohort Study of the National Trauma Data Bank (NTDB) | Hip Fx in the Elderly 2019 | BACKGROUND: Racial/ethnic disparities in trauma care have been reported. The American Indian/Alaska Native (AI/AN) population faces a twofold to fourfold increase of risk for traumatic injury. We hypothesized that surgical intervention and time to surgery were associated with race/ethnicity, specifically AI/AN compared to other race/ethnicity groups with open pelvic and lower extremity fractures (OPLEFx). METHODS: Non-AI/AN racial/ethnic groups were compared to AI/ANs among adults aged 15 years and older using the National Trauma Data Bank for 2008-2012. OPLEFx were identified via ICD-9-CM. Predictors of surgery and time to surgery were modeled via logistic regression and survival analyses. RESULTS: AI/AN patients (2.7 %, nâ??=â??206) were younger (36â??±â??16 versus 41â??±â??18 years, pâ??<â??0.001) and more likely to have Medicaid and other government insurance. There were no differences in AI/ANs versus non-AI/ANs undergoing surgery (88.4 versus 86.8 %, respectively) or time to surgery (11.7â??±â??25.3 versus 12.0â??±â??22.5 h, respectively). Injury severity was predictive of surgery in all six models (ORâ??=â??0.04 to 0.32). A race-gender interaction increased odds of surgery in the AI/AN versus all other races model (ORâ??=â??3.58, 95 % CI 1.18-10.84) and in three of five pairwise models. Median time to surgery varied by race, favoring AI/ANs with least preoperative time. CONCLUSION: The AI/AN population experienced no disparities in rate of, or time to, OPLEFx surgery. Race-specific predictors for surgery included gender, probability of death, and multiple fractures. More study is warranted to ameliorate trauma care disparities and achieve reasonably equitable care as demonstrated in AI/ANs with OPLEFx. |
0 | High blood pressure and bone-mineral loss in elderly white women: A prospective study | Management of Hip Fractures in the Elderly | Background. High blood pressure is associated with abnormalities in calcium metabolism. Sustained calcium loss may lead to increased bone-mineral loss in people with high blood pressure. We investigated the prospective association between blood pressure and bone-mineral loss over time in eldery white women. Methods. We studied 3676 women who were initially assessed in 1988-90 (mean age 73 years [SD 4, range 66-91 years]; mean bodyweight 65.3 kg [11.5]; blood pressure 137/75 mm Hg [17/9]) who were not on thiazide diuretics. Mean follow-up was 3.5 years. Anthropometry blood pressure, and bone-mineral density at the femoral neck were measured at baseline and bone densitometry was repeated after 3.5 years by dual-energy X-ray absorptiometry. Findings. After adjustment for age, initial bone-mineral density, weight and weight change, smoking, and regular use of hormone-replacement therapy, the rate of bone loss at the femoral neck increased with blood pressure at baseline. In the quartiles of systolic blood pressure, yearly bone losses increased from 2.26 mg/cm(2) (95% CI 1.48-3.04) in the first quartile to 3.79 mg/cm(2) in the fourth quartile (3.13-4.45; test for heterogeneity, p = 0.03; test for linear trend, p = 0.01), equivalent to yearly changes of 0.34% (0.20-0.46) and 0.59% (0.49-0.69; test for heterogeneity, p = 0.02; test for linear trend, p = 0.005). There was no significant interaction with age. The exclusion of women on antihypertensive drugs did not alter the results. For diastolic blood pressure, there was an association with bone loss in women younger than 75 years. Interpretation. Higher blood pressure in elderly white women is associated with increased bone loss at the femoral neck. This association may reflect greater calcium losses associated with high blood pressure, which may contribute to the risk of hip fractures |
0 | MR imaging of entrapment neuropathies at the elbow | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | MR imaging is a useful modality for diagnosing compressive neuropathies at the elbow. The most typical finding is denervation muscle edema and atrophy. Morphologic and signal alterations of the affected nerves also may be detected. Finally, tumors and other masses producing nerve compression can be identified |
0 | Well-aerated Lung on Admitting Chest CT to Predict Adverse Outcome in COVID-19 Pneumonia | Coronavirus Disease 2019 (COVID-19) | Background Computed tomography (CT) of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease depicts the extent of lung involvement in COVID-19 pneumonia. Purpose The aim of the study was to determine the value of quantification of the well-aerated lung obtained at baseline chest CT for determining prognosis in patients with COVID-19 pneumonia. Materials and Methods Patients who underwent chest CT suspected for COVID-19 pneumonia at the emergency department admission between February 17 to March 10, 2020 were retrospectively analyzed. Patients with negative reverse-transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2 in nasal-pharyngeal swabs, negative chest CT, and incomplete clinical data were excluded. CT was analyzed for quantification of well aerated lung visually (%V-WAL) and by open-source software (%S-WAL and absolute volume, VOL-WAL). Clinical parameters included demographics, comorbidities, symptoms and symptom duration, oxygen saturation and laboratory values. Logistic regression was used to evaluate relationship between clinical parameters and CT metrics versus patient outcome (ICU admission/death vs. no ICU admission/ death). The area under the receiver operating characteristic curve (AUC) was calculated to determine model performance. Results The study included 236 patients (females 59/123, 25%; median age, 68 years). A %V-WAL<73% (OR, 5.4; 95% CI, 2.7-10.8; P<0.001), %S-WAL<71% (OR, 3.8; 95% CI, 1.9-7.5; P<0.001), and VOL-WAL<2.9 L (OR, 2.6; 95% CI, 1.2-5.8; P<0.01) were predictors of ICU admission/death. In comparison with clinical model containing only clinical parameters (AUC, 0.83), all three quantitative models showed higher diagnostic performance (AUC 0.86 for all models). The models containing %V-WAL<73% and VOL-WAL<2.9L were superior in terms of performance as compared to the models containing only clinical parameters (P=0.04 for both models). Conclusion In patients with confirmed COVID-19 pneumonia, visual or software quantification the extent of CT lung abnormality were predictors of ICU admission or death. |
0 | Is a calculated total hip BMD of clinical use? | Management of Hip Fractures in the Elderly | The diagnosis of osteoporosis is based on bone mass measurement. To avoid the errors associated with the measurement of spinal bone density the total hip has been accepted as the standard measurement site. This information is not available for many early measurements. We have assessed whether it is possible to derive clinically useful information about total hip bone mineral density (BMD) from measurements at other hip sites. The bone mass measurements of 46 patients participating in a current trial of therapy for osteoporosis were reviewed. The total hip BMD as directly measured was compared with that obtained from the formula: Total hip BMD = 0.48 x Neck BMD + 0.62 x Trochanteric BMD + 0.03. In 30 patients with follow-up data the rate of change in hip BMD over a year was also determined by both methods. In the pretreatment state there was good agreement between the two measures (r2 = 0.96, SEE 0.012 g/cm2). If the formula was used to compute a change in total hip BMD, the agreement between both methods remained good. However, the standard error of the estimate of the change represented 59% of the observed change. This indicates that the error associated with this estimate is too great to allow clinically meaningful conclusions to be drawn from calculated total hip BMD. We conclude that, whilst it may be possible to obtain reasonable point estimates of total hip BMD from other measures in the hip, these estimates are too imprecise to allow conclusions about change in BMD to be made |
1 | Validity of magnetic resonance imaging in knee injuries | AMP (Acute Meniscal Pathology) | INTRODUCTION: Knee injuries are common in athletes, recreationists, and other people in their everyday activities.
OBJECTIVE: The study is aimed at establishing the validity of clinical findings, MRI and diagnostic arthroscopy of the knee in ACL, PCL, medial or lateral ligament lesions.
METHODS: The prospective research involved 63 inpatients at the Traumatology Clinic in Banja Luka- Nis between 1 January 2011 and 1 June 2012.
RESULTS: When clinically examining the ACL and based on the calculated post-test probability amounting to (LR+) = 0.8017, we conclude that there is a considerable probability (80.17%) that a patient with an arthroscopically diagnosed ACL lesion will have the same lesion diagnosed by MRI. The post-test probability following the clinical examination of the medial meniscus and amounting to (LR+) = 0.6943 suggests that there is a considerable probability (69.43%) that an arthroscopically diagnosed lesion of the medial meniscus will also be diagnosed by MRI. On the basis of the clinical examination of the lateral meniscus in the examined sample and calculated post-test probability amounting to (LR+) = 0.6346, we conclude that there is a considerable difference (63.46%) between the diagnostic arthroscopy and MRI of lateral meniscus lesions.
CONCLUSION: Arthroscopic examination of the knee is a more valuable method than diagnosis by MRI and clinical examination for detecting lesions of the ACL, PCL, medial and lateral meniscus. |
0 | The effect of total knee replacement on dynamic support of the body during walking and stair ascent | Surgical Management of Osteoarthritis of the Knee CPG | Background: Little is known about the effects of total knee replacement surgery on the contributions of individual joint moments to the total support moment. A better understanding of these effects may enhance rehabilitation protocols and determine factors related to long-term surgical outcome. Method: Twenty-one subjects with total knee replacement and 21 controls performed level walking and stair ascent at two testing periods, pre- and 6 months post-surgery. Variables studied included gait velocity, stride length, knee flexion angle, net joint moments of the hip, knee and ankle, and total support moment. Data were analyzed at the first peak vertical ground reaction force. Findings: For level walking, the total support moment, knee extensor moment, and knee flexion angle of total knee replacement patients were less than controls at post-surgery. For stair ascent, the patient group total support moment, ankle plantarflexor moment, and knee flexion angle were less than controls at both testing periods, while knee extensor moment was less than controls at post-surgery. Extensor synergies of the total knee replacement patients revealed less knee and more hip contributions during level walking and larger hip contributions during stair ascent to the total support moment than controls at both testing periods. Interpretation: A feature of total knee replacement gait, pre- and post-surgery, is a stiff knee attitude which may serve to protect the quadriceps. The larger hip extensor contribution to the total support moment observed in the patients may compensate for the diminished knee extensor contribution during level walking and stair ascent. (copyright) 2007 Elsevier Ltd. All rights reserved |
0 | Lysosomal enzymes in serum and synovial fluid in patients with osteoarthritis | Surgical Management of Osteoarthritis of the Knee CPG | Objective. To assess the activity of arylsulfatase (AS), acid phosphatase (ACP), cathepsin D (CAT-D) and alpha-1 antitrypsin (AAT) in blood serum and synovial fluid (SF) of patients with hip or knee osteoarthritis (OA). Methods. The study included 43 subjects with OA (35 hip OA, 8 knee OA), submitted total joint replacement. The control group consisted of 58 subjects with no past history of musculoskeletal disorders. Results. The OA blood serum samples showed a significantly higher level of lysosomal enzymes activity than in the control group (AS by 17.8%, AAT by 42.4%); only the CAT-D activity decreased by 50%). AS, ACP and CAT-D activities were about two-fold higher in SF when compared with blood of OA patients. The differences between the genders were visible in the SF: Total protein concentration, activity of ACP (both higher in OA men) and activity of CAT-D (higher in OA women). Between the involved hip and knee, there were no significant differences in all estimated parameters in the blood serum of the OA group. In regard to the SF, only ACP activity was significantly higher in patients with a hip involved. Conclusions. The osteoarthritic SF enzymatic profile differs from that in normal joints. The OA in joints is not reflected in the systemic response. Our preliminary results suggest further studies on role of lysosomal enzymes (ACP and AS) as biomarkers for the detection of osteoarthritis |
0 | Safety of Arthroscopic Versus Open or Combined Heterotopic Ossification Removal Around the Elbow | Pediatric Supracondylar Humerus Fracture 2020 Review | PURPOSE: To analyze the complications of arthroscopic heterotopic ossification (HO) excision and compare them with those of open removal of HO or a combined open-arthroscopic approach. METHODS: We performed a retrospective review of elbow HO removal cases performed by a single surgeon from 1997 to 2014. In all cases studied, the intention was to restore range of motion owing to the presence of HO causing functional impairment. The arthroscopic, open, and combined treatment groups were compared. RESULTS: The study cohort consisted of 223 surgical procedures performed on 213 elbows in 211 patients. Fifty major complications occurred in 46 cases (21%): 17 hematomas (8%) treated by irrigation and debridement, 8 cases of HO requiring reoperation (4%), 7 deep infections (3%), 4 contractures (2%), 3 cases of delayed-onset ulnar neuritis (1%), 2 cases of distal humeral avascular necrosis (1%), 2 tendon ruptures (1%), 2 cases of instability requiring reconstruction (1%), 2 postoperative fractures (1%), 1 intraoperative fracture (<0.5%), 1 case of worsening of pre-existing neuropathic pain (<0.5%), and 1 permanent partial posterior interosseous nerve injury (<0.5%). Of these 46 cases, the major complications occurred in 6 of the 41 (15%) performed arthroscopically, in 36 of the 158 (23%) performed open and in 4 of the 21 (17%) with combined (i.e. open + arthroscopic) HO removal. Preventive strategies, introduced to prevent hematomas and delayed-onset ulnar neuritis, reduced the rate of major complications from 35% during the period from 1997 to 2005 to 10% during the period from 2006 to 2014 (P < .0001). Moreover, the rate of reoperations was reduced from 34% to 10% in the same periods (P < .0001). Minor complications occurred in 36 cases (16%), including 17 cases of transient nerve palsy, 9 cases of superficial infection or delayed wound healing, 6 cases of mild instability, and 4 cases of hematoma resolved by aspiration. CONCLUSIONS: The use of arthroscopy-or a combination of arthroscopic and open techniques-to remove HO around the elbow by a surgeon skilled in both arthroscopic and open elbow surgery does not increase the risk of major complications or need for reoperation compared with traditional open surgery. Preventive strategies, such as avoiding raising skin flaps by using multiple separate incisions for open and prophylactic ulnar nerve decompression in arthroscopic cases, were developed during the study period. These strategies were monitored prospectively and found to be effective in preventing two-thirds of the major complications needing reoperation with both open and arthroscopic HO removal. LEVEL OF EVIDENCE: Level III, retrospective comparative study of prospectively collected data. |
0 | The impact of associated tenotomies on the outcome of incomplete phalangeal osteotomies for lesser toe deformities | DoD SSI (Surgical Site Infections) | BACKGROUND: Partial or incomplete osteotomy (IO) of the phalanx is recently described in the literature. However, the clinical outcome and the rate of complications when applied to lesser toe deformities (LTD) have been never addressed. This study aims to find out if the association of tenotomies to incomplete or partial phalanx osteotomies has a significant impact on the clinical outcomes, the occurrence of complications, and the recovery time after surgery.
METHODS: A retrospective review of two cohorts of cases operated in our institution for hallux abductus valgus (HAV) and associated LTD from 2008 to 2014 was carried out. The surgical correction of both HAV and the associated LTD was always performed by minimally invasive techniques. The study included a total of 223 patients (723 IO in 556 toes). In 129 cases, the IO for LTD correction was performed without tenotomies, and in 94, the procedure was combined with flexor and/or extensor tenotomies. Patients were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) questionnaire before surgery and at 6- and 12-month follow-up.
RESULTS: The mean preoperative AOFAS score before surgery was similar in both cohorts. At 12-month follow-up, the cohort without tenotomies showed better recovery (95.7 +/- 2.8 versus 92.5 +/- 6.8; p < 0.01). AOFAS scores decreased as the number of associated LTD increased (r = - 0.814; p < 0.001). Cases operated on by PO + tenotomy showed a high rate of complications such as delayed union of the osteotomy (p < 0.01), hypertrophic callus (p < 0.01), phalangeal fracture at the osteotomy site (p < 0.01), and lack of correction (p < 0.05). The overall occurrence of adverse events was 38.6% in cases operated by PO + tenotomy and 13.9% in cases receiving PO alone (p < 0.0001). Cases operated on without tenotomy showed a shorter time to complete recovery for daily life activities (37.4 +/- 2.3 versus 43.0 +/- 1.7 days; p < 0.01).
CONCLUSION: The performance of associated tenotomies to incomplete phalanx osteotomies provides worse clinical outcomes, higher complication rates, and longer recovery time as compared to similar forefoot surgeries without tenotomies.
TRIAL REGISTRATION: The study was based on retrospectively registered data starting on May 24, 2008. |
0 | Intraoperative use of bupivacaine for tumescent liposuction: the Robert Wood Johnson experience | Panniculectomy & Abdominoplasty CPG | BACKGROUND: Bupivacaine anesthetic is commonly used as a wetting solution additive in tumescent liposuction, but its routine use remains controversial because of a lack of evidence in the current literature. METHODS: In accordance with local institutional review board regulations, a retrospective chart review was conducted of liposuction cases performed from 1997 to 2007 at Robert Wood Johnson University Hospital in New Brunswick, New Jersey. The primary endpoint was adverse perioperative events. Secondary endpoints included length of postanesthesia care unit stay and length of total postoperative hospital stay. RESULTS: Eighty-seven cases were analyzed and two subsets of patients were identified. In group 1, 24 patients were compared who underwent liposuction as the primary procedure and received bupivacaine, lidocaine, or no additive in their wetting solution. No adverse events were encountered and the average length of stay was not significantly different. In group 2, 20 patients were compared who underwent abdominoplasty and liposuction and received bupivacaine or no additive in their wetting solution. No adverse events occurred and patients receiving bupivacaine had a significantly shorter average length of stay, 19 hours versus 36 hours, compared with controls (p = 0.015). CONCLUSIONS: A review of the experience at Robert Wood Johnson University Hospital reveals that the intraoperative use of bupivacaine for tumescent liposuction in 27 cases appeared to be as safe as other tumescent additives. There did not appear to be a significant difference in the incidence of adverse events or postoperative length of stay for patients who underwent liposuction with bupivacaine compared with other wetting solutions. Among a subset of patients who underwent concurrent abdominoplasty and liposuction procedures, patients who received bupivacaine spent significantly less time in the hospital postoperatively than those who did not receive it. Conducting future prospective studies involving larger samples among multiple centers is an essential next step to confirm these findings. |
0 | Comparison of different anesthetic techniques on postoperative outcomes in elderly patients with hip fracture | Management of Hip Fractures in the Elderly | Objective: Determining the type of anesthesia is a complex medical decision that depends on many factors including co-morbidity, age, type of surgery performed, and the risk of the anesthetic techniques. This study evaluated the effects of anesthesia type on postoperative mortality and morbidity in hip fractures. Material and Methods: One hundred eighty-five patients older than 60 years who were operated for hip fracture between 2005-2009 were retrospectively analyzed. Patients received general anesthesia (n=67), spinal anesthesia (n=67), or epidural anesthesia (n=51). The clinical features of the patients were obtained from the hospital records. Morbidity outcomes were assessed on postoperative day 7. Mortality rates were calculated on postoperative day 7 and postoperative day 30. Results: There were no significant differences between the three groups with regard to intraoperative blood loss, intraoperative blood transfusion, smoking status, length of stay in hospital, American Society of Anesthesiology (ASA) physical status, and Charlson Comorbidity Index (CCI) (p=0.393, p=0.088, p=0.369, p=0.228, p=0.491, p=0.371 respectively). Similarly, no difference was detected between the three groups regarding patient mortality rates for day 7 and 30 (p=0.738, p=0.805 respectively). Conclusion: No technique was superior to the others. Due to the similar mortality rates among the groups, we suggest that the proper anesthetic technique selected according to the clinical features of the patient combined with adequate monitoriza-tion would yield successful results with all three techniques. (copyright) 2012 by Turkiye Klinikleri |
0 | Survival analysis of an asymmetric primary total knee replacement: a European multicenter prospective study | Surgical Management of Osteoarthritis of the Knee CPG | PURPOSE OF THE STUDY: This multicenter prospective study objective is to provide midterm results and 10-year survival analysis of the original Natural Knee-I System as experienced by a group of surgeons performing, within various settings, primary total knee replacement (TKR) in the general population. HYPOTHESIS: The midterm experience with this TKR system in the hands of independent surgical teams can duplicate the satisfaction level that was already published by the designer's group itself. MATERIAL AND METHOD: Two hundred and sixty-three primary TKR were performed by seven surgical teams (37 surgeons) and prospectively evaluated in four European countries. Mean age of the 263 patients (sex ratio, 2.7 females/1 male) was 69 years (range, 35-92) and diagnosis was primary osteoarthritis in 85%. For the 247 TKR with complete operative data, the approach was subvastus in 59%, posterior cruciate ligament was spared in 78%, patella was resurfaced in 56%, and 79% of reconstructions were totally cement-free. Fixation mode was only depending on the surgeon's choice. RESULTS: At 76 months average follow-up (range 24-190 months), modified Hospital for Special Surgery knee mean score improved from 48 points preoperatively to 83 points. Four reoperations and five revision procedures were required for eight knees. Over the 14-year survey period, the overall revision rate burden was 2% and revision rate per 100 observed component/year, 0.32. At 10 years, survivorship (with revision for aseptic loosening as its end-point [two fully cementless knees]) was 98.6%. DISCUSSION: Both this multicenter study and data drawn from national registers provided outcomes with equivalent level of satisfaction at equivalent follow-up to those reported by the NK-I prosthesis designer. There was no significant difference between revision rates of cemented, hybrid or cementless reconstructions. CONCLUSION: In non-designer orthopaedists' hands, the Natural Knee-I System, either with cemented or cementless fixation, provided satisfying midterm results as normally expected in primary TKR with such a modern modular prosthesis. LEVEL OF EVIDENCE: Level IV. Prospective study |
0 | Consumer guidelines for chronic disease management | SR for PM on OA of All Extremities | This is the protocol for a review and there is no abstract. The objectives are as follows:To assess the effects of consumer guidelines for people with chronic illnesses, on health outcomes |
0 | Cardiac output during hemiarthroplasty of the hip. A prospective, controlled trial of cemented and uncemented prostheses | HipFx Supplemental Cost Analysis | In a prospective, controlled study, we measured the effect on cardiac output of the introduction of methylmethacrylate during hemiarthroplasty for displaced fractures of the femoral neck. We treated 20 elderly patients who were similar in age, height, weight and preoperative left ventricular function with either cemented or uncemented hemiarthroplasty. Using a transoesophageal Doppler probe, we measured cardiac output before incision and at six stages of the procedure: during the surgical approach, reaming and lavage of the femoral canal, the introduction of cement, the insertion of the prosthesis, and in reduction and closure. We found that before the cement was introduced, there was no difference in stroke volume or cardiac output (p > 0.25). Cementation produced a transient but significant reduction in cardiac output of 33% (p < 0.01) and a reduction in stroke volume of 44% (p < 0.02). The introduction of cement did not affect the heart rate or mean arterial pressure. There was no significant difference in cardiac function on insertion of the prosthesis. Standard non-invasive haemodynamic monitoring did not detect the cardiovascular changes which may account for the sudden deaths that sometimes occur during cemented hemiarthroplasty. The fall in stroke volume and cardiac output may be caused by embolism occurring during cementation, but there was no similar fall during reaming or insertion of the prosthesis |
0 | Non-steroidal anti-inflammatory drugs, including cyclo-oxygenase-2 inhibitors, in osteoarthritic knee pain: meta-analysis of randomised placebo controlled trials | SR for PM on OA of All Extremities | OBJECTIVE: To estimate the analgesic efficacy of non-steroidal anti-inflammatory drugs (NSAIDs), including selective cyclo-oxygenase-2 inhibitors (coxibs), in patients with osteoarthritis of the knee. DESIGN: Systematic review and meta-analysis of randomised placebo controlled trials. STUDIES REVIEWED: 23 trials including 10 845 patients, median age of 62.5 years. 7807 patients received adequate doses of NSAIDs and 3038 received placebo. The mean weighted baseline pain score was 64.2 mm on 100 mm visual analogue scale (VAS), and average duration of symptoms was 8.2 years. MAIN OUTCOME MEASURE: Change in overall intensity of pain. RESULTS: Methodological quality of trials was acceptable, but 13 trials excluded patients before randomisation if they did not respond to NSAIDs. One trial provided long term data for pain that showed no significant effect of NSAIDs compared with placebo at one to four years. The pooled difference for pain on visual analogue scale in all included trials was 10.1 mm (95% confidence interval 7.4 to 12.8) or 15.6% better than placebo after 2-13 weeks. The results were heterogeneous, and the effect size for pain reduction was 0.32 (0.24 to 0.39) in a random effects model. In 10 trials that did not exclude non-responders to NSAID treatment the results were homogeneous, with an effect size for pain reduction of 0.23 (0.15 to 0.31). CONCLUSION: NSAIDs can reduce short term pain in osteoarthritis of the knee slightly better than placebo, but the current analysis does not support long term use of NSAIDs for this condition. As serious adverse effects are associated with oral NSAIDs, only limited use can be recommended |
0 | CXCR7 mediates TGFbeta1-promoted EMT and tumor-initiating features in lung cancer | MSTS 2018 - Femur Mets and MM | In the tumor microenvironment, chemokine system has a critical role in tumorigenesis and metastasis. The acquisition of stem-like properties by cancer cells is involved in metastasis and drug resistance, which are pivotal problems that result in poor outcomes in patients with lung cancer. Patients with advanced lung cancer present high plasma levels of transforming growth factor-beta1 (TGFbeta1), which correlate with poor prognostic features. Therefore, TGFbeta1 may be important in the tumor microenvironment, where chemokines are widely expressed. However, the role of chemokines in TGFbeta1-induced tumor progression still remains unclear. In our study, TGFbeta1 upregulated CXC chemokine receptor expression, migration, invasion, epithelial-mesenchymal transition (EMT) and cancer stem cell (CSC) formation in lung adenocarcinoma. We found that CXCR7 was the most upregulated chemokine receptor induced by TGFbeta1. CXCR7 knockdown resulted in reduction of migration, invasion and EMT induced by TGFbeta1, whereas CXCR4 knockdown did not reverse TGFbeta1-promoted EMT. CXCR7 silencing significantly decreased cancer sphere-forming capacity, stem-like properties, chemoresistance and TGFbeta1-induced CSC tumor initiation in vivo. In clinical samples, high TGFbeta1 and CXCR7 expression was significantly associated with the late stages of lung adenocarcinoma. Moreover, TGFbeta1 and CXCR7 coexpression was positively correlated with the CSC marker, CD44, which is associated with lymph node metastasis. Besides, patients with high expression of both CXCR7 and TGFbeta1 presented a significantly worse survival rate. These results suggest that the TGFbeta1-CXCR7 axis may be a prognostic marker and may provide novel targets for combinational therapies to be used in the treatment of advanced lung cancer in the future. |
0 | Oral Rehabilitation With Bone Graft and Simultaneous Dental Implants in a Patient With Epidermolysis Bullosa: A Clinical Case Report | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | Epidermolysis bullosa (EB) represents a group of mainly hereditary skin disorders, manifested by an exceptional tendency of the skin and mucosa to form bullae and vesicles after minor friction and trauma. Oral features include repeated blistering, scar formation, elimination of buccal and vestibular sulci, and alveolar bone resorption. The use of endosseous implants in the fixed prosthetic rehabilitation of patients with recessive dystrophic EB might provide a considerably better outcome than conventional removable prosthetic methods. This clinical report describes the fixed rehabilitation with 2 implants placed simultaneously with bone graft in a partially edentulous patient diagnosed with recessive dystrophic EB. The implants, with simultaneous bone graft, were placed to decrease the number of surgical operations required, avoiding soft tissue ulcerations and discomfort in the patient. This treatment option appears to be favorable for recessive dystrophic EB patients compared with other options involving removable prostheses, which irritate the oral mucosa. (copyright) 2009 American Association of Oral and Maxillofacial Surgeons |
0 | A retrospective review of outcomes and flap selection in free tissue transfers for complex lower extremity reconstruction | DoD LSA (Limb Salvage vs Amputation) | PURPOSE: Complex lower extremity wounds present a significant challenge to the reconstructive surgeon. We report a consecutive experience of free tissue transfers for lower extremity reconstruction with a focus on outcomes and flap selection. METHODS: A retrospective review of all free tissue transfers for lower extremity reconstruction between 2006 and 2011 was performed. Minor complications were defined as nonoperative complications (infection, seroma, hematoma, wound breakdown, and partial loss). Major complication required a surgical intervention (total flap loss, thrombosis, nonunion, amputation, and hematoma). RESULTS: A total of 119 free flaps were performed in 114 patients. Reconstructed defects were most commonly derived from acute traumatic (N = 40) or chronic traumatic (N = 34) wounds, oncologic (N = 14), or diabetic (N = 8). Flap loss occurred at a rate of 5.9% and the overall lower extremity salvage rate was 93%. Complications were significantly higher for free tissue transfers to the region of the distal tibia (p = 0.04). Major complications were significantly higher in patients with chronic obstructive pulmonary disease (p = 0.02) and in patients who experienced intraoperative technical difficulties (p = 0.014). Flap loss was significantly higher when the rectus abdominis flap was used (p = 0.02) and when a delayed venous thrombotic event occurred (p = 0.001). CONCLUSION: Patient comorbidities and defect location can be associated with higher rates of complications; flap selection and delayed venous thrombotic events appear to be associated with flap failure.Level of Evidence Prognostic/risk category, level III. |
0 | Restorative procedures for articular cartilage in the ankle: State-of-the-art review | Osteochondritis Dissecans 2020 Review | Articular cartilage is a highly specialised connective tissue that serves to lubricate joint surfaces and distribute loads across the joint. Injury to articular cartilage is a significant cause of pain and dysfunction that may eventually lead to osteoarthritis or degenerative arthrosis. Management of these injuries is complicated by the complex architecture and poor vascularity of this tissue. The field of articular cartilage restoration has evolved rapidly over the past several decades and current techniques offer promising results. However, despite the fast pace of progress in the treatment and repair of articular cartilage injury, a clear gold standard in management has yet to emerge. Current techniques for managing cartilage injuries discussed in this review include bone marrow stimulation, osteochondral transplantation, chondrocyte implantation, cell-based transplantation, biological augmentation and scaffold-based therapies. Heterogeneity in study design, including surgical procedures, lesion and patient characteristics, cell collection, biologics preparation protocols and outcome measures limits interpretation of results presented in the literature. Therefore, standardisation across research protocols and collaboration among centres will be necessary. This 'state-of-the-art review' presents the indications and techniques for managing ankle articular cartilage lesions, as well as future directions and geographical differences in management. |
0 | Complete endoscopic carpal canal decompression | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | We made a model of the endoscopic decompression of the carpal canal in clinical cases. The model entailed the release of the transverse carpal ligament, ie, the flexor retinaculum, first; then the transverse fibers: deep layer of the midpalmar fascia or distal portion of the flexor retinaculum; and, finally, release of the forearm fascia. Carpal canal pressure was measured using the continuous infusion technique, and the carpal canal was observed endoscopically at each step. Carpal canal pressure data were analyzed by using the Wilcoxon matched pairs signed-rank test. When the transverse carpal ligament and the transverse fibers were divided, carpal canal pressure was significantly statistically lower than that with release of the transverse carpal ligament alone. We conclude that release of both the transverse carpal ligament and the transverse fibers are essential for complete decompression of the carpal canal in endoscopic surgery |
0 | Associations of the collagen type Ialpha1 Sp1 polymorphism with five-year rates of bone loss in older adults | Management of Hip Fractures in the Elderly | The collagen type Ialpha1 Sp1 (ColIA1) polymorphism has been associated with reduced bone mineral density (BMD) and increased prevalence of osteoporosis. This study examines associations of the ColIA1 genotype with BMD and 5-year rates of change in BMD in elderly men and women. The 243 subjects, aged 65 years and older, were participants in two consecutive studies lasting a total of 5-years. BMD of the total body, femoral neck, and lumbar spine were made by dual-energy X-ray absorptiometry (DXA). The distribution of the genotypes (155 in the SS genotype, 79 in Ss, and 9 in ss) was proportionately similar to those reported by others. Baseline BMD did not differ significantly at any skeletal site. Unadjusted 5-year percent changes in BMD differed significantly by genotype only at the total body (P = 0.009), where the change was -0.29+/-0.21 (SEM) in the SS genotype, -0.60+/-0.25 in the Ss genotype, and -3.01+/-0.72 in the ss genotype. This 9.4% increase in bone loss of the ss genotype relative to the SS genotype was reduced to an 8.9% increase after adjustment for sex, age, weight, and supplementation group. Results at the femoral neck were directionally similar, but not statistically significant. No effect of genotype on change in spine BMD was observed. In conclusion, bone loss from the total body was significantly greater in elderly men and women who were homozygous for the s allele compared with heterozygotes and SS homozygotes. This finding suggests a possible explanation for the association of the ColIA1 polymorphism with increased rates of osteoporotic fracture, but should be interpreted with caution because of the small number of subjects in the unfavorable ss genotype |
0 | Shoulder hemi arthroplasty radiological and clinical outcomes at more than two years follow-up | Glenohumeral Joint OA | INTRODUCTION: Humeral head replacement is used for glenohumeral osteoarthritis in young or active patients, for conditions sparing glenoid cartilage or when glenoid implantation does not appear feasible. These surgical procedures usually give satisfactory results but there is a risk of glenoid erosion and a possible deterioration of long-term outcomes.
HYPOTHESIS: There is a risk of glenoid erosion after humeral head replacement which can be radiographically measured. The importance and progression of this erosion should be evaluated to determine its clinical relevance.
PATIENT AND METHODS: This is a retrospective study in 15 patients (19 shoulders) who underwent humeral head replacement between 1999 and 2006. There were 11 women and four men with an average age of 54.5 years. Etiologies were avascular necrosis (11 cases) and glenohumeral osteoarthritis (eight cases). All patients were reviewed in 2008 with more than two years follow-up. Clinical evaluation included measurements of range of motion and determination of the Constant and Murley score. In addition, the patients were asked to provide a subjective evaluation of their shoulder. Radiographic analysis included computer-assisted measurements.
RESULTS: The average follow-up was 45.8 months (26-108). At one year postoperative and at the final follow-up, clinical parameters such as the Constant and Murley score (37.4/100 preoperative to 64.4/100 at final follow-up) were significantly increased. During the first year, the rate of glenoid wear was 1.03 mm/year in case of avascular necrosis and 0.27 mm/year in case of osteoarthritis (p<0.001). Glenoid depth at the final follow-up was 6.97 mm for osteoarthritis compared to 4.59 mm for avascular necrosis (p<0.01). We did not find any correlation between glenoid erosion severity and clinical results.
DISCUSSION: Isolated humeral head replacement may result in glenoid erosion. The rate of progression of this erosion is clearly influenced by the etiology and therefore by the preexisting condition of the glenoid cartilage. At the average follow-up, the radiological glenoid deterioration is not correlated with pain or deterioration of clinical results.
LEVEL OF EVIDENCE: Level IV. Therapeutic study. |
0 | Fractures of the distal radius. Current concepts for treatment | Distal Radius Fractures | The authors review the treatment of fractures of the distal radius, based on their experience and from data in the literature. The choice of a treatment for any given fracture must take into account first of all the stability of the fracture. The best results are achieved in stable fractures. Only minimally displaced distal radius fractures can be treated functionally. However, a plaster cast for one week is indicated for the comfort of the patient. In displaced but stable fractures both closed reduction and percutaneous fixation are indicated. In case of closed reduction, the plaster cast should be applied for 5 to 6 weeks with an above-elbow cast for 3 weeks. Percutaneous fixation gives the best results in extraarticular fractures in younger patients. Because of its simplicity however, it should not be ignored in the elderly osteoporotic patients. In the authors' experience, both techniques were only used for extraarticular fractures. Good and excellent results were found in the closed reduction and plaster cast group in 74% of the patients; the Kapandji technique gave 75% good and excellent results. These results are in line with other findings which show that, for simple fracture types, the Kapandji technique and closed reduction seem to give similar results. External fixation is widely used for intra-articular comminuted fractures. Dynamic external fixation does not show any advantage over static devices. Additional K-wires or bone grafting may be necessary. External fixation gives superior results to plate and screw fixation. Internal fixation should be reserved for fractures with ventral comminution or severe displacement with unacceptable reduction by closed or minimally invasive techniques. [References: 68] |
0 | Intervention thresholds for osteoporosis | HipFx Supplemental Cost Analysis | The aim of this study was to determine the threshold of fracture probability at which interventions become cost-effective. We modeled the effects of a treatment costing $500/year, given for 5 years, that decreased the risk of all osteoporotic fractures by 35%, followed by a waning of effect for 5 years. Sensitivity analyses included a range of effectiveness (10%-50%) and a range of intervention costs (200-500 dollars/year). Data on costs and risks were from Sweden. Costs included direct costs and costs in added years of life, but excluded indirect costs due to morbidity. A threshold for cost-effectiveness of 60,000 dollars per quality-adjusted life-year (QALY) gained was used. Costs of added years were excluded in a sensitivity analysis for which a threshold value of 30,000 dollars per QALY was used. In the base case, intervention was cost-effective when treatment was targeted to women at average risk at age of >or=65 years. Irrespective of the efficacy modeled (10%-50%) or of cost of intervention (200-500 dollars/year) segments of the population at average risk could be targeted cost-effectively: The lower the intervention cost and the higher the effectiveness, the lower the age at which intervention was cost-effective. With the base case (500 dollars/year; 35% efficacy) treatment in women was cost-effective with a 10 year hip fracture probability that ranged from 1.4% at the age of 50 years to 4.4% at the age of 65 years. The exclusion of osteoporotic fractures other than hip fracture would increase the threshold to a 9%-11% 10 year probability because of the substantial morbidity from fractures other than hip fracture, particularly at younger ages. We conclude that the inclusion of all osteoporotic fractures has a marked effect on intervention thresholds, that these vary with age, and that available treatments can be cost-effectively targeted to individuals at moderately increased risk |
0 | Latissimus dorsi muscle transfer reduces external rotation deficit at the cost of internal rotation in reverse shoulder arthroplasty patients: a cohort study | DoD SSI (Surgical Site Infections) | Hypothesis: We hypothesized that treatment of rotator cuff arthropathy (RCA) with reverse shoulder arthroplasty (RSA) and an additional latissimus dorsi transfer (LDT) in patients with an active external rotation deficit (ERD) would restore external rotation (ER) with concomitant deterioration in internal rotation. Methods: In our cohort study, 26 RCA patients with an active ERD (ie, positive lag sign and maximum active ER of 0°) underwent RSA between September 2007 and February 2015; LDT was completed in 13 of these patients. In addition, 88 control patients without ERD who underwent only RSA were identified. Clinical outcomes of strength, range of motion, Constant-Murley score, and Shoulder Pain and Disability Index score, as well as complications, were documented 6, 12, 24, and 60 months postoperatively. We made comparative analyses using statistical mixed models. Results: The LDT procedure extended the surgical time by 26 minutes (P =.003). LDT patients had up to 22° better postoperative active ER than control patients (P <.001), although this was accompanied by an internal rotation deficit (77% vs 46% of control patients could not reach the lumbosacral region, P =.010). We calculated a 23% risk of local procedure–related complications for RSA patients with an active ERD and LDT. Conclusion: Patients with RCA and an active ERD seem to benefit from an LDT, although this is accompanied by the potential loss of internal rotation. This additional procedure is associated with an extended surgical time as well as a possible increase in the risk of a complication occurring. |
0 | Is monocyte chemotactic protein 1 elevated in aseptic loosening of TKA? A pilot study | Surgical Management of Osteoarthritis of the Knee CPG | BACKGROUND: Failure of TKA from aseptic loosening is a growing concern, as TKA is performed with increasing frequency. Loosening is multifactorial and may be associated with elevated inflammatory cytokines in addition to biomechanical failure. QUESTIONS/PURPOSES: We asked whether proinflammatory cytokines and chemokines are elevated in synovial fluid from patients undergoing revision surgery as compared to those with osteoarthritis (OA) or rheumatoid arthritis (RA). METHODS: We obtained synovial fluid samples from 20 patients: six with aseptic loosening of TKA (all with bone loss), 10 with primary OA, and four with RA. A panel of cytokines/chemokines was screened using a SearchLight((R)) Array (Pierce Biotechnology, Rockford, IL, USA) in one revision sample. Using these data, we assayed the synovial fluids for monocyte chemotactic protein 1 (MCP-1) by ELISA. RESULTS: We observed an increase in synovial MCP-1 levels in samples from patients planned for TKA revision compared to those with OA or RA. In patients undergoing revision arthroplasty, the mean (+/- SD) MCP-1 concentration was 21,233 +/- 18,966 pg/mL (range, 1550-50,657 pg/mL; n = 6). In patients with OA, the mean MCP-1 level was 3012 +/- 3321 pg/mL. In patients with RA, the mean MCP-1 concentration was 690 +/- 561 pg/mL. CONCLUSIONS: All patients undergoing revision TKA showed elevated concentrations of MCP-1 compared to patients with OA and RA, suggesting MCP-1 may serve as a potential marker or predictor of bone loss in patients undergoing revision surgery. CLINICAL RELEVANCE: MCP-1 may be a novel biomarker in patients showing early symptoms of aseptic loosening of TKA |
0 | Osteochondritis Dissecans of the Adult Knee | Diagnosis and Treatment of Osteochondritis Dissecans AUC | Osteochondritis dissecans is a disease that originates in the subchondral bone that affects the articular cartilage. It generally presents gradually and is associated with non-specific symptoms. The true etiology is unknown but likely related to genetic, vascular or trauma. Multiple modes for diagnosis and classification exist. Conservative management often fails in adults unless the lesion is stable. Different surgical techniques have shown improvement over baseline, but there are no randomized controlled trials that demonstrate superiority of one technique over another. (copyright) 2008 |
0 | Determining the rotational alignment of the tibial component at total knee replacement | Surgical Management of Osteoarthritis of the Knee CPG | We prospectively assessed the benefits of using either a range-of-movement technique or an anatomical landmark method to determine the rotational alignment of the tibial component during total knee replacement. We analysed the cut proximal tibia intraoperatively, determining anteroposterior axes by the range-of-movement technique and comparing them with the anatomical anteroposterior axis. We found that the range-of-movement technique tended to leave the tibial component more internally rotated than when anatomical landmarks were used. In addition, it gave widely variable results (mean 7.5(degrees) 2(degrees) to 17(degrees)), determined to some extent by which posterior reference point was used. Because of the wide variability and the possibilities for error, we consider that it is inappropriate to use the range-of-movement technique as the sole method of determining alignment of the tibial component during total knee replacement. (copyright) 2007 British Editorial Society of Bone and Joint Surgery |
0 | Multiple timescales of body schema reorganization due to plastic surgery | Panniculectomy & Abdominoplasty CPG | Plastic surgery modifies the distribution of mass centers of a person's body segments, changing his or her posture. The functional reorganization processes that lead subjects to re-integrate these body changes into a new stable body (posture) schema is poorly understood but current theories suggest the possible contribution of two components: a feedback mechanism that strongly depends on sensory input and an internal model that is relatively less dependent on sensory input and improves posture control, for example by compensating for delayed feedback. To assess the relative contributions of these two mechanisms during the functional reorganization of a posture scheme, we have conducted a longitudinal postural study in a population of healthy adults who were subject to breast plastic surgery to reduce or augment body weight. We measured participants' orthostatic posture and ground reaction force immediately after, after 4 months, and 1 year after the surgery. To investigate the role of visual sensory information in the reorganization process we tested the participants with eyes open and closed. Our results indicate that participants find a new dynamical equilibrium within a few days. However, posture maintenance remains sub-optimal long after the center of masses and the resultant of ground reaction force stop changing; in some cases, for more than 4 months. Furthermore, the re-adaptation process is faster and more efficient in the eyes-open than in the eyes-closed condition. These results suggest that the reorganization involves different subsystems (responsible for the biomechanical changes, the re-calibration of feedback mechanisms, and the re-adaptation of internal models), which act at different timescales. |
0 | Palpebral fissure height and downgaze in patients with Graves upper eyelid retraction and congenital blepharoptosis | Upper Eyelid and Brow Surgery | PURPOSE: To compare the relation between vertical eyelid fissure height and downgaze in healthy subjects and in patients with Graves upper eyelid retraction and congenital blepharoptosis. METHODS: With a caliper rule, the authors measured the vertical eyelid fissure height of 25 patients with no previous history of eye disease, 34 patients with Graves disease, and 16 patients with congenital blepharoptosis. All measurements were done at the primary position and at four levels of downgaze (10 degrees, 20 degrees, 30 degrees, and 40 degrees). In 13 patients with Graves disease, vertical phoria was quantified with a Maddox rod and prism. RESULTS: The relation between vertical eyelid fissure height and downgaze is linear. The slope was identical for the control subjects and for the patients with Graves disease (b = -1.36) but it was almost zero for the patients with congenital blepharoptosis (b = -0.037). When vertical eyelid fissure height was corrected to arc values, the slope of the relation between vertical eyelid fissure height and downgaze was significantly greater for the patients with Graves disease. Vertical phoria was not related to the amount of Graves upper eyelid retraction. CONCLUSIONS: The data support the hypotheses that upper eyelid retraction secondary to Graves eye disease results from hyperactivity of the levator palpebrae superioris muscle. |
0 | Antibacterial activity of 2% chlorhexidine gluconate and 5.25% sodium hypochlorite in infected root canal: in vivo study | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | In this study, the antibacterial activity of the different antibacterial solutions using as root canal irrigant was compared in the teeth with pulpal necrosis and with periapical pathosis. Thirty root canals of incisors and premolars of 20 patients were used. Before and after the root canal preparation, two canal samples were obtained by a harvesting method using a sterile paper point in the first appointment. During the biomechanical preparation, both irrigant solutions were used for each tooth which were randomly divided into two groups. Last samples were also obtained before the root filling procedure. Samples obtained from the root canals were subjected to microbiologic processing, including anaerobic incubation on trypticase soy agar for 5 to 7 days. After counting of CFU on the plates, we concluded that both chlorhexidine gluconate and sodium hypochlorite were significantly effective to reduce the microorganisms in the teeth with necrotic pulp, periapical pathologies, or both, and could be used successfully as an irrigant solution |
0 | Ultrasound-guided continuous femoral nerve block: a randomized trial on the influence of femoral nerve catheter orifice configuration (six-hole versus end-hole) on post-operative analgesia after total knee arthroplasty | AAHKS (8) Anesthetic Infiltration | BACKGROUND: Multiorifice catheters have been shown to provide superior analgesia and significantly reduce local anesthetic consumption compared with end-hole catheters in epidural studies. This prospective, blinded, randomized study tested the hypothesis that, in continuous femoral nerve block (CFNB) under ultrasound guidance, multiorifice catheter would reduce local anesthetic consumption at 24 h compared with end-hole catheter.
METHODS: Eighty adult patients (aged >=18 years) scheduled to undergo primary total knee arthroplasty under a combination of CFNB, sciatic nerve block and general anesthesia were randomized to CFNB using either a 3-pair micro-hole (Contiplex, BRAUN R, 20G - 400 mm) or an end-hole (Silverstim VYGON R, 20G - 500 mm) catheter. Once the femoral catheter was sited, a bolus of 20 mL lidocaine 1% was injected. An electronic pump then delivered an automated 5 mL bolus of ropivacaine 0.2% hourly, with 10 mL self-administered patient controlled analgesia boluses.
RESULTS: There was no inter-group difference in either median number of ropivacaine boluses on demand during the first 24 h (4(2-7) vs. 4(2-8) in six-hole and end-hole groups, respectively; P = 0.832) or median ropivacaine consumption at 48 h (365(295-418) vs. 387(323-466); P = 0.452). No significant differences were recorded between the groups at 24 h regarding median average verbal rate pain scale (2(0-3) vs. 2(0-4); P = 0.486) or morphine consumption (0(0-20) vs. 0(0-20); P = 0.749). Quadriceps muscle strength declined to 7% (0-20) and 10% (0-28) in the six-hole and end-hole groups, respectively, at 24 h after surgery (P = 0.733).
CONCLUSIONS: In this superiority trial, catheter orifice configuration did not influence the effectiveness of CFNB in this setting: quality of analgesia was similar, with no reduction in either local anesthetic or morphine consumption, and equivalent postoperative quadriceps weakness.
TRIAL REGISTRATION: Retrospectively registered at ( NCT03376178 ). Date: 21 November 2017. |
0 | Is Ultrasound Remission a Real Remission? Does Ultrasound Permit to Achieve and Maintain the Remission in Rheumatoid Arthritis Patients More Efficiently Than Clinical Scores? | Glenohumeral Joint OA | REVECHO is an international prospective multicentre simple blinded randomized study with a longitudinal followâ?up of 18 months and a total study duration of 48 months. During the first visit, after having signed the consent form, Patients undergo at each visit, a clinical evaluation comprising an assessment of tender joint count (TJC), of swollen joint count (SJC), pain assessment, patient global assessment of the activity of disease, as well as a physician global assessment of the disease activity, an ultrasound examination of small and large joints by an independent physician blinded to the clinical data, and to the results of biological exams (blood sampling to assess CRP, complete blood count (CBS), and renal and hepatic functions). The clinical, biological and ultrasound assessments will be performed every 3 months. Patients will be then randomly assigned to one of the 3 groups: 1) "Usual care group", 2) "Clinical (DAS28)â?ultrasound followâ?up group" (ultrasoundâ?driven therapy) or 3) "DAS28â?ACR/EULAR remission criteria group" (ACR/EULAR remission criteriaâ?driven therapy), with a followâ?up of 18 months. Therapeutic decisions are taken by the Referring Rheumatologist. He/she will have DAS28 + US results in the group US followâ?up or DAS28 + ACR/EULAR remission criteria results in the group ACR/EULAR followâ?up. Therapeutic recommendations (therapeutic options, according to the randomization group, a threshold of activity will be decided by a scientific committee for increasing, stop or change therapy) will be given according to the group of randomization and based on the level of inflammation. The Referring Rheumatologist, will be free to follow or not the therapeutic advices. In "Usual care" group, DAS28 and PDUS assessment will be performed at each time point, however, no suggestion neither DAS28 nor PDUS results will be given to the Referring Rheumatologist. The Referring Rheumatologist will be free to manage the patient as he/she thinks more appropriate. Conventional radiography (hand and feet) will be performed at baseline and at M18 followâ?up. Centralized evaluation of radiographs will be performed by 2 independent readers, using SvH score. Radiographic progression will be defined by a change of SvH score between baseline and M18 >0. PDUS examination will be performed every 3 months by an independent Physician in each centre, blinded to clinical, biological and radiographic data. Shoulders, elbows, wrists, MCP 1 to 5, PIP 1 to 5, knees, ankles (tibiaâ?talar) and MTP 1 to 5 will be examined in B mode and in Power Doppler mode. Each joint will be scored for synovitis according to the OMERACT definition and to the OMERACT scoring system (semiâ?quantitative score from 0 to 3 for grey scale, PD and for combined score). Questionnaire (RAPID and HAQ) scores will be also evaluated every 3 months in each group. |
0 | Hypertension in nursing home patients | Management of Hip Fractures in the Elderly | There have been few studies of hypertension in nursing home patients. To assess the prevalence, demographic characteristics, comorbidity and drug therapy in hypertensive nursing home patients compared with those who are normotensive, we reviewed all medical charts of patients in three nursing home facilities. Of the 804 patients, 355 (44.2%) have hypertension. Calcium channel blockers were the most frequently prescribed anti-hypertensive (30.3%) and together with diuretics (28.4%) and ACE inhibitors (27.7%) account for more than 85%. Hypertensive patients take more cardiac, hypoglycaemic, and analgesic drugs (P = <0.001, <0.001, and 0.004, respectively) than those who are normotensive. Overall patients take an average of 8.68 medications daily. In hypertensive patients, the average number of comorbid conditions (excluding hypertension) is 5.02 compared with 3.23 in normotensive patients. Hypertension is significantly associated with diabetes, heart disease, cerebrovascular disease, neoplasms, endocrine disorders, gastrointestinal diseases, psychiatric disorders, dementia, other central nervous system diseases, skin problems, blood diseases and inversely with hip fracture. Blood pressure control (<140/90 mm Hg) is achieved in 88.8%, is not related to age and is significantly more frequent in males than females (91.8% vs 82.6% P = 0.025). The problem of hypertension in nursing home patients is complex and has received insufficient study. Since studies demonstrating benefit from anti-hypertensive therapy in the elderly excluded the very elderly and those with significant comorbid conditions, additional research is needed |
0 | Fresh-socket implants in periapical infected sites in humans | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | BACKGROUND: The aim of the present study is to compare the outcome of the immediate placement of implants when used in the replacement of teeth with and without chronic periapical lesions. METHODS: Thirty patients requiring a single-tooth extraction of a monoradicular or premolar tooth were selected. The control group (CG) included 15 patients without periapical lesions but with root caries and root fractures. The test group (TG) included 15 patients with periapical lesions, periapical radiolucencies, and no signs of pain, fistulas, or suppuration. Thirty teeth were extracted, and implants were immediately positioned in fresh sockets and loaded after 3 months in both groups. Clinical parameters (probing depth [PD], modified plaque index, modified bleeding index [mBI], marginal gingiva level [MGL], and keratinized mucosa [KM]) and marginal bone levels were evaluated at baseline and 12 and 24 months after implant placement. Comparisons between CG and TG values over time were performed by the Student two-tailed t test. RESULTS: At the 24-month follow-up, a survival rate of 100% was reported for all implants. The mean bone loss was 0.82 +/- 0.52 mm for the CG and 0.86 +/- 0.54 for the TG. Plaque accumulation was 0.74 +/- 0.29 for the CG and 0.69 +/- 0.29 for the TG. The mBI was 0.77 +/- 0.33 for the CG and 0.72 +/- 0.36 for the TG. The soft tissue profile MGL and KM remained stable for up to 24 months for the CG and TG. The mean PD was 2.05 +/- 0.66 mm for the CG and 1.99 +/- 0.57 mm for the TG. Differences that were not statistically significant were reported between the CG and TG over time and between time points. CONCLUSION: At the 24-month follow-up, endosseous implants placed immediately in extraction sites affected by periapical infection rendered an equally favorable soft and hard tissue integration of the implants, revealing a predictable outcome |
1 | Cost effectiveness of denosumab versus oral bisphosphonates for postmenopausal osteoporosis in the US | HipFx Supplemental Cost Analysis | BACKGROUND: In the US, 26 % of women aged >/=65 years, and over 50 % of women aged >/=85 years are affected with postmenopausal osteoporosis (PMO). Each year, the total direct health care costs are estimated to be $US12-18 billion. OBJECTIVE: The cost effectiveness of denosumab versus oral bisphosphonates in postmenopausal osteoporotic women from a US third-party payer perspective was evaluated. METHODS: A lifetime cohort Markov model was developed with seven health states: 'well', hip fracture, vertebral fracture, 'other' osteoporotic fracture, post-hip fracture, post-vertebral fracture, and dead. During each cycle, patients could have a fracture, remain healthy, remain in a post-fracture state or die. Relative fracture risk reductions, background fracture risks, mortality rates, treatment-specific persistence rate, utilities, and medical and drug costs were derived using published sources. Expected costs and quality-adjusted life years (QALYs) were estimated for generic alendronate, denosumab, branded risedronate, and branded ibandronate in the overall PMO population and high-risk subgroups: (a) >/=2 of the following risks: >70 years of age, bone mineral density (BMD) T score less than or equal to -3.0, and prevalent vertebral fracture; and (b) >/=75 years of age. Costs and QALYs were discounted at 3 % annually, and all costs were inflated to 2012 US dollars. Sensitivity analyses were conducted by varying parameters e.g., efficacies of interventions, costs, utilities, and the medication persistence ratio. RESULTS: In the overall PMO population, total lifetime costs for alendronate, denosumab, risedronate, and ibandronate were $US64,400, $US67,400, $US67,600 and $US69,200, respectively. Total QALYs were 8.2804, 8.3155, 8.2735 and 8.2691, respectively. The incremental cost-effectiveness ratio (ICER) for denosumab versus generic alendronate was $US85,100/QALY. Risedronate and ibandronate were dominated by denosumab. In the high-risk subgroup (a), total costs for alendronate, denosumab, risedronate and ibandronate were $US70,400, $US70,800, $US74,000 and $US76,900, respectively. Total QALYs were 7.2006, 7.2497, 7.1969 and 7.1841, respectively. Denosumab had an ICER of $US7,900/QALY versus generic alendronate and dominated all other strategies. Denosumab dominated all strategies in women aged >/=75 years. Base-case results between denosumab and generic alendronate were most sensitive to the relative risk of hip fracture for both drugs and the cost of denosumab. CONCLUSION: In each PMO population examined, denosumab represented good value for money compared with branded bisphosphonates. Furthermore, denosumab was either cost effective or dominant compared with generic alendronate in the high-risk subgroups |
0 | High Tibial Osteotomy following Biologic Replacement of the Knee | AMP (Acute Meniscal Pathology) | Biologic unicondylar replacement with fresh osteoarticular allografts of the femoral condyle and tibial plateau plus a meniscus transplant provides an option for young or active patients with severe articular cartilage loss. The timing of osteotomy procedures to correct malalignment either before, concurrent, or after allograft implantation has become an area of research interest. Concurrent osteotomies and allograft transplantation have become increasingly popular due to the decreased patient morbidity from multiple surgeries that require a period of toe-touch weight bearing (TTWB) postoperatively. We discuss here our techniques for correcting malalignment, which concurrently repair major bipolar knee lesions while transplanting the meniscus. We prefer to perform a simultaneous biologic unicondylar replacement with an osteotomy, if needed. Weight bearing alignment radiographs should be obtained 6 weeks following surgery to confirm the intraoperative findings that were obtained using fluoroscopy and the alignment rod. If malalignment persists and the biologic grafts are overloaded, a staged osteotomy should be performed as soon as possible. |
0 | Psychosocial factors in fibromyalgia compared with rheumatoid arthritis: II. Sexual, physical, and emotional abuse and neglect | DoD PRF (Psychosocial RF) | OBJECTIVE: Two recent reports have found associations between fibromyalgia and sexual victimization, but had methodologic characteristics that limited their interpretation.
METHOD: We compared 36 patients with fibromyalgia and 33 patients with rheumatoid arthritis by using structured interviews for sexual, physical, and emotional victimization histories, as well as dimensional self-report measures of victimization severity.
RESULTS: Compared with the patients with rheumatoid arthritis, those with fibromyalgia had significantly higher lifetime prevalence rates of all forms of victimization, both adult and childhood, as well as combinations of adult and childhood trauma. Although childhood maltreatment was found to be a general risk factor for fibromyalgia, particular forms of maltreatment (eg, sexual abuse per se) did not have specific effects. Experiences of physical assault in adulthood, however, showed a strong and specific relationship with unexplained pain. Trauma severity was correlated significantly with measures of physical disability, psychiatric distress, illness adjustment, personality, and quality of sleep in patients with fibromyalgia but not in those with rheumatoid arthritis.
CONCLUSIONS: Fibromyalgia seems to be associated with increased risk of victimization, particularly adult physical abuse. Sexual, physical, and emotional trauma may be important factors in the development and maintenance of this disorder and its associated disability in many patients. |
0 | The Impact of Metabolic Syndrome on 30-Day Outcomes Following ORIF for Ankle Fractures | DoD SSI (Surgical Site Infections) | <b>Introduction:</b> Metabolic syndrome (MetS) is associated with significant postoperative morbidity. Despite an increasing prevalence of MetS in the US population, its impact on postoperative outcomes following ankle fractures remains limited. <b>Materials and Methods:</b> The 2012-2016 American College of Surgeons-National Surgical Quality Improvement Program database was queried for patients undergoing open reduction with internal fixation (ORIF) for ankle fractures using Current Procedural Terminology codes: 27766, 27769, 27792, 27814, 27822, and 27823. The study cohort was divided into 2 groups: MetS versus No MetS. MetS was identified using a predefined criteria as the coexistence of (1) diabetes mellitus, (2) hypertension, and (3) body mass index >=30 kg/m<sup>2</sup>. |
0 | Treatment of adolescents with a periacetabular osteotomy after previous pelvic surgery hip | Developmental Dysplasia of the Hip 2020 Review | Background: Although the success of the Bernese periacetabular osteotomy (PAO) has been reported for primary dysplasia, there is no study analyzing the radiographic, functional, and gait results of the PAO to correct residual hip dysplasia after previous pelvic surgery. Questions/purposes: We assessed (1) radiographic and (2) functional and gait outcomes of patients treated with a PAO after previous pelvic surgery (PPSx) and compared their results with results of patients with no previous surgery (NPSx) to determine whether the PAO was equally effective in patients with revision pelvic surgery. Methods: Twentyâ?nine dysplastic hips in 26 patients (average age, 16.3 years) were included: 13 in the PPSx group and 13 in the NPSx group. Radiographic parameters included the lateral centerâ?edge angle, acetabular index, and femoral head extrusion index measured preoperatively and at 6 months and 1 year. We assessed preoperative and postoperative function using the Harris hip score (HHS). Preoperative and postoperative gait analysis included the hip abductor impulse. Results: Improvements in groups were seen from preoperatively to 1 year postoperatively for the lateral centerâ?edge angle, acetabular index, and femoral head extrusion index without differences between groups. The modified HHSs improved at 6 months and were maintained at 1 year for patients in both groups without differences between groups. The hip abductor impulse returned to preoperative values at 6 months in the NPSx group but not until 1 year in the PPSx group. Conclusions: The Bernese PAO is effective in providing similar final radiographic and functional results, however, a trend toward decreased hip flexion and abduction power at 1 year was seen with previous pelvic surgery. Level of Evidence: Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. © 2012 The Association of Bone and Joint Surgeons®. |
0 | Predictors of post-traumatic psychological growth in the late years after lung transplantation | DoD PRF (Psychosocial RF) | BACKGROUND: Although lung transplantation improves quality of life, most psychosocial research focuses on adverse psychological and social functioning outcomes. Positive effects, particularly in the late-term years as physical morbidities increase, have received little attention. We provide the first data on a psychological benefit - post-traumatic growth (PTG) - and we focused on long-term (>5 yr) survivors.
METHODS: Among 178 patients from a prospective study of mental health during the first two yr post-transplant, we recontacted survivors 6-11 yr post-transplant. We assessed PTG (i.e., positive psychological change resulting from the transplant) and examined its relationship to other patient characteristics with multivariable regression analyses.
RESULTS: Sixty-four patients (86% of survivors) were assessed (M = 8.1 yr post-transplant, SD = 1.2). Mean PTG exceeded the scale's midpoint (M = 38.6, SD = 10.0; scale midpoint = 25). Recipients experiencing greater PTG were female (p = 0.022), less educated (p = 0.014), and had a history of post-transplant panic disorder (p = 0.005), greater friend support (p = 0.048), and better perceived health (p = 0.032). Neither other pre- or post-transplant mood and anxiety disorders nor transplant-related morbidities (acute rejection, bronchiolitis obliterans syndrome) predicted PTG.
CONCLUSIONS: PTG exceeded levels observed in other chronic disease populations, suggesting that lung transplantation may uniquely foster positive psychological change in long-term survivors. PTG occurs despite physical and psychiatric morbidities. Whether PTG promotes other positive post-transplant psychosocial outcomes deserves attention. |
1 | High resolution US of peripheral nerves | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | Peripheral nerves have a typical ultrasound structure that correlates well with histologic appearance and makes differentiation between nerves and adjacent structures possible in most cases. This allows ultrasonography to study a large variety of lesions involving peripheral nerves such as entrapment syndromes, tumors, traumas and degenerative lesions. Three main patterns of disease can be observed: 1) extrinsic lesions, such as carpal or epithroclear tunnel syndrome and involvement from adjacent masses or fibrous scar; 2) tumors, such as schwannomas and neurofibromas. Their different shapes can allow the differential diagnosis; furthermore, presence of signs of infiltration of surrounding organs can suggest malignancy. 3) Intrinsic diseases. Congenital neuromegaly syndromes, as well as degenerative changes, post-traumatic neuromas, nervous changes after reconstruction surgery and Morton's neuromas can be recognized |
0 | Rotating hinge prosthesis for complex revision total knee arthroplasty: A review of the literature | OAK 3 - Non-arthroplasty tx of OAK | Introduction: The rotating hinge prosthesis was originally used and designed as a primary total knee arthroplasty implant, but was hampered due to poor outcomes and catastrophic failures. Newer rotating hinge implants can be utilized in complex revision total knee arthroplasties when appropriately indicated, but their outcome data is very difficult to interpret due to the strict and varied indications for use and subsequently small number of procedures performed. The goal of this review is to evaluate the current evidence on large cohort, rotating hinge knee prostheses used in the revision setting, in order to provide a clearer understanding of the indications, outcomes and complications. Methods: The PubMed database was utilized to search the available literature regarding â??hinged knee,â? or â??rotating hingeâ? devices. Exclusion criteria included papers focusing on primary arthroplasty, revision for oncologic issues, one-stage revision for infection or studies with less than fifty cases. Results: Review of 115 abstracts after initial search, led to ten studies in the literature that met our inclusion and exclusion criteria. The data shows that rotating hinge knee implants have good survivorship ranging from 51% to 92.5% at 10 years post-operatively. Complication rates range from 9.2% to 63% with infection and aseptic loosening as the most common complications. Conclusion: Rotating hinge knee prostheses are most commonly indicated for infection, aseptic loosening, instability and bone loss in the literature. They have good outcome scores and survivorship, but continue to have high complication and revision rates. The implant is a good option when utilized appropriately for patients that are not candidates for less constrained devices. |
0 | Increased localization of (99m)Tc pyrophosphate in a bone island: case report | MSTS 2018 - Femur Mets and MM | A positive (99m)Tc pyrophosphate bone scan is reported in a proven case of large compact bone island. Pyrophosphate uptake in this case is presumed to be due to either large size or growth of the bone island. A radionuclide bone scan does not always differentiate bone islands from metastatic or inflammatory sclerotic bone lesions. |
0 | Evaluation of NFKB1A variants in patients with knee osteoarthritis | OAK 3 - Non-arthroplasty tx of OAK | A key feature of osteoarthritis (OA) is articular cartilage loss mediated by numerous catabolic factors including pro-inflammatory cytokines. Cytokine expression is modulated by the nuclear factor kappaB (NF-kappaB) family of transcription factors that are in turn, regulated by the inhibitor of NF-kappaB IkappaBalpha encoded by NFKB1A. We examined eight, previously reported common germline polymorphisms to determine whether NFKB1A variants are associated with knee OA. Eight common single-nucleotide polymorphisms (SNPs) across the NFKB1A gene were genotyped in 189 cases with knee OA and 197 healthy controls. Allele, genotype and haplotype frequencies were compared between case and control groups and stratified according to gender due to the increased prevalence of female OA. Serum concentrations of four biochemical markers elevated in OA were compared with genotype for each knee OA case. None of the SNPs showed an association with knee OA; however, stratification of the data for gender showed an increased frequency of the rs8904 variant allele in the female knee OA case group (P = 0.02). Six common haplotypes were identified (H1-H6). H6 was marginally more prevalent in the knee OA group (P = 0.05). The rs8904 variant was associated with increased levels of hyaluronan (HA), a marker of synovial inflammation at 12 and 24 months compared to baseline levels. The nearby rs696 variant demonstrated increased levels of C-reactive protein (CRP) at 12 months and HA at 12 and 24 months. A reduction in CRP levels at 12 months was observed for the rs2233419 variant. These findings provide evidence for the association of NFKB1A variants and knee OA. |
0 | A case report describing a suspected rivaroxaban hypersensitivity reaction in a surgical patient | Surgical Management of Osteoarthritis of the Knee CPG | Summary What is known and Objective: Rivaroxaban is an oral anticoagulant, currently licensed for use as a venous thromboembolism (VTE) prophylaxis, and recommended by the National Institute for Clinical Excellence (NICE) for all patients undergoing elective hip and knee replacement surgery in the UK. We present the first case of a suspected hypersensitivity to rivaroxaban. Case summary: A 57-year-old man with no previous allergies underwent an uncomplicated, elective partial knee replacement, after which he was prescribed a routine 2-week course of rivaroxaban 10 mg. He developed an allergic response requiring readmission for assessment and treatment 7 days post-operatively. What is new and Conclusion: We believe this to be the first published case of hypersensitivity associated with rivaroxaban. More research is needed to determine this association. At the same time, given the growing range and increasing use of anticoagulants, particular vigilance is required regarding potential side effects so that these may be managed quickly and effectively in the early stages. (copyright) 2012 Blackwell Publishing Ltd |
0 | Nonbridging external fixation of distal radius fractures | Distal Radius Fractures | Surgical management of distal radius fractures continues to evolve because of their high incidence in an increasingly active elderly population. Traditional radiocarpal external fixation relies on ligamentotaxis for fracture reduction but has several drawbacks. Nonbridging external fixation has evolved to provide early wrist mobility in the setting of anatomic fracture reduction. Several studies of the nonbridging technique have demonstrated satisfactory results in isolated nonbridging external fixation series and in comparison with traditional spanning external fixation. Nonbridging external fixation for surgical treatment of distal radius fractures can be technically demanding and requires at least 1 cm of intact volar cortex in the distal fracture fragment for successful implementation. |
0 | Sonographic imaging of meniscal subluxation in patients with radiographic knee osteoarthritis | AMP (Acute Meniscal Pathology) | BACKGROUND/PURPOSE: This study was undertaken to describe the sonographic features of meniscal subluxation in the weight-bearing position and to determine any association between meniscal subluxation and radiographic osteoarthritis.
METHODS: In total, 238 knees with symptoms were examined successfully with weight-bearing anteroposterior and lateral radiographs and high resolution ultrasonography. The radiographs were examined to determine whether participants had radiographic osteoarthritis, graded using the Kellgren-Lawrence Scale. The degree of subluxation of the medial meniscus in each knee was measured using high resolution ultrasound with a 10-MHz linear transducer, at the level of the medial collateral ligament in weight-bearing condition. The degree of subluxation was compared in knees with the presence or absence of radiographic osteoarthritis using Students t test. Additional analysis between knees with early and advanced radiographic osteoarthritis was also performed.
RESULTS: Meniscal subluxation for knees with (n = 141) and without (n = 97) radiographic signs of osteoarthritis were 4.3 1.9 mm and 0.7 0.6 mm, respectively. The difference was highly significant (p < 0.001). After age adjustment, the medial meniscal subluxation of age-matched subjects were 4.8 1.7 mm for knees with radiographic osteoarthritis (n = 43) and 1.0 0.8 mm for knees without such changes (n = 43). The difference between the two groups was still significant (p < 0.001). The greatest meniscal subluxation was seen in knees with advanced radiographic signs of osteoarthritis; no knee with osteoarthritic changes on radiographs had an undisplaced meniscus.
CONCLUSION: Meniscal subluxation is a prominent feature on weight-bearing sonographic imaging in patients with radiographic osteoarthritis and could be considered as a risk factor for the development of knee osteoarthritis. By using musculoskeletal ultrasonography, one can detect this occult meniscal derangement early before the appearance of radiographic signs of osteoarthritis. |
0 | Bony island within the articular cartilage of the knee in a child: a rare condition for early osteoarthritis | Diagnosis and Treatment of Osteochondritis Dissecans AUC | Articular cartilage is a specific type of connective tissue composed of hydrated proteoglycans within a matrix of collagen fibrils. In the elderly population, it shows degenerative changes that may results in osteoarthritis. The more severe form of osteoarthritis occasionally demonstrates bone formation within the cartilage, which is designated as a bony protuberance, however, such lesions are rare in children. This report presents the case of a 10-year-old boy with a bony protuberance within the articular cartilage of the knee. The patient initially complained of knee pain and he subsequently developed flexion contracture. Radiological and arthroscopic examinations revealed a bony protuberance in the articular cartilage and degenerative changes of the cartilage above it. He was successfully treated by the removal of the bony protuberance and osteochondral grafting. The bony protuberance may have caused cartilage degradation since the thickness of the cartilage above it was thinner than that around the lesion. The bony protuberance within the articular cartilage formed in the younger population may be a possible cause of osteoarthritis. This case is a noteworthy with regard to the pathogenesis of osteoarthritis |
0 | Are lesions of the posterior cruciate ligament predictable before knee arthroplasty? A histological study of 434 ligaments in osteoarthritic knees | Surgical Management of Osteoarthritis of the Knee CPG | Despite the number of publications which have dealt with posterior cruciate ligament (PCL) retaining total knee arthroplasty, few studies have addressed the histology of the PCL. Based on these, the use of some predictive factors for lesions of the PCL has been suggested, as a decisive argument to substitute the ligament or not. The objective of this study was to assess the value of some predictive factors, based on objective findings. We performed histological analysis of 434 PCLs removed during total knee arthroplasty for osteoarthritis. Fifty-eight percent of these ligaments presented histological lesions. The degree of preoperative knee deformity, the intra-operative appearance of both cruciate ligaments, and gender were found to correlate with the severity of the microscopic lesions of the PCL. No such correlation was found with age nor with the type of knee deformity. Calcium pyrophosphate deposits were a frequent and potentially pejorative finding in the PCLs from osteoarthritic knees. Due to their poor sensitivity and specificity, the criteria suggested in previous studies to decide on preserving or substituting the PCL appeared fairly unreliable |
0 | Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group | Management of Hip Fractures in the Elderly | The purpose of this randomized, double-masked, placebo-controlled study was to determine the efficacy and safety of risedronate in the prevention of vertebral fractures in postmenopausal women with established osteoporosis. The study was conducted at 80 study centers in Europe and Australia. Postmenopausal women (n = 1226) with two or more prevalent vertebral fractures received risedronate 2.5 or 5 mg/day or placebo; all subjects also received elemental calcium 1000 mg/day, and up to 500 IU/day vitamin D if baseline levels were low. The study duration was 3 years; however, the 2.5 mg group was discontinued by protocol amendment after 2 years. Lateral spinal radiographs were taken annually for assessment of vertebral fractures, and bone mineral density was measured by dual-energy X-ray absorptiometry at 6-month intervals. Risedronate 5 mg reduced the risk of new vertebral fractures by 49% over 3 years compared with control (p<0.001). A significant reduction of 61% was seen within the first year (p = 0.001). The fracture reduction with risedronate 2.5 mg was similar to that in the 5 mg group over 2 years. The risk of nonvertebral fractures was reduced by 33% compared with control over 3 years (p = 0.06). Risedronate significantly increased bone mineral density at the spine and hip within 6 months. The adverse-event profile of risedronate, including gastrointestinal adverse events, was similar to that of control. Risedronate 5 mg provides effective and well-tolerated therapy for severe postmenopausal osteoporosis, reducing the incidence of vertebral fractures and improving bone density in women with established disease |
1 | Psychosocial and health correlates of types of traumatic event exposures among U.S. military personnel | DoD PRF (Psychosocial RF) | The prevalence of lifetime exposure to violence, natural disaster, or major accidents involving injuries or fatalities was examined in the largest population-based epidemiologic survey of U.S. military personnel to date. The psychosocial and health effects of types of exposure experience (witness only, victim/survivor, relief worker), gender differences, and social support were also evaluated. Over 15,000 active duty U.S. military personnel from stratified random samples of active duty U.S. personnel from all services responded to either mail questionnaires and/or worksite surveys. The lifetime exposure to one or more traumatic events was 65%; the most prevalent trauma for men was witnessing a major accident, and for women, witnessing a natural disaster. Victims of any traumatic event were at twice the risk of having two or more physical and mental health problems than nonexposed controls. Health outcomes of trauma exposure vary by type of traumatic event: type of exposure experience, rank, and gender. |
0 | Prevention and management of infection after total joint replacement | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | Prophylactic antimicrobial regimens providing adequate drug levels in tissue during surgery and for periods of 24 hours to 14 days are of proven effectiveness in reducing infection rates after joint arthroplasty. Although most surgeons employ short regimens of <24 hours' duration, their efficacy has not been clearly established for joint replacement in placebo-controlled trials. Careful preparation of the patient before surgery and attention to operating room asepsis are also important. In early postoperative infections, surgical debridement and antibiotic treatment may allow conservation of the prosthetic components. In established infection in which the components have become loose, radical surgical debridement must include removal of all prosthetic material as well as involved bone and soft tissue; reconstruction by exchange arthroplasty has an acceptable success rate. For infections caused by organisms of low virulence, exchange arthroplasty has been successful as a one-stage procedure, but no comparative trial with two-stage exchange has yet been reported |
0 | Osteomyelitis as a Late Complication of Percutaneous Pinning of a Supracondylar Fracture of the Distal Part of the Humerus | Pediatric Supracondylar Humerus Fracture 2020 Review | CASE: We report a case of an eleven-year-old boy who presented to our clinic with a draining wound from the left elbow. He had a history of a left closed supracondylar humeral fracture that had been treated with closed reduction and percutaneous pinning at five years of age, and he subsequently developed late-onset osteomyelitis. The patient was successfully treated with surgical irrigation and debridement, followed by intravenous and oral antibiotics. CONCLUSION: Dormant osteomyelitis should be considered in the differential diagnosis for any child who presents with elbow symptoms with a prior history of a supracondylar humeral fracture that has been treated with closed reduction and percutaneous pinning. |
0 | Surgical indication and significance of portal vein resection in biliary and pancreatic cancer | MSTS 2018 - Femur Mets and MM | Tumor and vascular resection was carried out in 27 patients with biliary and pancreatic cancer. Vascular resection included resection and reconstruction of the both the portal vein and hepatic artery in two of the patients. Portal vein resection only was carried out in 23 patients, and resection of the side wall and plasty of the portal vein was carried out in the other two patients. The technical limit of portal vein resection without graft was 4 cm in the hepatic hilus and 7 cm after total pancreatectomy or pancreatoduodenectomy without grafts. On temporary occlusion of the portal vein between resection and reconstruction, simple occlusion was sufficient if it occurred within 30 minutes. In occlusion of more than 30 minutes, simultaneous occlusion of the superior mesenteric artery is better to prevent congestion of the intestine. If occlusion of more than 60 minutes is anticipated, a bypass between the superior mesenteric vein and the femoral vein with Anthron tube is recommended. The postoperative course was uneventful in 20 of the 27 patients. Two patients died within 1 month after surgery. The mortality rate for this aggressive surgery was 8.4%. Minor complications such as hydrothorax, small bile leakage, and localized abscess were observed but soon subsided in five patients. Fourteen of 27 patients survived or are alive after more than 1 year, and 9 of 14 patients survived or are alive after 2 years. Forty-seven percent of the patients who had no lymph node metastasis or peritumor lymph node metastasis without cancerous invasion of the portal vein intima survived more than 2 years. The longest length of survival of a patient with nonfunctioning islet cell carcinoma of the pancreatic head was 5 years 9 months. The longest surviving patient with ductal cell carcinoma of the pancreas is still living after 4 years. This approach is recommended in certain patients with vascular involvement but without lymph node metastasis or those patients with only peritumor lymph node involvement. Frozen section of mesenteric and paraaortic nodes should be standard practice before this aggressive resection. |
1 | Detection and quantitation by lysis-filtration of bacteremia after different oral surgical procedures | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | Patients with bacteremia after dental extraction, third-molar surgery, dental scaling, endodontic treatment, and bilateral tonsillectomy were studied by means of lysis-filtration of blood samples with subsequent aerobic and anaerobic incubation. Samples were obtained before, during, and 10 min after treatment. Bacteremia was observed in 100% of patients after dental extraction, 55% of patients after third-molar surgery, 70% of patients after dental scaling, 20% of patients after endodontic treatment, and 55% of patients after bilateral tonsillectomy. Anaerobic microorganisms were isolated more frequently than aerobic microorganisms were, and viridans group streptococci were the most commonly isolated bacteria. Ten minutes after treatment, the frequency as well as the magnitude of bacteremia showed pronounced reduction |
0 | The value of an organized fracture program for the elderly: early results | HipFx Supplemental Cost Analysis | OBJECTIVES: To describe the early financial results of an organized hip fracture program for older adults. DESIGN: Retrospective evaluation of financial data for a 1-year period on a hip fracture program for older adults. SETTING: University medical center. PATIENTS: All 193 adults older than age 60 with a native, nonpathologic hip fracture admitted to the hospital and surgically treated from May 2005 to April 2006 were included as subjects in this study. INTERVENTION: The comanaged, protocol-driven fracture management program was used as the specific intervention for treating all patients with hip fractures. MAIN OUTCOME MEASURE: The primary outcome was profit or loss resulting from treatment of patients. Key quality measures studied included length of hospital stay, mortality rates, complication rates, and hospital readmission rates. RESULTS: With use of an organized program, substantial savings in nearly all areas of expenditure is demonstrated. Adjusting for patient characteristics, costs are demonstrated to be 66.7% of the expected costs nationally. The length of stay, mortality, complication rates, and readmission rates were all noted to be below national averages. CONCLUSIONS: The improved quality measures suggest that better quality of patient care is associated with reduced costs |
0 | Effect of retaining articular capsule in total hip arthroplasty through posterior approach on hip stability | Management of Hip Fractures in the Elderly | Background: Articular capsule ligaments can lead articular surface to move normally and limit the excessive movement, especially to prevent any non-physiological movement. They are the important structures for stabilizing hip joints. It was previously thought that articular capsule should be routinely resected in the total hip arthroplasty (THA). Objective: This study was designed to investigate the effect of retaining articular capsule in THA through posterior approach on maintaining hip stability. Design, time and setting: This study, a retrospective case analysis, was performed on 61 patients with femoral neck fracture, who received treatment in the Department of Orthopedics, Xiangya Second Hospital of Central South between January 2005 and December 2006. Participants: Twenty-nine patients who underwent THA with retaining articular capsule from January to December 2006 were included as retaining group, and thirty-two patients who underwent THA with routine resection of partial articular capsule were included as routine group. The two groups were kept identical in case selection, prosthesis selection, post-surgery processing and operators. Methods: Four holes were drilled on greater trochanter on the proximal femoral bone. The superior part of articular capsule valve was sutured to the superior part of original articular capsule using No.1-0 absorbing thread, then sutured to base of femoral neck in mattress manner, and the suture was not ligated. The inferior part of articular capsule valve was sutured to the inferior part of original articular capsule using another suture. And the suture passed through two bone holes on base of femoral neck. The lower limbs were externally rotated and the suture was ligated. Subsequently, the excised extortor was repaired. Prior to and subsequent to suture, hip was slowly bent for 90(degrees) and femur was internally rotated for 45(degrees) to investigate the suture of articular capsule on strengthening articular stability. Mai outcome measures: Operation time, bleeding volume and hip dislocation after THA. Results: The operation time and bleeding volume were lower in the retaining group than in the routine group (P < 0.05). After THA, hip dislocation did not occur in any patients in the retaining group but occur in 2 patients (6.2%) in the routine group. Statistical tests could not be performed due to less data, resulting in no statistical significance. Conclusion: There has been no precise conclusion about the effects of retaining articular capsule or not on hip stability. But retaining articular capsule shortens operation time, reduces intrao-perative bleeding, unable raise operation risk, and re-establishes hip soft tissue balance |
0 | Diagnosing snapping sartorius tendon secondary to a meniscal cyst using dynamic ultrasound avoids incorrect surgical procedure | AMP (Acute Meniscal Pathology) | We describe a case of painful snapping in the medial aspect of the knee of a 40-year-old man, following a knee hyperflexion injury. Dynamic real-time ultrasonography determined that the snapping was due to the distal tendon of sartorius passing over a medial meniscal cyst. The patient subsequently underwent arthroscopic decompression of the cyst instead of an inappropriate hamstring tendon harvest procedure, with complete resolution of symptoms. |
0 | Vitamin D status, parathyroid function, bone turnover, and BMD in postmenopausal women with osteoporosis: global perspective | HipFx Supplemental Cost Analysis | Poor vitamin D status is common in the elderly and is associated with bone loss and fractures. The aim was to assess worldwide vitamin D status in postmenopausal women with osteoporosis according to latitude and economic status, in relation to parathyroid function, bone turnover markers, and BMD. The study was performed in 7441 postmenopausal women from 29 countries participating in a clinical trial on bazedoxifene (selective estrogen receptor modulator), with BMD T-score at the femoral neck or lumbar spine <or= -2.5 or one to five mild or moderate vertebral fractures. Serum 25(OH)D, PTH, alkaline phosphatase (ALP), bone turnover markers osteocalcin (OC) and C-terminal cross-linked telopeptides of type I collagen (CTX), and BMD of the lumbar spine, total hip, femoral neck, and trochanter were measured. The mean serum 25(OH)D level was 61.2 +/- 22.4 nM. The prevalence of 25(OH)D <25, 25-50, 50-75, and >75 nM was 5.9%, 29.4%, 43.5%, and 21.2%, respectively, in winter and 3.0%, 22.2%, 47.2%, and 27.5% in summer. Worldwide, a negative correlation between 25(OH)D and latitude was observed. With increasing 25(OH)D categories of <25, 25-50, 50-75, and >75 nM, mean PTH, OC, and CTX were decreasing (p < 0.001), whereas BMD of all sites was increasing (p < 0.001). A threshold in the positive relationship between 25(OH)D and different BMD parameters was visible at a 25(OH)D level of 50 nM. Our study showed a high prevalence of low 25(OH)D in postmenopausal women with osteoporosis worldwide. Along with latitude, affluence seems to be an important factor for serum 25(OH)D level, especially in Europe, where it is strongly correlated with latitude |
0 | Pain and recovery of physical functioning nine months after total knee arthroplasty | Surgical Management of Osteoarthritis of the Knee CPG | OBJECTIVE: To describe pain and recovery of physical functioning after total knee arthroplasty. DESIGN: A longitudinal design with assessments preoperatively, and 1 week, 3 and 9 months postoperatively. SUBJECTS: Sixty-three patients participated. METHODS: Pain was assessed by visual analogue scale. Physical functioning was measured by 40-metre timed walking, timed stair-climbing and goniometry. At 9 months the Short Form-36 pain and physical function scales were added to make comparisons with the general population. RESULTS: Pain score one week after surgery was 40 (standard deviation (SD) 23) vs 24 (SD 19) at 3 months (p < 0.001). At 9 months the pain score was 22 (SD 23) vs 49 (SD 18) preoperatively (p < 0.001). Knee extension did not differ from preoperative scores, but knee flexion reduced from 124 (SD 13) to 112 (SD 12) (p < 0.001). Forty-metre walking time improved from 37 (SD 13) to 34 (SD 11) s (p < 0.001), while the number of patients able to climb stairs was unchanged (p > 0.05). The patients' Short-Form 36 pain score did not differ from the general population, while the physical function score was 60 (SD 24) vs 75 (SD 24) (p < 0.001). CONCLUSION: Early pain reduction was registered. At 9 months, pain was equal to that in the general population, but a considerable number of patients still had problems in performing strenuous activities |
0 | Unilateral spinal anesthesia with hyperbaric bupivacaine versus hyperbaric articaine in out-patient knee surgery | Surgical Management of Osteoarthritis of the Knee CPG | Hemodynamic alterations due to sympathetic blockade during spinal anesthesia should be minimized. Restriction of sympathetic blockade during unilateral spinal anesthesia causes minimal hemodynamic alterations. The aim of this study was to compare the effect of hyperbaric bupivacaine and hyperbaric articaine on hemodynamic parameters and the level of sensory blockade for unilateral spinal anesthesia in outpatient knee arthroscopy. Twenty-seven patients undergoing elective lower extremity arthroscopy were included in this study. After spinal anesthesia in the lateral decubitus position. 15 patients in the bupivacaine group (Group B) were given 2 ml 0.5% hyperbaric bupivacaine and 12 patients in the articaine group (Group A) were given 1 ml 0.5% hyperbaric articaine. After the lateral position was maintained for 10 min. the final segmental blockade level and the degree of motor blockade on both the operated and unoperated sides were evaluated. Hemodynamic alterations and complications were also noted. There was no statistical difference between the groups with regards to hemodynamics, maximum sensorial blockade level, complications and number of patients in whom third degree motor blockade was achieved. However, two patients in the articaine group required general anesthesia due to inadequate surgical analgesia. In conclusion, unilateral spinal anesthesia could not be achieved with both of these techniques. However, both of these techniques can be safely used in outpatient arthroscopy for hemodynamic stability |
1 | Why not resurface the patella? | Surgical Management of Osteoarthritis of the Knee CPG | The results of resurfacing or not resurfacing the articular cartilage of the patella were reviewed in 71 knees--47 with rheumatoid arthritis and 24 with osteoarthritis--which had been replaced with the ICLH prosthesis. Two rheumatoid and osteoporotic patellae developed transverse fractures with separation and were excluded from the review. The results showed that resurfacing the patella greatly reduced peripatellar pain with no counter-balancing disadvantage |
0 | Repair of five distal radius fractures with an investigational cancellous bone cement: a preliminary report | Distal Radius Fractures | OBJECTIVE: The purpose of the study was to evaluate the feasibility of Norian SRS bone cement injected percutaneously into a distal radius following reduction in both preventing loss of reduction as well as safety.
DESIGN: The study was a prospective clinical study with an established protocol.
SETTING: The study was conducted at the Massachusetts General Hospital following approval of the institutions Investigational Review Board. All patients were required to read and approve an informed consent document.
PATIENTS: While twenty patients' radiographs fulfilled the requirement of a dorsally displaced extraarticular fracture to have occurred within 72 hours of presentation, only five consented to participate fully and one voluntarily withdrew after a six-month follow-up.
INTERVENTION: All fractures were reduced under regional or general anesthesia, and the Norian SRS was introduced via a catheter system into the metaphyseal defect of the fracture. A short arm cast was applied and remained in place for six weeks.
MAIN OUTCOME MEASUREMENTS: Radiographic parameters of fracture reduction were measured prospectively by an independent radiologist throughout the 12 months of the study. Clinical parameters of hand and wrist function were measured prospectively by an independent occupational therapist.
RESULTS: At 12-month follow-up, radial length was a mean 9.9 mm with an average loss of < 1 mm; radial angle maintained at a mean 25.4 degrees; volar angle was within normal range (0-21 degrees) in 4; and 1 patient had a dorsal angle of 7 degrees. Wrist motion improved 50 percent between 6 weeks and 3 months and improved further by 12 months when grip strength reached a mean of 88 percent of the contralateral side. Dorsal and volar extrusion of injected Norian SRS in 4 patients resorbed over time. There were no clinically significant adverse effects or complications.
CONCLUSIONS: Norian SRS proved to be clinically safe and effective as a cancellous bone cement to maintain fracture reduction of unstable extraarticular distal radius fractures. |
0 | Volumetric bone mineral density using peripheral quantitative computed tomography in Japanese women | Distal Radius Fractures | The present study evaluated a commercial device for peripheral quantitative computed tomography (pQCT) and examined the age-related changes in normal Japanese women. The volumetric bone mineral density (vBMD) of the distal radius [integral bone mineral density (BMDI), trabecular bone mineral density (BMDT) and cortical with subcortical bone mineral density (BMDSC)] was measured using pQCT (Norland-Stratec XCT960) in 617 healthy women aged 20-79 years and 75 subjects with osteoporosis aged 60-89 years who exhibited at least one vertebral fracture. The short-term precision errors in vivo (CV, %) were 1.1% for BMDI, 1.1% for BMDT and 1.2% for BMDSC. The correlations between pQCT and dual-energy X-ray absorptiometry measurements (Lunar DPX) of the lumbar spine were r approximately 0.8 (BMDI, BMDT and BMDSC). The maximal mean vBMD values were observed between 20 and 49 years; BMDI, BMDT and BMDSC all showed a linear postmenopausal decline averaging 1.1% per year. The overall decreases in vBMD from the peak values in those 70-79 years were 34%, 32% and 33% in BMDI, BMDT and BMDSC, respectively. The diagnostic sensitivity of osteoporosis was expressed as a T-score. T-scores using pQCT were -3.0 (BMDI), -2.4 (BMDT) and -2.9 (BMDSC). Bone mineral measurement of the distal radius may be useful in the evaluation of age-related bone loss and for the diagnosis of osteoporosis. |
0 | Poverty is a risk factor for osteoporotic fractures | Management of Hip Fractures in the Elderly | This study assesses the possible association between poverty and osteoporosis and/or fragility fractures in a population of postmenopausal women. We found that postmenopausal women with low socioeconomic status had lower values of BMD at the lumbar spine, a higher prevalence of densitometric osteoporosis, and a higher prevalence of total and vertebral fractures. INTRODUCTION: Some lifestyles are related to the presence of osteoporosis and/or fragility fractures, whereas poverty is related to some lifestyles. Because of this, we studied the possible association of poverty with osteoporosis and fractures. METHODS: This was an observational, cross-sectional study performed in the Canary Islands, Spain. Participants consisted of a total of 1,139 ambulatory postmenopausal women aged 50 years or older with no previous osteoporosis diagnosis and who were enrolled in some epidemiological studies. The prevalence of fractures (vertebral and non-vertebral) and the prevalence of osteoporosis (T-score <-2.5 either at the lumbar spine or the femoral neck). A previously validated questionnaire elicited the most important risk factors for osteoporosis: socioeconomic status, defined by the annual income was also assessed by a personal interview. A dorso-lateral X-ray of the spine was performed, and bone mineral density (BMD) was measured by DXA in the lumbar spine (L2-L4) and proximal femur. RESULTS: Compared to women with a medium and high socioeconomic status (n = 665), those who were classified into poverty (annual family income lower than 6,346.80 Euros, in a one-member family, n = 474), were older and heavier and had lower height, lower prevalence of tobacco and alcohol consumption, lower use of HRT and higher use of thiazides. After correcting for age and body mass index (BMI), women in poverty had lower spine BMD values than women with a medium and high socioeconomic status (0.840 g/cm(2) vs. 0.867 g/cm(2), p = 0.005), but there were no statistical differences in femoral neck BMD between groups. The prevalence of osteoporosis was also higher in women in poverty [40.6% vs. 35.6%, (OR 1.35, CI 95%: 1.03; 1.76)] after adjusting by age and BMI. Moreover, 37.8% of women in poverty had a history of at least one fragility fracture compared to 27.7% of women not in poverty (OR: 1.45, CI 95%: 1.11; 1.90). The prevalence of vertebral fractures was also higher in women in poverty 24.7% vs. 13.4%, (OR 2.01, CI 95%: 1.44; 2.81). CONCLUSIONS: Postmenopausal women with low socioeconomic status had lower values of BMD at the lumbar spine, and a higher prevalence of densitometric osteoporosis, and a higher prevalence of total and vertebral fractures. Because of this, apart from the well known risk factors for osteoporosis, poverty should be taken into account as a possible risk factor for both osteoporosis and fragility fractures, in order to establish sanitary strategies to protect unfavoured postmenopausal women |
1 | Minimally invasive technique versus conventional technique of dynamic hip screws for intertrochanteric femoral fractures | Management of Hip Fractures in the Elderly | INTRODUCTION: Intertrochanteric fractures of femur are common in elderly patients. The compression hip screw has become the predominant method for osteosynthesis of intertrochanteric fractures. However, the conventional dynamic hip screws (CDHS) technique has some disadvantages. Recently, we have used a minimally invasive dynamic hip screws (MIDHS) technique to reduce these disadvantages. This prospective study is to compare curative effect of MIDHS with that of CDHS with open reduction on Evans type 1 intertrochanteric fractures. MATERIALS AND METHODS: All 97 fractures were classified according to the Evans systems. The MIDHS group included 47 patients with an average age of 68.7 years, and the CDHS group included 50 patients with an average age of 68.7 years. The Singh index was used as a measure of osteoporosis. RESULTS: Both groups were similar in injury mechanism, fracture types, mean Singh index and medical diseases (all P > 0.50). All fractures were healed within 4 months in both groups except three cases who were implant failure and nonunion in the CDHS group. The MIDHS group had significantly smaller wound size, shorter surgery time, less blood loss, lower blood transfusion rate, earlier active mobilization of fractured hip joint, shorter hospital stay, lower serious complication rate and higher Harris hip score than the CDHS group (all P < 0.05). The satisfactory reduction, adequate screw position, healing time and union rate was not significantly difference between two groups (all P > 0.05). CONCLUSION: When the fractures are treated adequately, either the MIDHS or the CDHS with open reduction is an effective and safe method, but the MIDHS is superior to the CDHS with open reduction for the treatment of Evans type 1 intertrochanteric fractures of femur |
0 | Balneotherapy for osteoarthritis. A cochrane review | SR for PM on OA of All Extremities | OBJECTIVE: Balneotherapy (or spa therapy, mineral baths) for patients with arthritis is one of the oldest forms of therapy. We assessed effectiveness of balneotherapy for patients with osteoarthritis (OA). METHODS: We performed a broad search strategy to retrieve eligible studies, selecting randomized controlled trials comparing balneotherapy with any intervention or with no intervention. Two authors independently assessed quality and extracted data. Disagreements were solved by consensus. In the event of clinical heterogeneity or lack of data we refrained from statistical pooling. RESULTS: Seven trials (498 patients) were included in this review: one performed an intention-to-treat analysis, 2 provided data for our own analysis, and one reported a "quality of life" outcome. We found silver-level evidence of mineral baths compared to no treatment (effect sizes 0.34-1.82). Adverse events were not measured or found in included trials. CONCLUSION: We found silver-level evidence concerning the beneficial effects of mineral baths compared to no treatment. Of all other balneological treatments, no clear effects were found. However, the scientific evidence is weak because of the poor methodological quality and the absence of an adequate statistical analysis and data presentation |
0 | Efficacy of Single-stage Revision with Aggressive Debridement Using Intra-articular Antibiotics in the Treatment of Infected Joint Prosthesis | PJI DX Updated Search | Prosthetic joint infections (PJI) of the hip and knee are uncommon, but result in significant morbidity and mortality when they do occur. Current management consists of a combination of either single- or two-stage exchange of the prosthesis and/or exchange of polymer components with intravenous (IV) antibiotics (4-6 weeks) and intraoperative debridement of the joint prior to reimplantation. However, failure rate, morbidity, and expense associated with current management are high, especially if the infection involves resistant pathogens and/or osteomyelitis. Also, the current use of systemic antibiotics does not allow for high local concentrations of the drug and biofilm penetration of the infected prosthesis. To overcome these difficulties, we examined the outcomes of aggressive operative debridement of the infected prosthesis. This was achieved through the use of a single-stage revision and administration of high concentrations of local intra-articular antibiotics via Hickman catheters. We present 57 patients with PJI who were treated with intra-articular antibiotics and single-stage revisions. Minimal systemic toxicity was observed along with a 100% microbiologic cure rate and 89% without relapse at 11-month follow-up despite isolation of multidrug resistant pathogens. This is the largest study to date using this method in the treatment of PJI |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.