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1 | Incidence and cost of serious fall-related injuries in nursing homes | HipFx Supplemental Cost Analysis | BACKGROUND: Fall-related injuries (FRIs) result in morbidity and mortality for patients, as well as unnecessary expense to health care institutions. OBJECTIVES: (a) Estimate the incidence of falls and FRIs with a nursing home as the source of admission in Veterans Administration (VA) and non-VA facilities. (b) Estimate the cost of hospitalizations for each level of FRI severity. RESEARCH DESIGN: Retrospective analysis of falls and FRI resulting in a hospitalization whose source of admission was a VA nursing home. DATA: Falls and FRIs were obtained from Minimum Data Set (MDS) reports (January 2007-June 2009). Costs were obtained from the VA Decision Support System reports and Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) reports (2000-2006). MEASURES: Incidence of falls, fracture incidence, number of hospitalizations for FRIs, and costs associated with hospitalization for by level of FRI severity. RESULTS: Fall incidence was 10.6% in VA and 13.1% in CMS facilities. Fracture incidence was 0.9% in VHA and 1.65% in CMS facilities. Over a 3-year period, there were 2,400 admissions to VHA hospitals for FRI, with 55.4% hip fractures and10.1% intracranial injuries, with an average cost of US$23,723 per admission. Over a 9-year period, there were 141,308 admissions from nursing homes to non-VA hospitals for FRIs, with 38.8% hip fractures, 35.7% other fractures, and 11.1% intracranial injuries, with an average cost of US$31,507 per admission. CONCLUSIONS: Prevention program emphasis should shift away from a focus on preventing falls as a measure of quality care to decreasing FRIs. These findings support implementation of injury prevention programs for the elderly that reduces risk for injury as the primary outcome |
0 | Twenty-four hour care for schizophrenia | Management of Hip Fractures in the Elderly | BACKGROUND: Despite modern treatment approaches and a focus on community care, there remains a group of people who cannot easily be discharged from psychiatric hospital directly into the community. Twenty-four hour residential rehabilitation (a 'ward-in-a-house') is one model of care that has evolved in association with psychiatric hospital closure programmes. OBJECTIVES: To determine the effects of 24 hour residential rehabilitation compared with standard treatment within a hospital setting. SEARCH STRATEGY: We searched the Cochrane Schizophrenia Group Trials Register (May 2002 and February 2004). SELECTION CRITERIA: We included all randomised or quasi-randomised trials that compared 24 hour residential rehabilitation with standard care for people with severe mental illness. DATA COLLECTION AND ANALYSIS: Studies were reliably selected, quality assessed and data extracted. Data were excluded where more than 50% of participants in any group were lost to follow-up. For binary outcomes we calculated the relative risk and its 95% confidence interval. MAIN RESULTS: We identified and included one study with 22 participants with important methodological shortcomings and limitations of reporting. The two-year controlled study evaluated "new long stay patients" in a hostel ward in the UK. One outcome 'unable to manage in the placement' provided usable data (n=22, RR 7.0 CI 0.4 to 121.4). The trial reported that hostel ward residents developed superior domestic skills, used more facilities in the community and were more likely to engage in constructive activities than those in hospital - although usable numerical data were not reported. These potential advantages were not purchased at a price. The limited economic data was not good but the cost of providing 24 hour care did not seem clearly different from the standard care provided by the hospital - and it may have been less. AUTHORS' CONCLUSIONS: From the single, small and ill-reported, included study, the hostel ward type of facility appeared cheaper and positively effective. Currently, the value of this way of supporting people - which could be considerable - is unclear. Trials are needed. Any 24 hour care 'ward-in-a-house' is likely to be oversubscribed. We argue that the only equitable way of providing care in this way is to draw lots as to who is allocated a place from the eligible group of people with serious mental illness. With follow-up of all eligible for the placements - those who were lucky enough to be allocated a place as well as people in more standard type of care - real-world evaluation could take place. In the UK further randomised control trials are probably impossible, as many of these types of facilities have closed. The broader lesson of this review is to ensure early and rigorous evaluation of fashionable innovations before they are superseded by new approaches. TWENTY-FOUR HOUR CARE FOR SCHIZOPHRENIA: Schizophrenia is a long-term, chronic, illness with a worldwide lifetime prevalence of about one per cent. It has a high disability rate and the cost to individuals, their carers and health services is substantial. Although the majority of people with schizophrenia learn to cope in the community, there are some people who need help and reminders if they are to manage self-care and other aspects of day-to-day living. In many countries these people end up as long stay patients on hospital wards. This review aims to look at the economic costs and quality of life of people in 24 hour non-hospital care compared to those still in hospital. Only one trial of 22 people and lasting two years was identified, and it took place in the UK. Most of the participants but not all had schizophrenia. Half were assigned to live in a house staffed by a psychologist, and enough nurses and nursing assistants to provide 24 hour care. The staff were expected to help prepare and share meals with the residents and the residents had a programme of domestic work and some self-care tasks. The psychologist worked with each individual to improve social interaction and behaviour. The control group had normal hospital care with access to occupational therapy, industrial therapy and recreational facilities. They were also allowed home on leave and were counted as part of the group if they were discharged, transferred to hostels or in prison. The majority of the data were difficult to interpret because the numbers needed to make statistical comparisons were not given. Three people from the house had to be readmitted to the hospital and several of the others had short stays there. Those people who were resident in the house were reported to be significantly more likely to use social facilities and spent more time in socially constructive activities (self-care, eating with the group). All other measures reported were not significantly different between the groups. The costs for each group were similar, however if cost was calculated for those in the house who did not use the hospital at all, it was slightly less expensive. This was a small study which was not designed well. A larger, well-designed trial would answer the question of whether 24 hour care would benefit this group of people.(Plain language summary prepared for this review by Janey Antoniou of RETHINK, UK www.rethink.org) |
0 | The Study of Neuromuscular Exercise Therapy and Patients Self-management Program in Knee Osteoarthritis | OAK 3 - Non-arthroplasty tx of OAK | The study plans to enroll patients above 50 years old who suffered from knee OA, but patients meets any of the exclusion criteria will not be enrolled. 400 patients of knee OA will be randomly divided into A, B, C, D four parallel groups with fully informed, each group will enroll 100 patients, A for control group, B for neuromuscular exercise, C for selfâ?management program, D for neuromuscular exercise and selfâ?management program, respectively. Each collaborate hospital would enroll patients as a multicenter clinical trial. Patient will receive a baseline and 3m, 6m, 12m followâ?up evaluation of their knee physical function. Primary outcome measure is KOOS (Knee Injury and Osteoarthritis Outcome Score), secondary evaluation include VAS, EQâ?5D, Arthritis selfâ?efficacy score, 6â?minutes Walk test, TUG test, 20 meters quick walk test,Stand up test in 30 seconds, Balance test, Kellgren& Lawrenceï¼?KLï¼?, Pain medication. Outcome will compare the mean difference between baseline survey and 12 months of followâ?up in each group, using tâ?test or chiâ?square test,respectively. |
1 | Effectiveness of liposome bupivacaine for postoperative pain control in total knee arthroplasty: A PRISMA-compliant meta-analysis of randomized controlled trials | AAHKS (8) Anesthetic Infiltration | BACKGROUND: Adequate pain control after total knee arthroplasty (TKA) enables quicker recovery and reduces readmissions and treatment costs. The aim of this study was to determine the effect of liposomal bupivacaine (LB) for postoperative pain control in patients prepared for TKA.
METHODS: We searched for the reports that evaluating the effect of liposomal bupivacaine for postoperative pain control in patients prepared for TKA between March 1983 and May 2017 in the electronic database Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, Web of Science, and Ovid. The main outcomes were visual analog scale (VAS) at 24, 48, and 72 hours. The secondary outcomes were total morphine consumption, the length of hospital stay, range of motion, and the occurrence of nausea.
RESULTS: Seven randomized controlled trials (RCTs) enrolling 825 patients, with 413 in the LB group and 412 in the control group, were included in this meta-analysis. Our results suggested that administration LB was associated with a reduction of VAS by 4.22 points at 72 hours after TKA (WMD = -4.22, 95% CI -7.47, -0.97, P = .011) on a 100-point VAS. What's more, LB can decrease the occurrence of nausea when compared with traditional bupivacaine by 18.3% (risk ratio = 0.70, 95% confidence interval 0.55, 0.89, P = .003). LB was associated with an increase of the range of motion than traditional bupivacaine (P < .05). There was no significant difference between the VAS at 24, 48 hours, total morphine consumption and the length of hospital stay.
CONCLUSIONS: Administration with LB was associated with pain-relieving effects and reduces the morphine-related complications (nausea). Due the limited number of the included RCTs, large number and high quality RCTs are still need to identify the effects of LB for pain control after TKA. |
0 | Patient and physician predictors of post-fracture osteoporosis management | HipFx Supplemental Cost Analysis | BACKGROUND: Undertreatment of osteoporosis after hip or wrist fracture has been well documented, but the reasons for current patterns of care are poorly understood. OBJECTIVE: We tested the role of physician and patient characteristics in predicting undertreatment when osteoporosis management was clearly indicated after a hip or wrist fracture in women over age 65 |
0 | Popliteal Artery Pseudoaneurysm After Total Knee Arthroplasty | DOD - Acute Comp Syndrome CPG | Background Popliteal artery pseudoaneurysm is a rare complication after total knee arthroplasty. Early recognition is imperative in its management to prevent the subsequent development of compartment syndrome and soft tissue ischemia. The aim of this study was to evaluate the complication rate, recognition, and management of symptomatic popliteal artery pseudoaneurysm after total knee arthroplasty. Methods Between January 2004 and October 2014, 7937 consecutive total knee arthroplasties were identified from the Theatre Management (Ormis) System and cross-referenced against 1304 radiology reports containing the key words â??poplitealâ? and â??aneurysmâ?? identified from the Patient Archiving Communication System. Results Seven patients (0.088%) were found to have had a symptomatic popliteal artery pseudoaneurysm. The median (range) interval between total knee arthroplasty and the radiological diagnosis of a pseudoaneurysm was 15 (7-27) days. Popliteal artery pseudoaneurysm was diagnosed on duplex imaging (n = 4), arteriogram (n = 2), and computed tomography angiogram (n = 1). Fasciotomies were undertaken in 3 patients. Conclusion The complication rate of popliteal artery pseudoaneurysm was comparable to the literature. Recognition was identified as a problem. An appreciation of the mechanisms of injury and an awareness of this potential complication among orthopedic surgeons are imperative in reducing the complication rate and interval to diagnosis. Popliteal artery pseudoaneurysm should be included in the differential diagnosis for patients with a clinical presentation of postoperative compartment syndrome or deep vein thrombosis, and examination of the popliteal pulse should be undertaken early. |
0 | Effect of leptin on differentiation of human dental stem cells | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | Oral Diseases (2011) Objectives: Mesenchymal stem cells (MSCs) were identified in adult human periodontal ligament and dental pulp that are considered as potential stem cell sources for future clinical applications in dentistry. Leptin is known as an important regulator of mesenchymal differentiation. The objective of this study was to elucidate the role of leptin on proliferation and differentiation of dental MSCs. Materials and methods: Enhancement of cemento/odontoblastic differentiation of dental stem cells by leptin was confirmed by alizarin red S staining and alkaline phosphatase activity staining. In contrast, leptin reduced adipogenesis in both dental pulp stem cells (DPSCs) and periodontal ligament stem cells (PDLSCs) confirmed by oil red O staining and RT-PCR. The expression of adipogenic markers, lipoprotein lipase and proliferator-activated receptor (gamma)2 (PPAR(gamma)2), were suppressed in PDLSCs incubated on media supplemented with leptin for 2weeks. Results: Leptin had a relatively stronger osteogenesis promoting effect and adipogenesis suppressing effect in PDLSCs than in DPSCs. Conclusions: Collectively, leptin had a relatively stronger promoting effect on cemento/odontoblastic differentiation and a suppressing effect on adipogenesis in PDLSCs than in DPSCs. This study has provided evidence that leptin acts as an important modulator of dental MSCs differentiation. (copyright) 2011 John Wiley and Sons A/S |
0 | Total hip replacement as primary treatment of unstable intertrochanteric fractures in elderly patients | Management of Hip Fractures in the Elderly | Fifty-three patients with A2.2 and A2.3 intertrochanteric fracture according to the Muller classification were treated with total hip replacement between April 2000 and February 2004. The average age of the patients was 77 years. Average follow-up period was 3.7 years. We studied postoperative complications, mortality rate, functional outcome using the Harris hip score, time to return to normal activities, and radiographic evidence of healing. Two patients died on the third and fifth postoperative days. Seven more patients died within one year. The Harris hip score at one month was 66 +/- 7 (mean +/- standard deviation); at three months 72 +/- 6; at one year 74 +/- 5; at three years 76 +/- 6 and in the 27 patients who completed five year follow-up it was 76 +/- 8. Mobilisation and weight-bearing was started immediately in the postoperative period. Average time taken to return to normal daily activities was 28 days (range 24-33). No loosening or infection of the implants was observed. Total hip arthroplasty is a valid treatment option for mobile and mentally healthy elderly patients with intertrochanteric fractures. This procedure offers quick recovery with little risk of mechanical failure, avoids the risks associated with internal fixation and enables the patient to maintain a good level of function immediately after surgery |
0 | The Effect of Isometric Massage on Global Grip Strength after Conservative Treatment of Distal Radial Fractures. Pilot Study | Pediatric Supracondylar Humerus Fracture 2020 Review | BACKGROUND: The most common fracture of the distal end of the radius is Colles' fracture. Treatment modalities available for use in hand rehabilitation after injury include massage. The aim of this study was to evaluate the effect of isometric massage on the recovery of hand function in patients with Colles fractures. For this purpose, the strength of the finger flexors was assessed as an objective criterion for the evaluation of hand function. MATERIAL AND METHODS: The study involved 40 patients, randomly divided into Group A of 20 patients and Group B of 20 patients. All patients received physical therapy and exercised individually with a physiotherapist. Isometric massage was additionally used in Group A. Global grip strength was assessed using a pneumatic force meter on the first and last day of therapy. Statistical analysis was performed using STATISTICA. Statistical significance was defined as a P value of less than 0.05. RESULTS: In both groups, global grip strength increased significantly after the therapy. There was no statistically significant difference between the groups. The men and women in both groups equally improved grip strength. A statistically significant difference was demonstrated between younger and older patients, with younger patients achieving greater gains in global grip strength in both groups. CONCLUSION: The incorporation of isometric massage in the rehabilitation plan of patients after a distal radial fracture did not significantly contribute to faster recovery of hand function or improve their quality of life. |
1 | Hybrid external fixation in the treatment of tibial pilon fractures: A retrospective analysis of 162 fractures | DoD SSI (Surgical Site Infections) | OBJECTIVES: To determine the efficacy of hybrid external fixation in the treatment of tibial pilon fractures.
DESIGN: Retrospective, multicentre study.
PATIENTS/PARTICIPANTS: Adult patients with tibial pilon fractures treated with hybrid external fixation.
INTERVENTION: Fracture reduction with ligamentotaxis and fixation with XCaliber hybrid external fixator.
MAIN OUTCOME MEASUREMENTS: Fracture union, complications, functional outcome (Mazur Ankle Score).
RESULTS: Union was obtained in 159 fractures at an average of 125days; there were three delayed unions and three non-unions. The most frequent complication was superficial pin-track infections (48), all of which responded to local wound care and antibiotics. There were no deep infections and no DVT. Only one fracture had loss of reduction that required frame revision. The overall functional scores were 91 (excellent) for AO/OTA type A fractures, 89 (good) for type B fractures, and 75 (satisfactory) for type C fractures.
CONCLUSIONS: Hybrid external fixation is an effective method of stabilising tibial pilon fractures, particularly those with marked comminution. The minimally-invasive technique and stable fixation enable early mobilisation, with good functional results and minimal complications.
LEVEL OF EVIDENCE: Level IV Case series. |
0 | Perioperative care of patients with hip fracture: Management of vitamin K antagonists | Hip Fx in the Elderly 2019 | Hip fracture is a major concern for elderly patients and longer delay of surgery is associated with poor clinical outcomes. It is recommended to perform surgery within 2 days from hospital admission. The proportion of these patients undergoing vitamin K antagonist therapy is approximately 5 to 10%. They present with more comorbidities and often suffer surgical delay. A reversal strategy with vitamin K, sometimes associated with prothrombin complex concentrates, reduces the preoperative delay to surgery and leads to better outcome. Safety data around reversal strategies are lacking, but overall the risk of thrombotic events associated with anticoagulant reversal seems low. |
0 | Utility of interim and end-of-treatment PET/CT in peripheral T-cell lymphomas: A review of 124 patients | MSTS 2022 - Metastatic Disease of the Humerus | According to the updated guidelines for imaging in lymphoma, 18F-FDG positron emission tomography/computed tomography (PET/CT) is recommended for staging and evaluation of treatment response in FDG-avid lymphomas. The purpose of the study was to evaluate the utility of PET/CT in nodal peripheral T-cell lymphomas (PTCL). Patients with newly diagnosed nodal PTCL (peripheral T-cell lymphoma NOS, anaplastic large-cell lymphoma, or angioimmunoblastic T-cell lymphoma) seen at five Danish hematology centers during the period 2006 to 2012 were included, if they had been pretherapeutically staged with PET/CT. Medical records were reviewed for baseline clinical and follow-up information. Staging, interim (I-PET), and end-of-treatment PET/CT (E-PET) studies were centrally reviewed, and reported using the Deauville 5-point score (DS). A total of 124 patients fulfilled the inclusion criteria. The median age was 58 years, and 88% received CHOP/CHOP-like therapy. Five years PFS and OS of the study population was 36.8% (95% CI 27.3-46.4) and 49.7% (95% CI 38.9-59.6), respectively. The presence of PET/CT-ascertained lung and/or liver involvement was associated with a worse outcome. The sensitivity of PET/CT for detecting biopsy-defined bone marrow involvement was only 18% (95% CI 4-43). An interim DS >3 was not prognostic for worse OS and PFS among CHOP/CHOP-like treated patients in uni- or multivariate analyses. A DS >3 after treatment predicted a worse prognosis. In conclusion, I-PET was not predictive of outcome in CHOP/CHOP-like treated PTCL patients when using the DS. Prospective studies are needed to determine the optimal use of PET/CT in PTCL including the role of quantitative PET/CT analysis. |
1 | Lateral wedge insoles as a conservative treatment for pain in patients with medial knee osteoarthritis: a meta-analysis | OAK 3 - Non-arthroplasty tx of OAK | IMPORTANCE: There is no consensus regarding the efficacy of lateral wedge insoles as a treatment for pain in medial knee osteoarthritis.
OBJECTIVE: To evaluate whether lateral wedge insoles reduce pain in patients with medial knee osteoarthritis compared with an appropriate control.
DATA SOURCES: Databases searched include the Cochrane Central Register of Controlled Trials, EMBASE, AMED, MEDLINE, CINAHL Plus, ScienceDirect, SCOPUS, Web of Science, and BIOSIS from inception to May 2013, with no limits on study date or language. The metaRegister of Controlled Trials and the NHS Evidence website were also searched.
STUDY SELECTION: Included were randomized trials comparing shoe-based treatments (lateral heel wedge insoles or shoes with variable stiffness soles) aimed at reducing medial knee load, with a neutral or no wedge control condition in patients with painful medial knee osteoarthritis. Studies must have included patient-reported pain as an outcome.
DATA EXTRACTION AND SYNTHESIS: Trial data were extracted independently by 2 researchers using a standardized form. Risk of bias was assessed using the Cochrane Risk of Bias tool by 2 observers. Eligible studies were pooled using a random-effects approach.
MAIN OUTCOME AND MEASURES: Change in self-reported knee pain at follow-up.
RESULTS: Twelve trials met inclusion criteria with a total of 885 participants of whom 502 received lateral wedge treatment. The pooled standardized mean difference (SMD) suggested a favorable association with lateral wedges compared with control (SMD, -0.47; 95% CI, -0.80 to -0.14); however, substantial heterogeneity was present (I2 = 82.7%). This effect size represents an effect of -2.12 points on the 20-point Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain scale. Larger trials with a lower risk of bias suggested a null association. Meta-regression analyses showed that higher effect sizes (unstandardized beta, 1.07 [95% CI, 0.28 to 1.87] for trials using a no treatment control) were seen in trials using a no wedge treatment control group (n = 4 trials; SMD, -1.20 [95% CI, -2.09 to -0.30]) and lower effect sizes (unstandardized beta, 0.26 [95% CI, 0.002 to 0.52] for each bias category deemed low risk) when the study method was deemed at low risk of bias. Among trials in which the control treatment was a neutral insole (n = 7), lateral wedges showed no association (SMD, -0.03 [95% CI, -0.18 to 0.12] on WOMAC; this represents an effect of -0.12 points), and results showed little heterogeneity (I2 = 7.1%).
CONCLUSIONS AND RELEVANCE: Although meta-analytic pooling of all studies showed a statistically significant association between use of lateral wedges and lower pain in medial knee osteoarthritis, restriction of studies to those using a neutral insole comparator did not show a significant or clinically important association. These findings do not support the use of lateral wedges for this indication. |
0 | Hemophilus aphrophilus osteomyelitis | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | Hemophilus aphrophilus is a slow-growing, aerobic (capnophilic), gram-negative bacillus. H. aphrophilus was the cause of hematogenous vertebral osteomyelitis in a patient who had a lip laceration. This was successfully treated with parenteral penicillin. The antimicrobial susceptibilities of 14 antimicrobial agents are presented |
0 | Abdominal Flap-based Breast Reconstruction versus Abdominoplasty: The Impact of Surgical Procedure on Scar Location | Panniculectomy & Abdominoplasty CPG | BACKGROUND: Autologous breast reconstruction has been demonstrated to be associated with superior patient-reported outcomes, and hence is regarded as the gold standard reconstructive modality. A common drawback of this procedure, however, is related to a high abdominal scar. Recently, hybrid breast reconstruction (ie, the combination of autologous and implant-based reconstruction) was presented as an approach that would combine the benefits of both reconstructive modalities. In this study, we sought to assess abdominal aesthetic outcomes associated with this approach. METHODS: Thirty-two blinded reviewers evaluated standardized pre- and postoperative abdominal images of patients following autologous reconstruction with free abdominal flap (Group 1; N = 10), hybrid reconstruction (Group 2; N = 5), and abdominoplasty (Group 3; N = 10). Aesthetic abdominal appearance, including overall result, scar position, skin redundancy, and lateral abdominal contour, was rated on a 5-point Likert scale and a comparative analysis was performed. RESULTS: Hybrid reconstruction was associated with significantly lower abdominal scars compared with Group 1 (P = 0.01), nearing results of patients in Group 3 (P = 0.39). Significantly higher aesthetic ratings were ascribed to Groups 2 and 3 when compared with Group 1 (P < 0.001) with regard to scar positioning (P < 0.001), skin redundancy (P < 0.001), and lateral abdominal contour (P < 0.001). No significant difference in aesthetic ratings was noted between Groups 2 and 3. CONCLUSIONS: When applied to the appropriate patient population, hybrid breast reconstruction is a powerful method to achieve reconstructive goals while optimizing abdominal aesthetics. A significantly lower scar position was noted and higher abdominal aesthetic ratings were given following abdominoplasty and hybrid reconstruction compared with conventional abdominal flap-based reconstruction. |
0 | Postural control in rheumatoid arthritis patients scheduled for total knee arthroplasty | Surgical Management of Osteoarthritis of the Knee CPG | OBJECTIVE: To investigate the use of compensatory visual and attentional control strategies for standing balance in patients with rheumatoid arthritis (RA) with severe knee joint impairment. DESIGN: Experimental 2-group design. SETTING: Specialized clinic for orthopedics, rheumatology, and rehabilitation in The Netherlands. PARTICIPANTS: Eighteen patients without comorbidity (age range, 65 +/- 7.7 yr; 16 women, 2 men) from a consecutive sample of patients with RA scheduled for total knee arthroplasty; 23 controls of the same age group also were tested (13 women, 10 men). MAIN OUTCOME MEASURES: By means of a dual-plate force platform, the velocity of center of pressure (COP) fluctuations were analyzed in the anteroposterior and lateral sway directions during quiet standing with eyes open, eyes closed, and while performing a secondary attention-demanding arithmetic task. RESULTS: Patients showed an average 80% greater COP velocity in both directions of sway compared with controls. In addition, stability deteriorated substantially more in patients than controls when deprived of visual information, which was associated with the degree of knee destruction. The effect of the arithmetic task was small and similar in patients and controls. CONCLUSION: RA patients with severe knee joint impairment can have a substantial basic postural instability; their relatively high reliance on visual information suggests impaired sensory feedback from the lower limbs. Current research is aimed at determining whether these postural deficits can be improved by total knee replacement |
0 | In-Office Needle Arthroscopy Can Evaluate Meniscus Tear Repair Healing as an Alternative to Magnetic Resonance Imaging | AMP (Acute Meniscal Pathology) | PURPOSE: To assess the healing of horizontal cleavage tears of the meniscus 1 year after surgical repair and to determine what modality is best to determine healing.
METHODS: Patients were prospectively followed for 12 months after surgical meniscus repair using a circumferential compression stitch. Inclusion criteria were preoperative magnetic resonance imaging (MRI) evidence of horizontal cleavage tear, age between 18 and 50 years, and no concomitant anterior cruciate ligament reconstruction. Patients were excluded if they were >50 years old, had a meniscus tear pattern other than horizontal cleavage tear, and underwent concomitant ligament reconstruction. MRIs were performed 1-year postoperatively for evaluation of repair healing. Preoperative and postoperative MRIs of tears were evaluated blindly by a musculoskeletal radiologist. In-office needle arthroscopy was performed at 6 months post-operatively.
RESULTS: Eight patients were included and had surgery between March 2016 and November 2017. There were 4 medial and 4 lateral meniscus tears. No patients had recurrence of preoperative symptoms or evidence of retear. Six repairs evaluated by in-office needle (at 5.9 months postsurgery) arthroscopy demonstrated complete healing. Seven of the 8 patients had grade III changes on preoperative MRI, and 1 patient had grade IIc changes. On postoperative MRI, 5 of 7 patients had grade III changes, 1 patient had IIc changes, and 1 had IIb changes. There was no significant difference in the proportion of patients with grade III changes preoperatively compared with postoperatively (P = .57). One of 8 patients with preoperative MRIs demonstrated extrusion where no patients demonstrate postoperative MRI evidence of extrusion (P = .47).
CONCLUSIONS: Horizontal cleavage meniscal tears repaired with a circumferential compression stitch demonstrate healing on in-office needle arthroscopy 6 months after surgery. No evidence of incomplete or failed healing was found. MRI at 1 year after surgery demonstrated residual tear evidence for all patients.
LEVEL OF EVIDENCE: IV, therapeutic case series. |
0 | Arthroscopic treatment of ulnar impaction syndrome | DOD - Acute Comp Syndrome CPG | Ulnar impaction syndrome occurs in the setting of a central traumatic or degenerative defect in the triangular fibrocartilage complex in patients with ulnar positive variance. Chondral and subchondral edema, mechanical impingement of the articular disc, and chondromalacia of the distal ulna, proximal lunate, and proximal triquetrum produce symptoms with activity that do not improve with rest. Decreasing ulnocarpal load-sharing across the wrist with recession of the distal ulna is necessary to relieve symptoms in the majority of patients. Arthroscopic treatment with triangular fibrocartilage complex debridement and arthroscopic ulnar wafer resection is an effective treatment for ulnar impaction syndrome. It affords a single-stage, minimally invasive approach, with similar efficacy and fewer complications than open wafer resection or ulnar shortening osteotomy. [References: 7] |
0 | Preemptive Analgesia in Total Knee Arthroplasty: Comparing the Effects of Single Dose Combining Celecoxib with Pregabalin and Repetition Dose Combining Celecoxib with Pregabalin: Double-Blind Controlled Clinical Trial | AAHKS (8) Anesthetic Infiltration | Acute pain is the most common early complication after total knee arthroplasty causing delayed mobilization and increased demands of morphine, leading to higher operative cost. Several studies have assessed the effectiveness, side-effects, and ease of use of various analgesics. Preemptive analgesia with combined celecoxib and pregabalin has been reported to yield positive outcomes. In this randomized, double-blind controlled clinical trial, 30 subjects underwent surgery for total knee arthroplasty using 15-20mg bupivacaine 5% epidural anesthesia. All subjects were divided into three groups. Group 1 was given celecoxib 400mg and pregabalin 150mg 1 hour before the operation, Group 2 was given celecoxib 200mg and pregabalin 75mg twice daily starting from 3 days before the operation, and Group 3 was given a placebo. The outcome was measured with Visual Analog Scale, knee range of motion, and postoperative mobilization. There was a significant difference in postoperative morphine usage between the groups that were administered with preemptive analgesia and the placebo group, but no significant difference was found between Group 1 and Group 2 that were given preemptive analgesia at different doses. ROM and postoperative mobilization were not significantly different among the three groups. Two patients in the first group, one patient in the second group, and one patient in the third group developed nausea. Preemptive analgesia is proven to reduce postoperative usage of morphine independent of the dosage. We recommend the use of combined celecoxib and pregabalin as preemptive analgesia after the total knee arthroplasty procedure. This trial is registered with NCT03523832 (ClinicalTrials.gov). |
0 | Plate Fixation With Autogenous Calcaneal Dowel Grafting Proximal Fourth and Fifth Metatarsal Fractures: Technique and Case Series | DoD SSI (Surgical Site Infections) | Metaphyseal and proximal diaphyseal fractures of the lateral column metatarsals can have problems with healing. In particular, those involving the fifth metatarsal have been associated with a high nonunion rate with nonoperative treatment. Although intramedullary screw fixation results in a high union rate, delayed healing and complications can occur. We describe an innovative technique to treat both acute and chronic injuries involving the metatarsal base from the metaphysis to the proximal diaphyseal bone of the fourth and fifth metatarsals. The surgical technique involves evacuation of sclerotic bone at the fracture site, packing the fracture site with compact cancellous bone, and plate fixation. In our preliminary results, 4 patients displayed 100% radiographic union at a mean of 4.75 (range 4 to 6) weeks with no incidence of refracture, at a mean follow-up point of 3.5 (range 1 to 5) years. The early results with our small series suggest that this technique is a useful treatment choice for metaphyseal and proximal diaphyseal fractures of the fourth and fifth metatarsals. |
0 | A safety and feasibility study of a novel radiofrequency-assisted liposuction technique | Panniculectomy & Abdominoplasty CPG | BACKGROUND: The feasibility, safety, and efficacy of a novel radiofrequency device for radiofrequency-assisted liposuction were evaluated in various body areas. METHODS: From July to December of 2008, 23 subjects underwent radiofrequency-assisted liposuction using the BodyTite system. Information regarding aesthetic results and local and systemic complications was collected immediately after the procedure and at 6- and 12-week follow-up. RESULTS: The mean age of the patients was 38.8 +/- 12.4 years, and 87 percent were women. Radiofrequency-assisted liposuction was performed successfully in all cases; volume aspirated per patient was 2404 +/- 1290 ml, whereas operative time was 158 +/- 44 minutes. All patients underwent liposuction at the hip and low abdominal areas, bilaterally. Body contour improvement was observed postoperatively in all patients and there were no severe systemic or local complications, although postoperative pain was minimal in all patients. Weight and circumference reductions were significant at both 6-week and 3-month follow-up. Skin tightening was judged optimal by the surgeon in all patients. CONCLUSIONS: The authors' study suggests that the removal of moderate volumes of fat with concurrent subdermal tissue contraction can be performed safely and effectively with radiofrequency-assisted liposuction. Additional benefits of this technique are excellent patient tolerance and fast recovery time. Nonetheless, a larger sample is required to confirm the authors' results and guarantee the efficacy and safety of the procedure. Direct comparison with traditional liposuction or energy-assisted liposuction techniques may provide some insights to tailor future indications of this novel technique. |
0 | Associations between chronic conditions, body functions, activity limitations and participation restrictions: A cross-sectional approach in Spanish non-clinical populations | Hip Fx in the Elderly 2019 | Objectives To analyse the relationships between chronic conditions, body functions, activity limitations and participation restrictions in the International Classification of Functioning, Disability and Health (ICF) framework. Design A cross-sectional study. Setting 2 geographical areas in the Autonomous Region of Aragon, Spain, namely, a rural area, Cinco Villas, and an urban area in the city of Zaragoza. Participants 864 individuals selected by simple random sampling from the register of Social Security card holders, aged 50 years and over, positive to disability screening. Main outcome measures ICF Checklist-body function domains, WHO Disability Assessment Schedule 2.0 (WHODAS 2.0, 36-item (WHODAS-36)) global scores and medical diagnoses (chronic conditions) from primary care records. Results Mild disability (WHODAS-36 level 5-24%) was present in 51.5% of the sample. In the adjusted ordinal regression model with WHODAS-36 as the dependent variable, disability was substantially associated with moderate-to-complete impairment in the following functions: mental, OR 212.8 (95% CI 72 to 628.9); neuromusculoskeletal, OR 44.8 (24.2 to 82.8); and sensory and pain, OR 6.3 (3.5 to 11.2). In the relationship between health conditions and body function impairments, the strongest links were seen for: dementia with mental functions, OR 50.6 (25.1 to 102.1); cerebrovascular disease with neuromusculoskeletal function, OR 5.8 (3.5 to 9.7); and chronic renal failure with sensory function and pain, OR 3.0 (1.49 to 6.4). Dementia, OR 8.1 (4.4 to 14.7) and cerebrovascular disease, OR 4.1 (2.7 to 6.4) were associated with WHODAS-36 scores. Conclusions Body functions are heterogeneously linked to limitations in activities and restrictions on participation, with the highest impact being due to mental and musculoskeletal functions. This may be relevant for disability assessment and intervention design, particularly if defined on a body function basis. Control of specific health conditions, such as dementia and cerebrovascular disease, appears to be paramount in reducing disability among persons aged 50 years and over. |
0 | Paediatric supracondylar humerus fractures | Pediatric Supracondylar Humerus Fracture 2020 Review | This article gives a practical guide to the management of supracondylar fractures of the humerus in paediatric patients, from initial presentation to definitive treatment. It reviews the optimal management of this common and serious injury based on current evidence including the British Orthopaedic Association Standards for Trauma (BOAST) 11 standard. |
0 | Function following limb salvage for primary tumors of the shoulder girdle. 10 patients followed 4 (1-11) years | MSTS 2022 - Metastatic Disease of the Humerus | 10 patients with primary neoplasms of the shoulder girdle underwent limb salvage procedures involving resection of the proximal humerus and parts of the scapula and clavicle. The function of the ipsilateral limb was assessed in all patients, in 9 at least one and a half years after surgery. Function was good in 3 of the 6 patients in whom an interposition bone graft was used and a successful shoulder arthrodesis was achieved. In the remaining 3, proximal arthrodesis was unsuccessful and the result was fair in 2 and a failure in 1. All 3 patients in whom the extended Tikhoff Linberg type of reconstruction was undertaken had good function although unsatisfactory cosmetic results. The 10th patient, who had a temporary cement and wire interposition, died of distant metastases 8 months after surgery and was considered a failure. |
0 | Do osteoporosis-related vertebral fractures precede hip fractures? | Management of Hip Fractures in the Elderly | AIM: To evaluate the relationship between a vertebral fracture and a hip fracture in Saudi Arabians with osteoporosis. METHODS: In this retrospective study, 154 Saudi Arabian patients with osteoporosis-related hip fractures were analyzed for the presence of a vertebral fracture. Radiographs were retrieved from the IPAC (Image Picture Archiving and Computing) System, an imaging retrieval system, and were reviewed independently by two of the authors, Abid Hussain Gullenpet, and Mir Sadat-Ali, and later reviewed jointly. Patients admitted with proximal hip fracture who were >/= 50 years and had undergone Thoraco-lumber imaging and a dual energy X-ray absorptiometry (DEXA) scan were included in the study. Patients with a history of significant trauma to the spine and those with a malignancy or connective tissue disorder were excluded from the analysis. RESULTS: Out of 154 patients with hip fractures, 78 had a fracture of the femoral neck while 76 had an intertrochanteric hip fracture. Of the 111 patients who were finally included in the study, after applying inclusion and exclusion criteria, 76 patients with an average age of 67.28 +/- 12 years had no fractures of the spine. Thirty-five patients with an average age of 76.9 +/- 14.5 years (31.53%) had a total of 49 vertebral fractures. Patients with vertebral fractures were significantly older than those without fractures P < 0.001. Overall, 24.7% of these patients had an asymptomatic vertebral fracture. Further analysis showed that 11 males (18.96%) and 24 females (45.28%) had suffered a previous asymptomatic vertebral fracture. Interestingly, all women who participated in this study and who presented with a femoral neck fracture had experienced a prior asymptomatic vertebral fracture. CONCLUSION: We recommend that all elderly patients who go to the radiology department for a chest X-ray also have a DEXA scan and a lateral thoracic spine radiograph |
1 | Comparison of whole-body versus limited whole-body 18F-FDG PET/CT scan in malignant cutaneous melanoma | MSTS 2018 - Femur Mets and MM | OBJECTIVES: The objectives of this study were to estimate retrospectively the incidence of clinically significant findings in the lower extremities in patients with malignant cutaneous melanoma scanned from the skull vertex to the bottom of the feet and whether these add additional diagnostic and prognostic information and to demonstrate a confidence interval that would support exclusion of lower-extremity scans in these patients.
METHODS: This is a retrospective study of 200 patients who underwent (18)F-FDG PET/CT for staging melanoma. Whole-body PET/CT scans including the lower extremities were reviewed. PET/CT findings in the lower extremities were tabulated by location, pathology, and clinical progress notes with documented clinical history and physical examination correlation.
RESULTS: Among the 200 PET/CT scans, 3 scans had positive findings in the lower extremities. A biopsy was performed on 1 lesion, which was found to be an incidental squamous cell carcinoma. One lesion was considered a benign finding from inflammation demonstrated by clinical follow-up. One scan had a metastasis to the proximal femur, which is included in the standard FOV (eyes to midthighs). In this case series, the lower extremities' true-positive findings never impacted or changed clinical management.
CONCLUSIONS: Our study confirms with a high degree of confidence that in patients with malignant cutaneous melanoma, additional lower-extremity scan results in little additional useful information and could be discontinued in patients whose melanoma did not arise in the lower extremities. PET/CT acquisition of the lower extremities results in increased scan time and unnecessary extra radiation dose from CT to melanoma patients. |
0 | Recovery after total intravenous general anaesthesia or spinal anaesthesia for total knee arthroplasty: a randomized trial | AAHKS (8) Anesthetic Infiltration | BACKGROUND: This study was undertaken to compare the effects of general anaesthesia (GA) and spinal anaesthesia (SA) on the need for postoperative hospitalization and early postoperative comfort in patients undergoing fast-track total knee arthroplasty (TKA).
METHODS: One hundred and twenty subjects were randomly allocated to receive either intrathecal bupivacaine (SA group) or GA with target controlled infusion of propofol and remifentanil (GA group). Primary outcome was length of hospital stay (LOS) defined as time from end of surgery until the subject met the hospital discharge criteria. Secondary outcome parameters included actual time of discharge, postoperative pain, intraoperative blood loss, length of stay in the Post Anaesthesia Care Unit, dizziness, postoperative nausea and vomiting, need for urinary catheterization and subject satisfaction.
RESULTS: GA resulted in shorter LOS (46 vs 52 h, P<0.001), and less nausea and vomiting (4 vs 15, P<0.05) and dizziness (VAS 0 mm vs 20 mm, P<0.05) compared with SA. During the first 2 postoperative hours, GA patients had higher pain scores (P<0.001), but after 6 h the SA group had significantly higher pain scores (P<0.001). Subjects in the GA group used fewer patient-controlled analgesia doses and less morphine (P<0.01), and were able to walk earlier compared with the SA group (P<0.001). Subjects receiving SA would request a change in the method of anaesthesia in the event of a subsequent operation more often than the GA subjects (P<0.05).
CONCLUSION: GA had more favourable recovery effects after TKA compared with SA. |
1 | Prevalence of traumatic hip and pelvic fractures in patients with suspected hip fracture and negative initial standard radiographs--a study of emergency department patients | Management of Hip Fractures in the Elderly | OBJECTIVES: To determine the prevalence of hip and pelvic fractures in emergency department (ED) patients with hip pain and negative standard initial radiographs. METHODS: This was a retrospective, cohort study at an academic, community-based ED. ED patients presenting during a one-year period with hip pain for whom a plain-film radiograph was obtained were included. Eligible patients were identified by query of electronic records. Plain radiographs and magnetic resonance images (MRIs) were ordered at the discretion of the treating physician. Initial plain radiographs were read at the point of care by board-certified radiologists. MRI images were reviewed by radiologists with fellowship training in musculoskeletal imaging. Structured follow-up at more than one month postvisit was conducted to rule out a subsequent diagnosis of hip fracture. Ninety-five-percent confidence intervals (95% CIs) and kappa (kappa) were calculated as appropriate. RESULTS: Seven hundred sixty-four of 895 patients (85.3%) had follow-up completed (study group). Within the study group, 219 patients (29%) had evidence of fracture on initial radiographs. Of the 545 patients with negative initial radiographs, 62 patients (11.4%) underwent hip MRI during the ED visit. MRI identified 24 additional patients with hip fractures. Interobserver agreement for the presence of fracture on MRI was very good (kappa = 0.847). For patients with negative initial plain radiographs who did not have a hip MRI, follow-up did not identify any of these patients as having a subsequent diagnosis of fracture. Thus, 24 of 545 (4.4%; 95% CI = 3.0% to 6.5%) patients with negative initial plain radiographs had a hip fracture. CONCLUSIONS: In this cohort of ED patients with symptoms suspicious for hip fracture who had negative standard radiographs, the authors found that 4.4% were subsequently diagnosed as having fracture. Further studies are warranted to identify characteristics of patients requiring advanced hip imaging studies |
0 | Experiences with total femur replacement for malignant bone and soft tissue tumors | MSTS 2018 - Femur Mets and MM | Background: Reasonable function can be restored after total femur replacement after massive resection of bone and soft tissue sarcomas of the thigh. The type of femoral prosthesis and surgical approach are tailored to the clinical characteristics of individual patients and to tumor anatomy. Though the complication rate is high, total femur replacement offers the patient limb salvage and a chance at functional ambulation. Objective: We described the function and complications of total femur replacement performed at the institution as well as relevant literature reviews. Methods: Seven patients underwent total femur replacement for the treatment of malignant bone and soft tissue tumors of the lower extremities between 1992 and 2010 at our institute. Ages ranged from 12 to 68 (mean=34) years. The tumor was pathologically diagnosed as osteosarcoma in two patients, Ewing's sarcoma in two, chondrosarcoma (grade 3) in one, soft tissue malignant fibrous histiocytoma in one, and bone metastasis from renal cancer in one. Follow-up periods ranged from 1 to 17 years (mean = six years three months). All patients underwent wide resection, using the Howmedica Modular and Reconstruction System in five cases and the Kyocera Limb Salvage System in two cases. Function, complications and outcomes were evaluated in these patients, and the usefulness of the operative procedures is discussed herein. Results: The mean functional score was 60%. X-ray examination revealed migration in only one case. Complications were infection (n=2), bipolar head dislocation (n=1) and patellar fracture (n=2). The outcomes were DOD (died of disease) in three cases, NED (no evidence of disease) in two, AWD (alive with disease) in one, and CDF (continuous disease free) in one. Conclusion: The results suggest that total femur replacement is useful as a means of reconstructing affected limbs in patients with malignant bone and soft tissue tumors, but that latissimus dorsi muscle transplantation, as well as other procedures, must also be considered in cases requiring extensive soft tissue resection to prevent infection. Furthermore, early one-stage revision is advisable in cases showing signs of infection. |
0 | Beneficial Effects of Concentrated Growth Factors and Resveratrol on Human Osteoblasts In Vitro Treated with Bisphosphonates | MSTS 2018 - Femur Mets and MM | Bisphosphonates are primary pharmacological agents against osteoclast-mediated bone loss and widely used in the clinical practice for prevention and treatment of a variety of skeletal conditions, such as low bone density and osteogenesis imperfecta, and pathologies, such as osteoporosis, malignancies metastatic to bone, Paget disease of bone, multiple myeloma, and hypercalcemia of malignancy. However, long-term bisphosphonate treatment is associated with pathologic conditions including osteonecrosis of the jaw, named BRONJ, which impaired bone regeneration process. Clinical management of BRONJ is controversy and one recent approach is the use of platelet concentrates, such as Concentrated Growth Factors, alone or together with biomaterials or antioxidants molecules, such as resveratrol. The aim of the present study was to investigate the in vitro effects of Concentrated Growth Factors and/or resveratrol on the proliferation and differentiation of human osteoblasts, treated or not with bisphosphonates. Human osteoblasts were stimulated for 3 days in complete medium and for 21 days in mineralization medium. At the end of the experimental period, the in vitro effect on osteoblast proliferation and differentiation was evaluated using different techniques such as MTT, ELISA for the quantification/detection of osteoprotegerin and bone morphogenetic protein-2, immunohistochemistry for sirtuin 1 and collagen type I, and the Alizarin Red S staining for the rate of mineralization. Results obtained showed that Concentrated Growth Factors and/or resveratrol significantly increased osteoblast proliferation and differentiation and that the cotreatment with Concentrated Growth Factors and resveratrol had a protective role on osteoblasts treated with bisphosphonates. In conclusion, these data suggest that this approach could be promised in the clinical management of BRONJ. |
0 | Biomechanical evaluation of plate osteosynthesis for AO type C2 fracture of the distal radius--a cadaver study | Distal Radius Fractures | An AO type C2 distal radius fracture was simulated in a cadaver model by creating a metaphyseal defect of 5 mm and an intra-articular defect of 2 mm. Five different methods of plate osteosynthesis were tested biomechanically in each of six fresh cadaveric hands. Biomechanical testing suggested that cement augmented plating plus screws in the distal fragment was the strongest. Dorsal and volar plating plus screws on both sides of the distal fragment had the same effect of restoring stiffness and load transmission pattern as fixation with double plating plus volar screws alone. Fixation with plating plus dorsal screws was significantly weaker than these three methods, and double buttress plating with no screws in the distal fragments was the weakest. |
1 | Meniscal scaffolds: results and indications. A systematic literature review | AMP (Acute Meniscal Pathology) | PURPOSE: The aim of this systematic review was to document the available clinical evidence to support meniscal scaffold implantation, analysing results and indications for the treatment of meniscal loss.
METHODS: The systematic review of the literature was performed searching three medical electronic databases: PubMed, Scopus, and the Cochrane Collaboration. The guidelines for preferred reporting items for systematic reviews and meta-analysis (PRISMA) were used. Relevant data were then extracted and collected in a unique database with consensus of two observers. To assess the methodological quality of the collected data, the subscales of a modified Coleman methodology score (CMS) were determined.
RESULTS: A total of 23 studies on two scaffolds (CMI, Ivy Sports Medicine GmbH, Germany; Actifit, Orteq, United Kingdom) met the inclusion criteria and were used for the final analysis, of which more than half have been published in the last three years. Good clinical results have been documented in 613 patients, mainly young men affected by symptomatic chronic lesions, with a cumulative failure rate of 6.1% and presence of newly formed tissue documented both at histological and MRI evaluation in most cases. However, there is a lack of comparative trials and the average study quality is low.
CONCLUSION: An increase in publications regarding this topic has been seen recently, due to the introduction in the clinical practice of the second synthetic scaffold. Safety and positive results have been shown for both scaffolds. Although, literature lacks randomized trials at long-term follow-up to confirm real potential and most appropriate indications of meniscal scaffold implantation. |
0 | Does hip implant positioning affect the peak external adduction moments of the healthy knees of subjects with total hip replacements? | OAK 3 - Non-arthroplasty tx of OAK | After unilateral total hip replacement (THR) for hip osteoarthritis (OA), knee OA incidence or progression is common. The contralateral knee is at particular risk, and some have speculated that abnormal THR-hip biomechanics contributes to this asymmetry. We investigated the relationships between operated-hip joint geometry or gait variables and the peak external knee adduction moments - an indicator of knee OA risk - in 21 subjects with unilateral THRs. We found that the peak adduction moment was 14% higher on the contralateral versus the ipsilateral knee (p = 0.131). The best predictors of ipsilateral knee adduction moments were superior-inferior joint center position and operated-hip peak adduction moment (adj R2 = 0.291, p = 0.017). The sole predictor of the contralateral knee adduction moment was the medial-lateral hip center position (adj R2 = 0.266, p = 0.010). A postoperative medial shift of the hip center was significantly correlated with a lower postoperative contralateral/ipsilateral knee adduction moment ratio (R = 0.462, p = 0.035). Based on these relationships, we concluded that implant positioning could influence the biomechanical risk of knee OA progression after THR. Although implant positioning decisions are necessarily driven by other factors, it may be appropriate to assess individual THR candidate's knee OA risk and adjust perioperative management accordingly. Copyright © 2013 Orthopaedic Research Society. |
0 | Anthropometric Determinations of Umbilical Position in Iraqi Adults | Panniculectomy & Abdominoplasty CPG | Introduction Umbilicus is an important surface landmark on the anterior abdominal wall in addition to its aesthetic and psychological effect. Objectives The objective of the study is to determine the position of umbilicus in Iraqi adults to provide a guide for the neoumbilicus in abdominoplasty. Subjects and Methods This is an observational study performed on 100 volunteers with no abdominal wall abnormality. Measurements included weight, height, body mass index (BMI), distance from xiphoid to umbilicus, distance from xiphoid process to pubic symphysis, distance from xiphoid process to both anterior superior iliac spine (ASIS), distance from pubic symphysis to umbilicus and from pubic symphysis to xiphisternum, distance of umbilicus to both ASIS, and distance of umbilicus to interspinous line and to inter-anterior hypochondrium line. Results The study included 100 volunteers, with 50% male and 50% female whose age ranges between 18 to 60 years. The results were a follows: distance from xiphoid process to umbilicus and distance from xiphoid process to pubic symphysis were 18.03 ± 3.25 cm and 32.21 ± 4.64 cm, respectively; distances from xiphoid process to right ASIS and left ASIS were 25.95 ± 5.72 cm and 25.84 ± 6.02 cm, respectively; distance from pubic symphysis to umbilicus was 17.66 ± 3.12 cm; distance of umbilicus to interspinous line was 9.25 ± 1.84 cm. The distance from umbilicus to inter anterior hypochondrium line was 9.905 ± 2.19 cm. Conclusion These measurements can determine the neoumbilicus position, reduce practical mistakes, and improve postsurgical outcomes. |
0 | The association between erosive hand osteoarthritis and subchondral bone attrition of the knee: The Framingham Osteoarthritis study | OAK 3 - Non-arthroplasty tx of OAK | Objective: To examine whether erosive hand osteoarthritis (OA) is associated with knee subchondral bone attrition (SBA) and systemic bone mineral density (BMD). Methods: Associations of MRI-defined knee SBA with radiographic erosive hand OA were evaluated in 1253 Framingham participants using logistic regression with generalised estimating equations. We also examined the association between the number of erosive OA finger joints and SBA adjusted for the number of non-erosive OA finger joints. Associations between erosive hand OA and femoral neck BMD were explored in 2236 participants with linear regression. Analyses were adjusted for age, sex and body mass index. Results: Participants with erosive hand OA had increased odds of knee SBA (OR=1.60, 95% CI 1.07 to 2.38). The relation between the number of erosive OA finger joints and SBA became non-significant when adjusted for the number of non-erosive OA joints as a proxy for the burden of disease. There was a nonsignificant trend towards higher BMD in erosive hand OA compared with participants without hand OA. Conclusions: Erosive hand OA was associated with knee SBA, but the relation might be best explained by a heightened burden of disease. No signi ficant relation of erosive hand OA with BMD was found. |
0 | Musculoskeletal disorders associated with obesity: a biomechanical perspective | Glenohumeral Joint OA | Despite the multifactorial nature of musculoskeletal disease, obesity consistently emerges as a key and potentially modifiable risk factor in the onset and progression of musculoskeletal conditions of the hip, knee, ankle, foot and shoulder. To date, the majority of research has focused on the impact of obesity on bone and joint disorders, such as the risk of fracture and osteoarthritis. However, emerging evidence indicates that obesity may also have a profound effect on soft-tissue structures, such as tendon, fascia and cartilage. Although the mechanism remains unclear, the functional and structural limitations imposed by the additional loading of the locomotor system in obesity have been almost universally accepted to produce aberrant mechanics during locomotor tasks, thereby unduly raising stress within connective-tissue structures and the potential for musculoskeletal injury. While such mechanical theories abound, there is surprisingly little scientific evidence directly linking musculoskeletal injury to altered biomechanics in the obese. For the most part, even the biomechanical effects of obesity on the locomotor system remain unknown. Given the global increase in obesity and the rapid rise in musculoskeletal disorders, there is a need to determine the physical consequences of continued repetitive loading of major structures of the locomotor system in the obese and to establish how obesity may interact with other factors to potentially increase the risk of musculoskeletal disease. [References: 208] |
0 | Implications of Three-Phase Bone Scintigraphy for the Diagnosis of Bisphosphonate-Related Osteonecrosis of the Jaw | MSTS 2018 - Femur Mets and MM | Purpose: Bisphosphonate (BP)-related osteonecrosis of the jaw (BRONJ) is a well-known serious complication of BP treatment. This study was undertaken to evaluate the diagnostic usefulness of three-phase bone scintigraphy in patients with BRONJ. Methods: Forty-one patients (48 lesions) with clinically proven BRONJ (2 males, 39 females, age 74. 3 ± 6. 7 years) underwent Tc-99 m HDP bone scintigraphy. Visual interpretation and semiquantitative analysis of uptakes using lesion-to-contralateral uptake ratios during the blood pool phase (BUR) and during the osseous phase (OUR) were performed, and relations were sought between these and various clinical parameters. Results: Three-phase bone scintigraphy showed increased perfusion and blood pooling in 21 (63. 6 %) and 27 (81. 8 %) of 33 lesions, respectively. The osseous phase was positive for 45 (93. 8 %) of the 48 lesions. Of the four inflammatory clinical parameters of BRONJ [pus discharge, pain, swelling, and erythrocyte sedimentation rate (ESR)], patients with three or more parameters had more positive findings in vascular and blood pool phase images (p = 0. 033, p = 0. 027). By semiquantitative analysis, patients with a positive ESR had statistically higher BUR and OUR (both p < 0. 001). Higher stage BRONJ lesions had higher OUR than lower stage lesions (p = 0. 003). In addition, bone scintigraphy revealed three clinically covert BRONJ lesions without bone exposure, and four patients were up-staged based on bone scintigraphy. Conclusions: Bone scintigraphy provides a relatively sensitive means of detecting BRONJ, so it was helpful for accurate BRONJ staging. Furthermore, increased uptakes in vascular and blood pool phases of three-phase bone scintigraphy were related to the inflammatory activity of BRONJ. © 2012 Korean Society of Nuclear Medicine. |
1 | Transtendon repair in partial articular supraspinatus tendon tear | Trial Systematic Review Project | Introduction: Partial thickness rotator cuff tears (PTRCTs) are common, with an incidence between 17% and 37%, and a high prevalence in throwing athletes. Different surgical procedures are suggested when partial tears involve the articular portion of the rotator cuff, including arthroscopic debridement of the tear, debridement with acromioplasty, tear completion and repair, and lately transtendon repair. This systematic review describes the transtendon repair and examines indications, contraindications, complications and clinical outcome.
Source of data: We identified clinical studies listed in the Pubmed Google Scholar, CINAHL, Cochrane Central and Embase Biomedical databases in English and Italian concerning the clinical outcomes following treatment of partial articular supraspinatus tendon tear using transtendon surgical repair.
Areas of agreement: Eighteen studies fulfilled our inclusion criteria. All were published between 2005 and 2016, three were retrospective, and 15 prospective. The total number of patients was 507 with a mean age of 50.8 years.
Areas of controversy: Tear completion and repair and transtendon repair alone produce similar results.
Growing points: Transtendon surgical repair allows to obtain good-excellent results in the treatment of partial articular supraspinatus tendon tears.
Areas timely for developing research: Further studies are needed to produce clear guidelines in the treatment of partial articular supraspinatus tendon tears.
Level of evidence: IV. |
0 | Pharmacovigilance in oncology: Pattern of spontaneous notifications, incidence of adverse drug reactions and under-reporting | MSTS 2018 - Femur Mets and MM | The high toxicity and narrow therapeutic window of antineoplastic agents makes pharmacovigilance studies essential in oncology. The objectives of the current study were to analyze the pattern of spontaneous notifications of adverse drug reactions (ADRs) in oncology patients and to analyze the incidence of ADRs reported by outpatients on antineoplastic treatment in a tertiary care teaching hospital. To compose the pattern of ADR, the notification forms of reactions in oncology patients in 2010 were reviewed, and the reactions were classified based on the drug involved, mechanism, causality, and severity. To evaluate the incidence of reactions, a questionnaire at the time of chemotherapy was included, and the severity was classified based on the Common Terminology Criteria. The profiles of the 10 responses reported to the Pharmacovigilance Sector were type B, severe, possible, and they were primarily related to platinum compounds and taxanes. When the incidence of reactions was analyzed, it was observed that nausea, alopecia, fatigue, diarrhea, and taste disturbance were the most frequently reported reactions by oncology patients, and the grade 3 and 4 reactions were not reported. Based on this analysis, it is proposed that health professionals should be trained regarding notifications and clinical pharmacists should increasingly be brought on board to reduce under-reporting of ADRs. |
0 | The chemokine system in allogeneic stem-cell transplantation: A possible therapeutic target? | MSTS 2018 - Femur Mets and MM | Further improvements in allogeneic stem-cell transplantation will probably depend on a better balance between immunosuppression to control graft-versus-host disease and immunological reconstitution sufficient to ensure engraftment, reduction of infection-related mortality and maintenance of post-transplant antileukemic immune reactivity. The chemokine network is an important part of the immune system, and, in addition, CXCL12/CXCR4 seem to be essential for granulocyte colony-stimulating factor-induced stem-cell mobilization. Partial ex vivo graft T-cell depletion based on the expression of specific chemokine receptors involved in T-cell recruitment to graft-versus-host disease target organs may also become a future therapeutic strategy; an alternative approach could be pharmacological inhibition (single-receptor inhibitors or dual-receptor inhibitors) in vivo of specific chemokine receptors involved in this T-cell recruitment. Future clinical studies should therefore be based on a better characterization of various immunocompetent cells, including their chemokine receptor profile, both in the allografts and during post-transplant reconstitution. © 2011 Expert Reviews Ltd. |
1 | Buckling in the Iranian patients with knee osteoarthritis: Its frequency and correlation with physical activities and falling | OAK 3 - Non-arthroplasty tx of OAK | Introduction: Knee osteoarthritis (KOA), one of the most common articular diseases, sometimes leads to severe disability. This study aimed to estimate the prevalence of knee-buckling in patients with KOA during the past three months and to investigate its relation with the physical function. Methods: A cross-sectional study was performed on 190 patients with KOA. Two checklists and WOMAC questionnaire were completed by the participants. The patientsâ?? function was evaluated by timed up and go (TUG) and six-minute walk tests (6MWT). Comparison between the two groups of patients with and without buckling was done using independent t-test and the correlations were analyzed between the variables using K square and Pearson correlation tests. Results: Eighty three patients (43.68%) had a history of buckling in the past 3 months. Knee-buckling frequency was 40.87% and 48% in women and men, respectively. Statistical analysis showed significant differences between pain (p = 0.007), TUG (p =0.0001), 6MWT (p = 0.0001), WOMAC pain (p= 0.005), WOMAC stiffness (p = 0.006) and total WOMAC scores (p=0.03) concerning the two groups with and without buckling. There was a significant correlation between buckling with gender (Ï= 0.72, p=0.025), KOA history (p=0.67, p= 0.033) and the rate of fall (Ï=0.87, p=0.012). Moreover, there were reverse significant correlations between the history of buckling with WOMAC score (r= - 0.51, p=0.02) and the functional tests results including TUG (r= - 0.57, p=0.0001) and 6MWT (r= - 0.67, p=0.0001). Conclusion: The results indicated a prevalence of 43.68% buckling among the patients which was associated with their functional impairment. |
0 | Pattern of animal-related injuries in Iran | Management of Hip Fractures in the Elderly | Animal related injuries as most common causes of human morbidity have different pattern by geographical zones. We aimed to explore the main descriptive epidemiology of animal-related injuries in both rural and urban areas in Iran. Between 2000 and 2004, we collected the data of all the cases of animal related trauma hospitalized for more than 24 hours in eight cities (Tehran, Mashhad, Ahwaz, Shiraz, Tabriz, Qom, Kermanshah, and Babol). Further evaluations were conducted on 17753 eligible subjects. Of 17753 traumatic patients, 40 subjects (0.2%), had animal-related injuries. The highest rate was seen in Tabriz with 11 cases. Upper and lower extremities were the most frequent sites of trauma and they were injured in 13 and 11 cases respectively. Dog bite and cow-related injuries were responsible for 40% and 32.5% of injuries respectively. Amputation of the phalanx was done in 2 cases due to dog bite and bull gore occurred. One thoracotomy, one laparatomy and one craniotomy were done. One patient needed fasciatomy due to snake bite. Educating the patients could decrease the incidence of morbidity of these injuries. (copyright) 2011 Tehran University of Medical Sciences. All rights reserved |
0 | Development of an in vivo model of human multiple myeloma bone disease | MSTS 2022 - Metastatic Disease of the Humerus | Osteolytic bone destruction and its complications, bone pain, pathologic fractures, and hypercalcemia, are a major source of morbidity and mortality in patients with multiple myeloma. The bone destruction in multiple myeloma is due to increased osteoclast (OCL) activity and decreased bone formation in areas of bone adjacent to myeloma cells. The mechanisms underlying osteolysis in multiple myeloma in vivo are unclear. We used a human plasma cell leukemia cell line, ARH-77, that has disseminated growth in mice with severe combined immunodeficiency (SCID) and expresses IgG kappa, as a model for human multiple myeloma, SCID mice were irradiated with 400 rads and mice were injected either with 10(6) ARH-77 cells intravenously (ARH-77 mice) or vehicle 24 hours after irradiation. Development of bone disease was assessed by blood ionized calcium levels, x-rays, and histology. All ARH-77, but none of control mice that survived irradiation, developed hind limb paralysis 28 to 35 days after injection and developed hypercalcemia (1.35 to 1.46 mmol/L) a mean of 5 days after becoming paraplegic. Lytic bone lesions were detected using x-rays in all the hypercalcemic mice examined. No lytic lesions or hypercalcemia developed in the controls. Controls or ARH-77 mice, after developing hypercalcemia, were then killed and bone marrow plasma from the long bones were obtained, concentrated, and assayed for bone-resorbing activity. Bone marrow plasma from ARH-77 mice induced significant bone resorption in the fetal rat long bone resorption assay when compared with controls (percentage of total 45Ca released = 35% +/- 4% v 11% +/- 1%). Histologic examination of tissues from the ARH-77 mice showed infiltration of myeloma cells in the liver and spleen and marked infiltration in vertebrae and long bones, with loss of bony trabeculae and increased OCL numbers. Interestingly, cultures of ARH-77 mouse bone marrow for early OCL precursors (colony-forming unit-granulocyte-macrophage [CFU-GM]) showed a threefold increase in CFU-GM from ARH-77 marrow versus controls (185 +/- 32 v 40 +/- 3 per 2 x 10(5) cell plated). Bone-resorbing human and murine cytokines such as interleukin-6 (IL-6), IL-1 alpha or beta, TGF-alpha, lymphotoxin, and TNF alpha were not significantly increased in ARH-77 mouse sera or marrow plasma, compared with control mice, although ARH-77 cells produce IL-6 and lymphotoxin in vitro. Conditioned media from ARH-77 cells induced significant bone resorption in the fetal rat long bone resorption assay when compared with untreated media (percentage of total 45Ca released = 22% +/- 2% v 11% +/- 1%). This effect was not blocked by anti-IL-6 or antilymphotoxin (percentage of total 45Ca released = 19% +/- 1% and 22% +/- 1%, respectively). Thus, we have developed a model of human multiple myeloma bone disease that should be very useful to dissect the pathogenesis of the bone destruction in multiple myeloma. |
0 | Mechanisms of osteoarthritis in the knee: MR imaging appearance | AMP (Acute Meniscal Pathology) | Osteoarthritis has grown to become a widely prevalent disease that has major implications in both individual and public health. Although originally considered to be a degenerative disease driven by "wear and tear" of the articular cartilage, recent evidence has led to a consensus that osteoarthritis pathophysiology should be perceived in the context of the entire joint and multiple tissues. MRI is becoming an increasingly more important modality for imaging osteoarthritis, due to its excellent soft tissue contrast and ability to acquire morphological and biochemical data. This review will describe the pathophysiology of osteoarthritis as it is associated with various tissue types, highlight several promising MR imaging techniques for osteoarthritis and illustrate the expected appearance of osteoarthritis with each technique. Copyright © 2014 Wiley Periodicals, Inc. |
1 | Long-term follow-up after severe suicide attempt by multiple blunt trauma | DoD PRF (Psychosocial RF) | OBJECTIVE: After parasuicide there is a high risk of reattempts. However, it seems that patients who survived severe suicidal trauma recover well. Therefore, the outcome of patients with severe multiple blunt trauma as a result of a suicide attempt was investigated with respect to psychiatric and somatic health, quality of life (QOL) and suicide reattempt rates.
METHODS: Patients who underwent a suicide attempt were isolated from a prospectively collected sample of trauma patients from a level I University Trauma Centre. Follow-up examination was performed 6.1 +/- 3 years after the trauma. A physical and psychiatric examination was performed, using established psychiatric scales.
RESULTS: Twelve percent of severely injured patients were identified as suicide attempters (male/female: 37/28, mean age 38 +/- 18 years, mean Injury Severity Score (ISS) 40 +/- 15 points). A psychiatric diagnosis was present in 90% at the time of the suicide attempt. Twenty-one patients died during the hospital stay (32%) and six subjects died thereafter, none due to suicide. Thirty-five individuals were eligible for examination. None of them had reattempted suicide. Seventeen (48%) had good outcomes reflected by absent or ambulatory psychiatric treatment, employment, normal psychiatric findings and good psychosocial ability. An indeterminate outcome was determined in 24%. Predictive variables for an adverse outcome (10 patients, 28%) were found to be a diagnosis of schizophrenia, continued psychiatric treatment and being without employment.
CONCLUSION: Despite the seriousness of the suicide attempt, survivors recovered well in about half the cases with no further suicide attempt in any patient. An early psychiatric consultation already on the Intensive Care Unit (ICU) is recommended. |
0 | Antimicrobial prophylaxis in dentistry | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | Use of antibiotics both in humans and animals runs along with effects that can contribute to the spread of antibiotic resistance. Although several available guidelines for antibiotic treatment have been published to date, clinical practice in dentistry and particularly in oral surgery is not free from controversies regarding antibiotic prophylaxis. Antibiotic coverage to prevent infectious endocarditis, joint prostheses infections or local infections requires a careful evaluation of the patient condition, associated risks and other aspects that could influence the decision. It is of great relevancy for oral surgeons and for dentists in general to know exactly what they are up against. Here we review the literature regarding prophylactic use of antimicrobials in dentistry |
0 | Bipolar Hemiarthroplasty should not be selected as the primary option for intertrochanteric fractures in elderly patients aged 85 years or more | Hip Fx in the Elderly 2019 | This study aimed to compare the early outcome of proximal femoral nail antirotation (PFNA) and bipolar hemiarthroplasty (BPH) in elderly intertrochanteric fractures (ITFs) patients aged 85 years or more. This is a prospective cohort study, and we analyzed 120 elderly patients aged 85 years or more presented with ITFs who underwent BPH and PFNA between January 2017 and July 2018. 84 patients treated with PFNA were set as Group A, and 36 patients treated with BPH were set as Group B. Data such as gender, age, period of follow-up, fracture classification (according to Evans-Jensen classification), preoperative ASA (American Society of Anesthesiologists) physical status, interval between injury and operation, method of anaesthesia, duration of operation time, blood loss during surgery, time of weight bearing after operation, incidence of complications 2 weeks after operation, mortality rates and Harris Hip Score 12 months after operation were recorded and compared. There are no statistically significant differences when compared general data in patients from group A and B (P > .05). Operation time in Group A is less than Group B (103.33, 40-230 min vs 122.64, 75-180 minute, P < .01). Blood loss during surgery in Group A is less than Group B (70.24, 50-100 mL vs 194.44, 100-500 mL, P < .01). Time of weight bearing after operation in Group A is longer than Group B (50.70, 7-100 days vs 6.67, 4-14 days, P < .01). Incidence of complications 2 weeks after operation in Group A is less than Group B (14.12% vs 36.11%, P < .01). Mortality rates 12 months after operation in Group A is similar with Group B (13.10% vs 19.44%, P > .05). Harris Hip Score 12 months after operation in Group A is similar with Group B (64.64,0-91 points vs 64.41, 0-90 points, P > .05). Although BPH and PFNA have similar functional outcome and mortality rates 12 months after operation, BPH has more postoperative complications in elderly patients aged 85 years or more with ITFs, Bipolar Hemiarthroplasty should not be selected as the primary option for ITFs in elderly patients aged 85 years or more. |
0 | Tuberous breast correction by fat grafting | Reduction Mammoplasty for Female Breast Hypertrophy | Introduction: Tuberous breast is a rare malformation that has negative physical and psychological impacts during puberty. A range of surgical techniques has been used to correct breast shape and volume in this context, including a combination of skin plasty and mammary gland remodeling, as well as prostheses and locoregional flaps. The authors have used fat grafting as a complementary technique to correct tuberous breasts since 1998. Objectives: The authors discuss application of their lipomodeling technique for correction of tuberous breast deformity. Methods: The charts of tuberous breast patients treated consecutively over an 11-year period (n = 31) solely with fat grafting (ie, without using an implant) were retrospectively reviewed. Each breast deformation was graded according to the Grolleau classification. The number of sessions and the mean transfer of fat volume by lipomodeling session were recorded. Patient and surgeon satisfaction were evaluated. Results: Of the 31 patients in this series, 18 had bilateral formations and 13 had unilateral malformations. The mean patient age was 23 years, and the mean body mass index was 21.9. A single session (mean transfer volume, 158 mL; range, 90-253 mL) was required in 14 (45%) cases. A second session (mean transfer volume, 226 mL; range, 100-316 mL) was necessary in the remaining 55% of cases. Mean follow-up period after the last fat transfer session was 6.5 years (range, 1.5-11 years). Patients were very satisfied in 94% of cases (n = 29) and satisfied in 6% (n = 2). The surgical team rated 94% of cases as being successful or very successful. No complications were observed. One patient developed hypertrophy of the treated breast following weight gain and thus required breast reduction. Imaging performed preoperatively and 1 year postoperatively did not reveal any anomalies other than oil cysts. Conclusion: Fat grafting is a reliable technique that produces excellent results and high levels of patient satisfaction for the treatment of tuberous breast. The aesthetic outcome is natural, implant free, and long lasting. © 2013 The American Society for Aesthetic Plastic Surgery, Inc. |
0 | Biologic approaches to articular cartilage surgery: future trends | Surgical Management of Osteoarthritis of the Knee CPG | The treatment of unicompartmental osteoarthritis and focal chondral pathologic conditions in the knee in active aging athletes has captured the interest of patients, clinicians, basic scientists, and medical industry researchers. Most would agree that a biologic solution to treating hyaline cartilage injuries and degeneration would be optimal over prosthetic joint arthroplasty. Articular cartilage resurfacing techniques and biologic surgical methods continue to evolve and have gained more acceptance in orthopedic practice. A consensus exists for the ultimate goal of achieving a more predictable and durable result after surgical tissue repair or regeneration. Numerous promising approaches are now on the horizon and although the final word is far from in, the integration of many of the anticipated advances in molecular medicine, biomedical engineering, polymer chemistry, cell biology, and clinical orthopedics contributes to an exciting and rapidly evolving field. This article reviews the current concepts of the biologic approach to articular cartilage pathologic conditions and discusses future trends and novel technologies |
1 | Lateral meniscus allograft transplantation with platelet-rich plasma injections: A minimum two-year follow-up study | AMP (Acute Meniscal Pathology) | BACKGROUND: The aim of this study was to report the short-term clinical and imaging outcomes of lateral meniscus allograft transplantations (LMAT) combined with intra-articular platelet-rich plasma (PRP) injection.
METHODS: Thirty-three patients who had undergone LMAT combined with intra-articular PRP injection were evaluated. The Lysholm, International Knee Documentation Committee (IKDC), Western Ontario and McMaster Universities Osteoarthritis Index, Tegner activity level scale and visual analog scale for pain scores were used to evaluate the outcomes. Magnetic resonance imaging scans were performed postoperatively to assess graft position and chondral degeneration/damage.
RESULTS: A total of 31 of the original 33 patients were evaluated over a mean follow-up period of 37.0months. Patients demonstrated statistically significant improvements in all scoring data from the pre-operative to two-year follow-up period. The mean postoperative extrusion was 1.59+/-1.20mm (range 0-3.9mm). There were no significant differences in the distribution of the grade of chondral damage between the pre-operative and two-year follow-up periods. Three patients (9.7%) showed no improvements or had lower evaluation scores. One patient underwent matrix-induced autologous chondrocyte implantation at one year after LMAT.
CONCLUSION: Lateral meniscus allograft transplantation combined with intra-articular PRP injection resulted in statistically significant improvements in all functions and pain scores, and clinical improvements in Tegner, IKDC, and Lysholm values during short-term follow-up. A further case-control study with a larger sample size and longer follow-up is required to obtain an overall assessment of the benefits of PRP on MAT patients. Level of evidence IV. |
0 | External fixators for wrist fractures: a biomechanical and clinical study | Distal Radius Fractures | The rigidity of four external fixators for the wrist was determined by using the Instron universal testing instrument. Using the equivalent stiffness index, the small A.O. was 7.6, the mini Hoffman was 3.7, Roger Anderson was 3.5, and Ace Colles' was 4.3. Thus, the small A.O. was about twice as rigid overall as the other three external fixators. Twenty-two patients with unstable distal radius fractures were treated with the mini Hoffman external fixator over a 3-year period; and follow-up data were obtained. The average final angle of the distal radial articular surface on the anteroposterior x-ray film was 17.5 degrees. The final angle of the distal radial articular surface on the lateral x-ray film was 2 degrees dorsal. The final height of the distal radial styloid averaged 8 mm. The final range of motion of the wrist compared with the opposite normal hand was extension 77%, flexion 77%, ulnar deviation 82%, radial deviation 73%, pronation 84%, supination 78%, and grip strength 72%. Complications included three cases of broken pins, one of a pin loosening with migration, one case of tendon rupture, and one of intrinsic contracture. From our experience, the Hoffman external fixator gave adequate clinical and functional results and can be used safely in the small to average size patient. A more rigid external fixator should be used for larger and more active patients. External fixation is an excellent way to treat unstable distal radial fractures. |
0 | Lateral compartment osteoarthritis of the knee: Biomechanics and surgical management of end-stage disease | OAK 3 - Non-arthroplasty tx of OAK | The lateral compartment is predominantly affected in approximately 10% of patients with osteoarthritis of the knee. The anatomy, kinematics and loading during movement differ considerably between medial and lateral compartments of the knee. This in the main explains the relative protection of the lateral compartment compared with the medial compartment in the development of osteoarthritis. The aetiology of lateral compartment osteoarthritis can be idiopathic, usually affecting the femur, or secondary to trauma commonly affecting the tibia. Surgical management of lateral compartment osteoarthritis can include osteotomy, unicompartmental knee replacement and total knee replacement. This review discusses the biomechanics, pathogenesis and development of lateral compartment osteoarthritis and its management. |
1 | Cerebrospinal fluid neurotransmitter changes during the perioperative period in patients undergoing total knee replacement: a randomized trial | AAHKS (5) Gabapentinoids | BACKGROUND: Total knee replacement (TKR) is of enormous benefit to patients with osteoarthritis of the knee; however, the acute postoperative pain can be severe and difficult to manage. The role of major spinal cord neurotransmitters in this acute postoperative period is not clear, although there are a few studies in humans. We performed the first prospective clinical study undertaken to delineate the changes in the spinal neurotransmitters after a surgery such as TKR. Furthermore, we also determined whether antihyperalgesic drugs at clinically acceptable doses modulate spinal neurotransmitter concentrations in patients during the perioperative period.
METHODS: All patients had a spinal needle placed in the lumbar region and cerebrospinal fluid (CSF) obtained for baseline measurement of the neurotransmitters. An intrathecal catheter was then placed for spinal anesthesia for standard TKR and for continuous spinal postoperative analgesia. The spinal catheter was also used postoperatively to sample CSF at 2, 4, 8, 12, 24, and 32 hours after catheter placement. CSF samples were assayed for norepinephrine, substance P, calcitonin gene-related peptide (CGRP), and glutamate concentrations. SF-36 (36-item Short Form Health Survey) was measured preoperatively. Numerical rating scale (NRS) pain scores and intrathecal analgesic consumption were recorded postsurgery at 4-hour intervals for 32 hours. We performed a randomized, placebo-controlled, double-blind trial with 3 drug groups (n = 16 per group): placebo; single-dose pregabalin (150 mg administered before surgery); and multidose pregabalin (150 mg administered presurgery and 12 and 24 hours later), to determine the effect of an antihyperalgesic drug such as pregabalin on spinal neurotransmitters.
RESULTS: Forty-eight patients were randomly assigned to the 3 perioperative treatment groups, and multiple CSF samples were successfully obtained from 44 patients. Before surgery, increased bodily pain (from preoperative SF-36 measure) was correlated with increased CSF norepinephrine concentration (P = 0.044). Compared with presurgery values, norepinephrine levels were lower in the placebo group at the 2- and 4-hour time points (P < 0.005) whereas in the single and multidose groups, the reduction (P < 0.001) continued until 12 and 24 hours, respectively. Substance P CSF levels had an early peak value (at 2 hours) in all 3 groups, and then returned to baseline. Compared with baseline value, the CGRP CSF levels only decreased at the 32-hour time point in the placebo group, but in both pregabalin groups, CGRP levels decreased over the 4- to 32-hour period. In the placebo group only, CSF glutamate decreased over 4 to 32 hours compared with presurgery values. However, there was no difference in the CSF neurotransmitter concentrations among the 3 treatment groups over the 32-hour sampling period. In the placebo group, the early NRS pain score area under the curve, AUC [0-12 hours], was positively correlated (R = 0.67, P = 0.0088) with the CSF norepinephrine concentration AUC [12-24 hours], but none of the other neurotransmitters was correlated with the NRS. None of the CSF neurotransmitter concentrations correlated with postoperative analgesic consumption.
CONCLUSION: In the perioperative period, the concentration changes of the 4 spinal neurotransmitters have a distinct time course. CSF substance P seems to increase very rapidly with surgical intervention, whereas the CSF norepinephrine concentration tends to decrease. At clinical doses, pregabalin does not seem to modulate these spinal neurotransmitter concentrations. |
1 | Traumatic brain injury and functional outcomes: Does minority status matter? | DoD PRF (Psychosocial RF) | Objectives: (1) to determine differences between minorities vs. non-minorities on demographic, injury and rehabilitation characteristics and functional outcomes at admission, discharge and 1-year post-injury and (2) to examine differences in functional outcome at 1-year post-injury among (African-Americans, Hispanics and Whites). Design: Retrospective study. Setting: Longitudinal data were extracted from the TBI Model Systems database. Participants: 4929 individuals with moderate-to-severe TBI (3354 Whites vs. 1575 Minorities: 1207 African-Americans and 368 Hispanics) hospitalized between 1989-2004. Main outcome measures: Functional outcomes at 1-year post-injury (Disability Rating Scale, Functional Independence Measure, Glasgow Outcome Scale-Extended and Community Integration Questionnaire). Results: At discharge and 1-year post-injury, minorities had poorer functional outcomes compared with Caucasians on all measures. After controlling for sociodemographic, injury and functional characteristics at admission, Hispanics and African-Americans still showed worse functional outcomes at 1-year post-injury compared with Whites on the DRS, FIM and CIQ. There were no significant differences between African Americans and Hispanics. Conclusions: Minorities had significantly reduced long-term functional outcome after rehabilitation relative to Whites. It is imperative that rehabilitation professionals' consider factors related to poorer long-term functional outcome and work to improve the quality of life of minorities with TBI. |
0 | Neuromuscular ultrasound findings in eosinophilic fasciitis | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | OBJECTIVE: To describe the ultrasonographic features of eosinophilic fasciitis (EF), assess the efficacy of neuromuscular ultrasound in the diagnosis and management of EF, and propose standardized parameters for ultrasound in this condition.BACKGROUND: EF is a rare disorder characterized by stiffness,skin thickening, and decreased joint mobility. The use of imaging to aid in diagnosis, select biopsy sites, and monitor therapeutic response has primarily focused on MRI, but there has been recent interest in the utility of ultrasound.DESIGN/METHODS: Four cases of EF were identified at Wake Forest and Duke University in which neuromuscular ultrasound was used. Basic demographics were collected and ultrasound methods were compiled. Ultrasound findings were compared to MRI findings when present. Five additional cases documenting the use of ultrasound in EF were identified in a review of the literature and the results for all 9 cases were combined to determine the advantages and potential limitations of ultrasound.RESULTS: Ultrasound demonstrated thickening of skin, subcutaneous tissue, and fascia. Muscle echogenicity is abnormal in some cases though not diffusely. When the forearms are affected, the median nerve may be enlarged and a hypoechoic area can be seen surrounding the flexor tendons at the wrist. Ultrasound and MRI correlated in all cases in which both modalities were used for diagnosis. Only 1 case used both ultrasound and MRI for follow-up after treatment.CONCLUSIONS: Ultrasound can assist in the diagnosis and management of EF and has comparable accuracy to MRI. Ultrasound parameters should include thickness of skin, subcutaneous tissue, and fascial planes at specific osseous landmarks. Muscle echogenicity and anisotropy should be noted. Cross-sectional area of the median nerve and flexor tendons of the forearm with and without surrounding edema should also be included when the wrists are affected |
0 | Ankle strength impairments associated with knee osteoarthritis | OAK 3 - Non-arthroplasty tx of OAK | BACKGROUND: Knee Osteoarthritis seems to negatively impact ankle biomechanics. However, the effect of knee osteoarthritis on ankle muscle strength has not been clearly established. This study aimed to evaluate the ankle strength of the plantar flexors and dorsiflexors of patients with knee osteoarthritis in different degrees of severity.
METHODS: Thirty-seven patients with knee osteoarthritis and 15 controls, subjected to clinical and radiographic analysis, were divided into three groups: control, mild, and moderate knee osteoarthritis. Participants answered a self-reported questionnaire and accomplished a muscle torque assessment of the ankle using the Biodex dynamometer in isometric, concentric and eccentric modes.
FINDINGS: The mild osteoarthritis group (peak torque=26.85(SD 3.58)) was significantly weaker than the control (peak torque=41.75(SD 4.42)) in concentric plantar flexion (P<0.05). The control and mild osteoarthritis groups were not significantly different from the moderate osteoarthritis group (peak torque=36.12(SD 4.61)) in concentric plantar flexion. There were no significant differences for dorsiflexion among the groups; however the control and moderate osteoarthritis groups presented large and medium standardized mean differences. The mild osteoarthritis group was significantly lower than the control and moderate osteoarthritis groups in the concentric plantar flexion by concentric dorsiflexion torque ratio.
INTERPRETATION: Ankle function exhibited impairments in patients with knee osteoarthritis, especially in the plantar flexion torque, in which the mild osteoarthritis group was weaker than the control. Interestingly, patients with moderate knee osteoarthritis showed results similar to the control group in plantar flexion torque. The results raise the possibility of a compensatory mechanism of the plantar flexors developed by patients in more advanced degrees to balance other muscle failures. |
1 | Radial tears associated with cleavage tears of the medial meniscus in athletes | AMP (Acute Meniscal Pathology) | PURPOSE: To evaluate the significance of a small radial tear in the root of the posterior horn of the medial meniscus in an otherwise normal-looking meniscus in individuals who play vigorous sports.
TYPE OF STUDY: Retrospective review.
METHODS: Arthroscopy was performed in 1,270 patients; 11 patients (0.86%) had a small radial tear in the root of the medial meniscus. Trimming of the tear revealed a large horizontal cleavage tear of the posterior horn and body of the meniscus. The average age of the affected patients was 29.6 years (range, 21 to 45 years), and all were active in sports. Magnetic resonance imaging was of dubious diagnostic value. Three patients had undergone previous arthroscopy at which time the small radial root tear had been noted but was not thought to warrant treatment.
RESULTS: All 11 patients returned to their former levels of activity after adequate surgery.
CONCLUSIONS: When a radial root tear in the medial meniscus is found in an athletic patient, the edges of the tear should be trimmed, the root of the medial meniscus examined, and any additional torn cartilage resected. |
0 | The effect of canal fill on paediatric femur fractures treated with titanium elastic nails | Pediatric Diaphyseal Femur Fractures 2020 Review | PURPOSE: Traditional teaching for fixation of paediatric femur fractures recommends 80% nail diameter/medullary canal diameter ratio (ND/MCD) for successful maintenance of reduction. Prior studies have investigated this with stainless steel Enders nails. Our aim was to assess the impact of ND/MCD on maintenance of reduction and malunion rates in paediatric femur fractures treated with flexible intramedullary nails (FINs). METHODS: Retrospective data was collected on all paediatric patients treated with FINs for diaphyseal femur fractures at a single tertiary care institution over a ten-year period. Patients with co-morbidities affecting bone quality were excluded. Patients were subdivided into groups based on ND/MCD. RESULTS: A total of 66 patients met inclusion criteria. Mean ND/MCD was 76.3% (32.9% to 98.8%, SD 14.3). In all, 50% (n = 33/66) of patients had > 80% ND/MCD, and only 13.6% (n = 9/66) of patients had less than 60% ND/MCD. When controlling for fracture stability, ND/MCD had no correlation with mean shortening (p = 0.07) There was no correlation between ND/MCD and angulation in the sagittal (p = 0.96) or coronal plane (p = 0.20). Three patients fit malunion criteria. ND/MCD for these patients were 40%, 67% and 79%. CONCLUSION: There was no correlation between ND/MCD and shortening or malangulation. The majority of patients in this series with less than 80% fill with FIN healed within acceptable parameters. LEVEL OF EVIDENCE: III. |
0 | Genome-wide association analysis of osteochondrosis of the tibiotarsal joint in Norwegian Standardbred trotters | Diagnosis and Treatment of Osteochondritis Dissecans AUC | Osteochondrosis (OC), a disturbance in the process of endochondral ossification, is by far the most important equine developmental orthopaedic disease and is also common in other domestic animals and humans. The purpose of this study was to identify quantitative trait loci (QTL) associated with osteochondrosis dissecans (OCD) at the intermediate ridge of the distal tibia in Norwegian Standardbred (SB) using the Illumina Equine SNP50 BeadChip whole-genome single-nucleotide polymorphism (SNP) assay. Radiographic data and blood samples were obtained from 464 SB yearlings. Based on the radiographic examination, 162 horses were selected for genotyping; 80 of these were cases with an OCD at the intermediate ridge of the distal tibia, and 82 were controls without any developmental lesions in the joints examined. Genotyped horses descended from 22 sires, and the number of horses in each half-sib group ranged from 3 to 14. The population structure necessitated statistical correction for stratification. When conducting a case-control genome-wide association study (GWAS), mixed-model analyses displayed regions on chromosomes (Equus callabus chromosome - ECA) 5, 10, 27 and 28 that showed moderate evidence of association (P </= 5 x 10(-5); this P-value is uncorrected i.e. not adjusted for multiple comparisons) with OCD in the tibiotarsal joint. Two SNPs on ECA10 represent the most significant hits (uncorrected P=1.19 x 10(-5) in the mixed-model). In the basic association (chi-square) test, these SNPs achieved statistical significance with the Bonferroni correction (P=0.038) and were close in the permuted logistic regression test (P=0.054). Putative QTL on ECA 5, 10, 27 and 28 represent interesting areas for future research, validation studies and fine mapping of candidate regions. Results presented here represent the first GWAS of OC in horses using the recently released Illumina Equine SNP50 BeadChip |
0 | Posterior arthroscopic treatment of ankle osteochondral lesions: Technical note | Osteochondritis Dissecans 2020 Review | Osteochondral lesions of the ankle are lesions that involve the cartilage and the subchondral bone of the talus. The aim of this study is to describe the clinical results of a consecutive case series of posterior osteochondral lesions of the talus treated with debridement and bone marrow stimulation by means of posterior ankle arthroscopy. We hypothesise that posterior ankle arthroscopy is an effective and safe procedure to treat lesions less than 10-15 mm in size and 5 mm in depth located in zones 7, 8 and 9 of the Raikin and Elias grid. We prospectively analysed the outcomes of 36 patients who underwent posterior endoscopic treatment of osteochondral lesions of the talus. The American Orthopaedic Foot and Ankle Society (AOFAS) clinical rating system and the Foot and Ankle Ability Measure were used and patient satisfaction was evaluated. Visual Analogue Scale (VAS) was complementarily used with these measures to evaluate the clinical behaviour of the patients. The average AOFAS score improved from 42.3 preoperatively to 89.29 postoperatively. All patients were satisfied with the surgical outcome and would choose this surgical treatment again. Three minor and transitory postoperative complications (5.55%) were observed: One patient with pain on the portals, one ecchymosis and one hypoesthesia of the heel. The average score on VAS improved from 7.75 preoperatively to 1.54 postoperatively, with an average improvement of 6.21 points. 75% of patients were able to resume their 'preinjury' physical activity level. The posterior arthroscopic approach with bone marrow stimulation is technically simple and is a safe and effective procedure to treat posterior talar osteochondral lesions. It has few complications, thus reducing time to return to sports and/or work activity. Level of evidence IV, case series. |
0 | Meniscal root tears: repair and salvage techniques | AMP (Acute Meniscal Pathology) | Recent interest has uncovered the importance of understanding meniscal root anatomy, its effect on biomechanics of the knee joint, and appropriate treatment modalities. Meniscal root tears may account for up to one-fifth of all meniscal tears and have downstream consequences that can be as severe as total meniscectomy due to the unique force-dispersing properties of the meniscus. Meniscal biomechanics rely heavily upon the integrity of root attachments, and this historically overlooked etiology of knee pain and early onset osteoarthritis plays a vital role in maintaining the longevity of the knee joint. As meniscal root pathology becomes more commonly known and clinically assessed, an understanding of classifications, repair methods, and indications is important for surgeons. |
0 | Usefulness of additional measurements of the median nerve with ultrasonography | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | High resolution sonography is a relatively new diagnostic technique in diagnosing carpal tunnel syndrome (CTS). Normal values in different studies, however, vary and this makes their practical use difficult. The aim of this study was to establish normal values for the median nerve cross-sectional area (CSA) and to investigate the value of measuring additional parameters. Ninety-eight wrists of 29 women and 25 men without signs or symptoms of CTS were included. Width and circumference of the wrist were measured. The CSA of the median nerve at the level of the pisiform bone was measured using ultrasonography. We found a significant correlation between the CSA of the median nerve at the wrist and wrist circumference. Measuring wrist circumference will establish the upper level of normal more accurately compared to predictions solely based upon gender. This has important implications in diagnosing CTS with ultrasonography |
0 | Salmon calcitonin in the prevention of bone loss at perimenopause | Distal Radius Fractures | The objective of this study was to determine whether intranasal salmon calcitonin prevents physiological bone loss at perimenopause. A double-blind study of 120 perimenopausal women without present or past disease or medication that could affect bone metabolism were studied. The subjects were randomized in two groups and provided with nasal spray bottles containing either placebo (excipient only) or active compound (excipient plus 50 international units (IU) salmon calcitonin per dose). Subjects took one puff from the nasal spray in each nostril every morning. All subjects took one soluble tablet of calcium (1000 mg) per day. Serum biochemistry, dual-energy X-ray absorptiometry of lumbar spine and proximal femur, quantitative computed tomography of lumbar spine, and single photon attenuation of forearm were used to evaluate bone mineral density (BMD). There were no differences in demographic characteristics or hormone status at entry. No fractures were recorded during the study period. Serum calcium increased and serum dihydroxyvitamin D and osteocalcin decreased in both groups. There was no difference in biochemical parameters between the groups. The BMD of upper femur did not change during the study, but it was decreased in the lumbar spine in both groups. The mineral content of distal radius increased in both groups. In conclusion, nasal salmon calcitonin, 100 IU daily, has no protective effect on bone mass and does not modify bone metabolism at perimenopause. |
0 | Ultrasound measurement of knee synovial fluid during external pneumatic compression | OAK 3 - Non-arthroplasty tx of OAK | Synovial fluid based biomarker research has been limited by the small volumes of synovial fluid from the knees of some patients. We used ultrasound (US) to determine if synovial fluid could be displaced into an access port during pneumatic compression to 100 mmHg. Forty knees from 37 consecutive arthritis patients with rheumatoid arthritis -25, osteoarthritis -8, psoriatic arthritis -2, and 1 each with systemic lupus erythematosus and gout were evaluated. This group of 28 females and 9 males with a median age of 59 years and an average body mass index of 26.9 kg/m<sup>2</sup> had previously undergone a diagnostic arthrocentesis and or a therapeutic knee injection using this pneumatic compression device. Blinded digital image analysis of the anechoic region on ultrasound demonstrated an increase in fluid within the 9 cm x 6 cm access port (anterolateral or anteromedial joint) during inflation in all patients with a 2.5-3.5 fold increase in fluid area and a 2-3 fold increase in fluid depth after inflation, p < 0.001. Statement of clinical significance: External pneumatic compression to the knee provides a larger volume of synovial fluid under positive pressure which should allow investigators to achieve greater success in obtaining synovial fluid during arthrocentesis for biomarker research or provide more precise therapeutic injections than traditional non image-guided anatomical landmark-based techniques. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res. |
0 | Update: adverse events associated with anthrax prophylaxis among postal employees--New Jersey, New York City, and the District of Columbia metropolitan area, 2001 | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | Antimicrobial prophylaxis to prevent inhalational anthrax has been recommended for persons potentially exposed to Bacillus anthracis as a result of the recent bioterrorist attacks. During October 26-November 6, 2001, an epidemiologic evaluation to detect adverse events associated with antimicrobial prophylaxis was conducted among 8,424 postal employees who had been offered antimicrobial prophylaxis for 60 days in New Jersey (NJ), New York City (NYC), and one postal facility in the District of Columbia (DC). This report summarizes preliminary results of that evaluation, which found that few employees receiving antimicrobial prophylaxis sought medical attention for symptoms that may have been associated with anaphylaxis. Persons with exposures to B. anthracis related to the bioterrorist attacks should complete the full 60-day course of antimicrobial prophylaxis |
0 | Osteochondritis dissecans of the elbow: excellent results in teenage athletes treated by arthroscopic debridement and microfracture | Diagnosis and Treatment of Osteochondritis Dissecans AUC | AIM: To evaluate the outcome of patients who underwent microfracture procedure on osteochondritis dissecans (OCD) lesions in the elbow, which had already been proven successful on OCD lesions in the knee and ankle. METHODS: Nine young patients who were previously treated by arthroscopic debridement and microfracture by a single surgeon were included in the study. The median age at operation was 15 years (range 12-19). The median time between the procedure and evaluation was 5 years (range 2-9). The evaluation included physical examination and patient interview with elbow function scoring. Success of treatment was determined according evaluation Mayo Elbow Performance Index scores and the patients' return to sports. RESULTS: Eight patients scored excellent results and 1 scored a good result. Four out of 9 patients were able to increase their training intensity, 2 returned to the same level of activity, 2 changed sports (due to reasons unrelated to the health of their elbow), and 1 left professional sports and started training only recreationally. No patients stopped participating in sports altogether. CONCLUSIONS: We advocate arthroscopic microfracturing, followed by a strict rehabilitation regime, as a highly effective treatment for OCD of the humeral capitellum |
0 | Imaging of the optic chiasm and retrochiasmal visual pathways | Upper Eyelid and Brow Surgery | The exploration of the chiasmal and retrochiasmal visual pathways is based on magnetic resonance imaging. A bitemporal hemianopsis suggests a lesion of the optic chiasm while homonymous lateral hemianopsis should lead to a search for a lesion of the retrochiasmal visual pathways. The causes of chiasmal impairment are mainly tumoral. The exploration protocol is based on MRI with T1-weighted sagittal sections, then T2- and T1-weighted coronal sections with and without injection. In case of a retrochiasmal syndrome, the MRI exploration protocol is a function of the type of occurrence of the deficiency and the context. |
0 | Heating infiltration solutions used in tumescent liposuction: Minimizing surgical risk | Panniculectomy & Abdominoplasty CPG | Background: Liposuction, one of the most common operations performed by plastic surgeons, is not free of complications. One of the most common factors is patient hypothermia, a factor little studied but one capable of producing severe arrhythmias and cardiac arrest. A comparative clinical study was conducted to determine what effect using tumescent infiltration solutions at room temperature and at body temperature has on vital signs. Methods: Two similar groups of 15 healthy female subjects were studied. In the first group (group A), subcutaneous solutions were infiltrated at room temperature (24°C), and in the second group (group B), solutions were infiltrated at body temperature (37°C). Vital signs (i.e., heart rate, respiratory rate, temperature, and blood pressure) were monitored every 15 minutes until the basal vital signs were attained. Variables such as age, body mass index, infiltrated and aspirated liquids, and surgery time were very similar for both groups. Results: Although there were differences in heart rate, respiratory rate, and arterial pressure, they were not statistically significant. Nevertheless, the differences between groups A and B for body temperature (34.9 ± 1.1°C versus 35.7 ± 1.3°C, respectively) and for the time necessary to attain basal vital signs (120 ± 8 minutes versus 69 ± 4 minutes, respectively) were statistically significant (p < 0.05). Conclusions: Despite the existence of a significant change in the body temperature in healthy female subjects during manipulation of the temperature of the infiltration solution, this change had no important effect on the intraoperative hemodynamic values. Nevertheless, it could have a more significant effect on patients with greater surgical risk. |
0 | Emergency Department Frequent Utilization for Non-Emergent Presentments: Results from a Regional Urban Trauma Center Study | DoD PRF (Psychosocial RF) | OBJECTIVES: First, to test a model of the drivers of frequent emergency department utilization conceptualized as falling within predisposing, enabling, and need dimensions. Second, to extend the model to include social networks and service quality as predictors of frequent utilization. Third, to illustrate the variation in thresholds that define frequent utilization in terms of the number of emergency department encounters by the predictors within the model.
DATA SOURCE: Primary data collection over an eight week period within a level-1 trauma urban hospital's emergency department.
STUDY DESIGN: Representative randomized sample of 1,443 adult patients triaged ESI levels 4-5. Physicians and research staff interviewed patients as they received services. Relationships with the outcome variable, utilization, were tested using logistic regression to establish odds-ratios.
PRINCIPAL FINDINGS: 70.6 percent of patients have two or more, 48.3 percent have three or more, 25.3 percent have four or more, and 14.9 percent have five or more emergency department visits within 12 months. Factors associated with frequent utilization include gender, race, poor mental health, mental health drugs, prescription drug abuse, social networks, employment, perceptions of service quality, seriousness of condition, persistence of condition, and previous hospital admittance.
CONCLUSIONS: Interventions targeting associated factors will change global emergency department encounters, although the mutability varies. Policy interventions to address predisposing factors such as substance abuse or access to mental health treatment as well as interventions that speak to enabling factors such as promoting the resiliency of social networks may result in decreased frequency of emergency department utilization. |
0 | Long-term mortality following fractures at different skeletal sites: a population-based cohort study | The Treatment of Pediatric Supracondylar Humerus Fractures AUC | Summary: Adjusting for age, sex, and precipitating cause, the relative risk of death was increased following fractures at most skeletal sites. Introduction: This study aims to determine long-term survival following fractures due to any cause at each skeletal site. Methods: In a historical cohort study, 2,901 Olmsted County, MN, USA, residents (greater-than or equal to)35 years old who experienced any fracture in 1989-1991 were followed passively for up to 22 years for death from any cause. Standardized mortality ratios (SMRs) compared observed to expected deaths. Results: During 38,818 person-years of follow-up, 1,420 deaths were observed when 1,191 were expected (SMR, 1.2; 95 % CI, 1.1-1.3). The overall SMR was greatest soon after fracture, especially among the men, but remained elevated for over a decade thereafter. Adjusting for age and sex, relative death rates were greater for pathological fractures and less for severe trauma fractures compared to the fractures due to no more than moderate trauma. In the latter group, long-term mortality was increased following fractures at many skeletal sites. After further adjustment for precipitating cause, overall SMRs were elevated not only following fractures at the traditional major osteoporotic sites (i.e., distal forearm, proximal humerus, thoracic/lumbar vertebrae, and proximal femur) combined (SMR, 1.2; 95 % CI, 1.1-1.3) but also following all other fracture types combined (SMR 1.2; 95 % CI, 1.1-1.4), excluding the hand and foot fractures not associated with any increased mortality. Conclusions: The persistence of increased mortality long after the occurrence of a fracture has generally been attributed to underlying comorbidity, but this needs to be defined in much greater detail if specific opportunities are to be identified for reducing the excess deaths observed. (copyright) 2012 International Osteoporosis Foundation and National Osteoporosis Foundation |
0 | The surgical management of symptomatic articular cartilage defects of the knee: Consensus statements from United Kingdom knee surgeons | OAK 3 - Non-arthroplasty tx of OAK | BACKGROUND: Symptomatic articular cartilage and osteochondral lesions in the knee are an important source of pain and disability, and may lead to osteoarthritis. There are several surgical treatments for the condition, with emerging data evaluating their clinical effectiveness and longer-term clinical outcome. Health care providers have challenged the indications for the use of expensive techniques and have been reluctant to authorize funding or reimbursement.
METHODS: The UK Cartilage Consensus Meeting was convened, involving clinicians in the UK with experience in the treatment options, decision-making and evaluation of the literature on the subject.
RESULTS: This paper reports the consensus of attendees regarding appropriate surgical options for managing articular cartilage defects in the knee, validated by a large cohort of surgeons in the UK who are active in the field of articular cartilage surgery.
CONCLUSIONS: An evidence-based United Kingdom Consensus of 104 clinicians on the surgical management of symptomatic articular cartilage lesions of the knee. Several techniques may be suitable for small defects. Cell therapy has the best evidence-based outcomes for larger defects. Responsible innovation, pooled data collection and improvement in physical therapies are important. Surgeons should have access to the most appropriate evidence-based therapies for first-line treatment. |
0 | Intertrochanteric fractures of the femur: Results of treatment with 95° Condylar Blade Plate | Hip Fx in the Elderly 2019 | The aim of the present study was to analyze patients treated with 95° Condylar Blade Plate and to describe the technique that can prevent complications. 69 patients with closed intertrochanteric femoral fractures were treated by one surgeon using the 95° Condylar Blade Plate, and it was found that 56 of them met the minimum 10 months follow up requirement. 53 patients (94%) healed after the procedure. There were 4 patients (7%) requiring surgical intervention. One patient required bipolar arthroplasty because of the cutting through of the implant, two patients needed repeated open reduction and internal fixation (ORIF) with bone graft due to delayed union and broken implant, and one patient had an infection which was resolved after debridement and a course of antibiotics. The surgical time averaged 45 minutes and blood loss averaged 150 ml. It appeared that open reduction and internal fixation using the 95° Condylar Blade Plate was effective in treating patients with intertrochanteric femoral fractures. The surgical time and blood loss were minimized. Early patient rehabilitation was initiated, and the complications were decreased. |
0 | CXCR4 ligands: The next big hit? | MSTS 2018 - Femur Mets and MM | The G protein-coupled protein receptor C-X-C chemokine receptor 4 (CXCR4) is an attractive target for cancer diagnosis and treatment, as it is overexpressed in many solid and hematologic cancers. Binding of its ligand, C-X-C chemokine ligand 12 (CXCL12), results in receptor internalization and activation of several signal transduction pathways, such as phosphoinositide 3-kinase/protein kinase B, which are critical in cell proliferation, angiogenesis, development of metastasis, and survival. Also, the CXCR4-CXCL12 axis is involved in the interaction between hematopoietic stem cells (as well as hematologic and solid tumor cells) and their protective microenvironment. This interaction can be disrupted by CXCR4 antagonists. This concept is being used clinically to harvest hematopoietic stem or progenitor cells from bone marrow and to sensitize cancer cells to conventional chemotherapy and radiotherapy, and the potential to overcome tumor microenvironment-driven immunosuppression is being explored. This review focuses on new strategies for improvement of cancer treatment by targeting of the CXCR4-CXCL12 interaction. Because of its critical role in cancer, many peptidic and nonpeptidic ligands with different modes of antagonistic activity against the CXCR4-CXCL12 axis have been developed, with some of them reaching clinical trials. Molecular imaging with recently developed radiolabeled CXCR4 ligands could facilitate the selection of patients who might benefit from directed targeted therapy, including CXCR4-directed endoradiotherapy. |
0 | Genetic variant of lactase-persistent C/T-13910 is associated with bone fractures in very old age | Management of Hip Fractures in the Elderly | OBJECTIVES: To determine the relation between the C/T(-13910) single-nucleotide polymorphism residing 13,910 base pairs from the 5' end of the lactase gene associated with lactase persistence and the occurrence of bone fractures in elderly people. DESIGN: Population-based study. SETTING: Vantaa 85+ population-based study, including all 601 subjects born before April 1, 1906, who were living in the city of Vantaa, Finland, on April 1, 1991. PARTICIPANTS: Four hundred eighty-three people aged 85 and older (106 men and 377 women). MEASUREMENTS: Genotype determination was made using a polymerase chain reaction minisequencing technique. RESULTS: The frequency of the genotype C/C(-13910) associated with adult-type hypolactasia (low lactase enzyme activity or primary lactose malabsorption (LM)) was significantly greater in individuals with hip fractures, with an adjusted odds ratio (OR) of 3.7 (95% confidence interval (CI)=1.8-7.8), wrist fractures with an adjusted OR of 2.5 (95% CI=1.2-5.2), and hip and wrist fractures combined with an adjusted OR of 4.1 (95% CI=2.0-8.3). CONCLUSION: The C/C(-13910) genotype associated with primary LM could represent a genetic risk factor for bone fractures for elderly people |
0 | Multidisciplinary rehabilitation following botulinum toxin and other focal intramuscular treatment for post-stroke spasticity | Pediatric Supracondylar Humerus Fracture 2020 Review | Background: Spasticity may affect stroke survivors by contributing to activity limitations, caregiver burden, pain and reduced quality of life (QoL). Spasticity management guidelines recommend multidisciplinary (MD) rehabilitation programmes following botulinum toxin (BoNT) treatment for post-stroke spasticity. However, the evidence base for the effectiveness of MD rehabilitation is unclear. Objectives: To assess the effectiveness of MD rehabilitation, following BoNT and other focal intramuscular treatments such as phenol, in improving activity limitations and other outcomes in adults and children with post-stroke spasticity. To explore what settings, types and intensities of rehabilitation programmes are effective. Search methods: We searched the Cochrane Stroke Group Trials Register (February 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 12), MEDLINE (1948 to December 2011), EMBASE (1980 to January 2012), CINAHL (1982 to January 2012), AMED (1985 to January 2012), LILACS (1982 to September 2012), PEDro, REHABDATA and OpenGrey (September 2012). In an effort to identify further published, unpublished and ongoing trials we searched trials registries and reference lists, handsearched journals and contacted authors. Selection criteria: We included randomised controlled trials (RCTs) that compared MD rehabilitation (delivered by two or more disciplines in conjunction with medical input) following BoNT and other focal intramuscular treatments for post-stroke spasticity with placebo, routinely available local services, or lower levels of intervention; or studies that compared MD rehabilitation in different settings, of different types, or at different levels of intensity. We excluded RCTs that assessed the effectiveness of unidisciplinary therapy (for example physiotherapy only) or a single modality (for example stretching, casting, electrical stimulation or splinting only). The primary outcomes were validated measures of activity level (active and passive function) according to the World Health Organization's International Classification of Functioning, Disability and Health. Secondary outcomes included measures of symptoms, impairments, participation, QoL, impact on caregivers and adverse events. Data collection and analysis: We independently selected the trials, extracted data, and assessed methodological quality using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Due to the limited number of included studies, with clinical, methodological and statistical heterogeneity, quantitative meta-analysis was not possible. Therefore, GRADE provided qualitative synthesis of 'best evidence'. Main results: We included three RCTs involving 91 participants. All three studies scored 'low quality' on the methodological quality assessment, implying high risk of bias. All studies investigated various types and intensities of outpatient rehabilitation programmes following BoNT for upper limb spasticity in adults with chronic stroke. Rehabilitation programmes included: modified constraint-induced movement therapy (mCIMT) compared with a neurodevelopmental therapy programme; task practice therapy with cyclic functional electrical stimulation (FES) compared with task practice therapy only; and occupational, manual therapy with dynamic elbow extension splinting compared with occupational therapy only. There was 'low quality' evidence for mCIMT improving upper limb motor function and spasticity in chronic stroke survivors with residual voluntary upper limb activity, up to six months, and 'very low quality' evidence for dynamic elbow splinting and occupational therapy reducing elbow range of movement at 14 weeks. Task practice therapy with cyclic FES did not improve upper limb function more than task practice therapy alone, only at 12 weeks. No studies addressed interventions in children and those with lower limb spasticity, or after other focal intramuscular treatments for spasticity. Authors' conclusions: At best there was 'low level' evidence for the ef ectiveness of outpatient MD rehabilitation in improving active function and impairments following BoNT for upper limb spasticity in adults with chronic stroke. No trials explored the effect of MD rehabilitation on 'passive function' (caring for the affected limb), caregiver burden, or the individual's priority goals for treatment. The optimal types (modalities, therapy approaches, settings) and intensities of therapy for improving activity (active and passive function) in adults and children with post-stroke spasticity, in the short and longer term, are unclear. Further research is required to build evidence in this area. |
0 | Surface repair of the femoral head using press-osteochondral autograft transfer | Osteochondritis Dissecans 2020 Review | AIMS: Hyaline cartilage has a low capacity for regeneration. Untreated osteochondral lesions of the femoral head can lead to progressive and symptomatic osteoarthritis of the hip. The purpose of this study is to analyze the clinical and radiological long-term outcome of patients treated with osteochondral autograft transfer. To our knowledge, this study represents a series of osteochondral autograft transfer of the hip with the longest follow-up. METHODS: We retrospectively evaluated 11 hips in 11 patients who underwent osteochondral autograft transfer in our institution between 1996 and 2012. The mean age at the time of surgery was 28.6 years (8 to 45). Outcome measurement included standardized scores and conventional radiographs. Kaplan-Meier survival curve was used to determine the failure of the procedures, with conversion to total hip arthroplasty (THA) defined as the endpoint. RESULTS: The mean follow-up of patients treated with osteochondral autograft transfer was 18.5 years (9.3 to 24.7). Six patients developed osteoarthritis and had a THA at a mean of 10.3 years (1.1 to 17.3). The cumulative survivorship of the native hips was 91% (95% confidence interval (CI) 74 to 100) at five years, 62% (95% CI 33 to 92) at ten years, and 37% (95% CI 6 to 70) at 20 years. CONCLUSION: This is the first study analyzing the long-term results of osteochondral autograft transfer of the femoral head. Although most patients underwent conversion to THA in the long term, over half of them survived more than ten years. Osteochondral autograft transfer could be a time-saving procedure for young patients with devastating hip conditions who have virtually no other surgical options. A larger series or a similar matched cohort would be necessary to confirm these results which, in view of the heterogeneity of our series, seems difficult to achieve. |
0 | Effect of oral factor Xa inhibitor and low-molecular-weight heparin on surgical complications following total hip arthroplasty | PJI DX Updated Search | This prospective study was conducted to report the effect of oral factor Xa inhibitor and low-molecular-weight heparin (LMWH) on surgical complications following total hip arthroplasty (THA). The patients with an age < 60 years were randomly assigned to three groups (rivaroxaban, enoxaparin, and placebo) and the patients with an age >/= 60 years were assigned to two groups (rivaroxaban and enoxaparin). All drug regimens started at 12 hours postoperatively and continued for two weeks after surgery. Primary measure outcome was major surgical wound complications defined as haematoma requiring any intervention, superficial wound infection, deep periprosthetic infection, and increased wound bleeding. Secondary measured outcome included minor surgical complications (swelling, drainage, erythema, and oozing), organ bleeding, and venous thromboembolic (VTE) events. A total of 184 patients aged < 60 years and 167 patients aged >/= 60 years were included as the analysis population per group. Up to 14 days after surgery, the overall incidence of major surgical complications associated with thromboprophylaxis was 6.5 % (58/886). There were no significant differences in the rate of major surgical complications among all the three groups of the patients aged < 60 years and between two groups of the patients aged >/= 60 years. For the patients aged < 60 years, wound oozing continued significantly longer in the pharmacological group than in the placebo group, but wound infection did not occur in any case. The VTE events were similar in all the groups |
0 | Intraoperative application Platelet rich fibrin, postoperative injections OF PRP or microfracture only for osteochondral lesions of the knee: a five-year retrospective evaluation | Osteochondritis Dissecans 2020 Review | Cartilage lesions are the most common cause of chronic knee pain. Micro-fracturing is reliable, effective, easy to perform and inexpensive. We propose a novel approach to cartilage lesions where microfractures are performed contextually to intra-operative or post-operative administration of platelet concentrates. We retrospectively evaluate 48 patients divided in 3 groups. Group 1: 15 patients underwent microfractures and intraoperative administration of PRF (PRF group); group 2: 16 microfractures and postoperative injections of PRP (PRP group); group 3: 17 patients with isolated microfractures (Microfractures group). Clinical scores (IKDC, VAS pain) were administered at 2 and 5 years postoperative and MRI was performed to evaluate the lesions of patients according to the MOCART criteria (2006). Patients treated with platelet concentrates achieved better clinical results compared to patients treated with microfracture only. The PRF group showed better results than the PRP group at 2 years, with loss of significance at 5 years. At MOCART score, PRF group obtained better results earlier than the other two groups. |
0 | Listeria monocytogenes infection in a prosthetic knee joint in rheumatoid arthritis | Surgical Management of Osteoarthritis of the Knee CPG | The prosthetic knee joint of a 64 year old woman with severe rheumatoid arthritis was found to be infected with Listeria monocytogenes. After treatment with intravenous antibiotics, symptoms gradually resolved. She subsequently received prolonged treatment with oral co-trimoxazole and 18 months later remained well |
0 | Total hip arthroplasty in hemodialysis and renal transplant patients | Management of Hip Fractures in the Elderly | Osteoarticular complications are common in patients with chronic renal failure and they often require implantation of a hip arthroplasty (total or partial) due to osteoarthritis, femoral neck fracture or ischemic necrosis of multifactor aetiology. Between 1992 and 2005 we operated on eighteen patients (23 hips) with chronic renal failure who were receiving renal replacement therapy (ten haemodialysis and eight renal transplants), and in each case either a total or partial hip arthroplasty was implanted. This group comprised nine women and nine men, with a mean age of 56 years (range: 30-83). Five cases were bilateral. The clinical diagnoses were necrosis (fourteen cases), femoral neck fracture (five cases) and osteoarthritis (three cases). The main early complications were haemorrhage in seventeen cases (74%) and infection in six cases (33%) (two urinary infections and four of the surgical wound). The late complications involved eight cases (35%) of prosthetic loosening (five aseptic and three septic). The surgery-related mortality rate was 17% (three cases). Prosthetic hip surgery in patients receiving renal replacement therapy is associated with high morbidity and mortality, thus highlighting the importance of careful patient selection |
0 | Current evidence on risk factors for knee osteoarthritis in older adults: a systematic review and meta-analysis | SR for PM on OA of All Extremities | BACKGROUND: Osteoarthritis (OA) is a leading cause of pain and disability and leads to a reduced quality of life. The aim was to determine the current evidence on risk factors for onset of knee pain/OA in those aged 50 and over. METHODS: A systematic review and meta-analysis was conducted of cohort studies for risk factors for the onset of knee pain. Two authors screened abstracts and papers and completed data extraction. Where possible, pooled odds ratios (OR) were calculated via random effects meta-analysis and population attributable fractions (PAFs) derived. RESULTS: 6554 papers were identified and after screening 46 studies were included. The main factors associated with onset of knee pain were being overweight (pooled OR 1.98, 95% confidence intervals (CI) 1.57-2.20), obesity (pooled OR 2.66 95% CI 2.15-3.28), female gender (pooled OR 1.68, 95% CI 1.37-2.07), previous knee injury (pooled OR 2.83, 95% CI 1.91-4.19). Hand OA (pooled OR 1.30, 95% CI 0.90-1.87) was found to be non-significant. Smoking was found not to be a statistically significant risk or protective factor (pooled OR 0.92, 95% CI 0.83-1.01). PAFs indicated that in patients with new onset of knee pain 5.1% cases were due to previous knee injury and 28.8% related to being overweight or obese. DISCUSSION: Clinicians can use the identified risk factors to identify and manage patients at risk of developing or increasing knee pain. Obesity in particular needs to be a major target for prevention of development of knee pain. More research is needed into a number of potential risk factors |
1 | Carpal tunnel syndrome in patients on long-term haemodialysis | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | The purpose of this study was to describe the pathophysiology of carpal tunnel syndrome (CTS) in patients on long-term haemodialysis. We examined 110 patients, who had been having haemodialysis for chronic renal failure and had CTS, to clarify the clinical features and electrophysiological changes in peripheral nerves. There was a significant correlation between the incidence of CTS and the duration of haemodialysis. Compared with idiopathic CTS, CTS caused by long-term haemodialysis had relatively limited postoperative improvement. Symptoms recurred postoperatively in 11 patients (19%) of those with CTS caused by long-term haemodialysis. Electrophysiological measurements of sensory nerve conduction velocity showed that it was slower in distal segments of the median nerve in patients on haemodialysis compared with normal volunteers. Nerve conduction velocity in the carpal tunnel was significantly delayed (p < 0.05) in the patients with CTS on long-term haemodialysis. N9-13 interpeak latencies were significantly longer (p < 0.05) in subjects who had had haemodialysis for at least 10 years. All the patients with advanced destructive spondyloarthropathy had longer N9-13 interpeak latency. These results suggest that CTS in patients on long-term haemodialysis has its basis in neuropathy. The clinical course of CTS in these patients is different from that of patients with idiopathic CTS, because the neuropathy involves not only the carpal tunnel region, but also the proximal part of the median nerve both diffusely and progressively |
0 | An enlarging distal tibia osteochondroma in the adult patient | Diagnosis and Treatment of Osteochondritis Dissecans AUC | The extensive enlargement of a solitary osteochondroma in a skeletally mature patient is rare and might result from malignant transformation. Excision of such a lesion in the distal and lateral aspect of the tibia is difficult because of the risk of injury to the neurovascular structures and the possible functional consequences with respect to ankle stability. We present a case of an active osteochondroma arising from the posterolateral distal tibia in an adult patient. The tumor was successfully excised by using a transfibular approach with fibular reconstruction. No signs of recurrence were noted 2 years after surgery |
0 | Rheumatoid Arthritis in North Jordan | Surgical Management of Osteoarthritis of the Knee CPG | Objective- To describe the pattern of joint involvement, systematic complication and functional status in patients Rheumatiod Arthritis (RA). Design- Descriptive and analytical clinical study. Setting- Princes Basma Teaching Hospital (PBTH), Irbid, North Jodan. Material and Method- Followed up 54 patients with Rheumatoid Arthritis that fulfilled the American Rheumatism Association (ARA) criteria for the diagnosis of RA. Factors such as age, gender, socio-economic status, employment, joint pattern involvement, deformities, disability, kertoconjunctivitis sicca and drug therapy were recorded in the outpatient clinic.. Results- The results shows that Wrist, MCP, PIP, TMJ and knee founding 20% of patients with ulnar deviation being the commonest deformity. Only 3 of our patients underwent surgical treatment, two knee replacements and one Swanson arthroplasty. Subcutaneous nodules were found in 38% of patients. Average duration of morning stiffness was 1.3 hours during episodes of activity. Conclusion- The study demonstrated the lack of severe systemic complications and the preservation of adequate functional ability in our patients during the study period. Possible relevant factors such as diet and weather were mentioned |
0 | Increased mortality after fracture of the surgical neck of the humerus: a case-control study of 253 patients with a 12-year follow-up | Management of Hip Fractures in the Elderly | BACKGROUND: Several studies have shown a higher mortality rate in patients with osteoporosis-related fractures of the hip and vertebrae. METHOD: In 1999, we did a long-term follow-up case-control mortality study of 253 patients, mean age 72 years, who had sustained a fracture of the surgical neck of the humerus in 1987. RESULTS: We found a higher mortality in fracture patients giving at end point a cumulative survival difference of 16%. The median survival time was 8.9 years in patients and 12 years in controls (p = 0.005). The mortality rate was higher in men during the first 3 years after fracture and fewer than half of the male patients survived this period. The median survival time was 6.5 years in male patients and 12 years in their male controls (p = 0.02). The mortality was only slightly higher in women (p = 0.06). INTERPRETATION: Cardiovascular disease and malignancy were the commonest causes of death in both groups. We could not explain the higher mortality rate in patients with a fracture of the surgical neck of the humerus |
0 | Liposuction-Augmentation Mammaplasty | Panniculectomy & Abdominoplasty CPG | Background: The female breast loses superior fullness and becomes more ptotic over time. Women often present to their plastic surgeon requesting reversal of this evolution. While liposuction alone has been proven to lift the breast, no solution combining augmentation and liposuction has been reported. Objectives: Herein, we introduce a technique called liposuction-augmentation mammaplasty (LAM) that can achieve "scarless" lifting or simply volume equalization prior to inserting same-sized implants. We then compare its safety and efficacy to two gold-standard techniques with similar aims, mastopexy-augmentation mammaplasty (MAM) and reduction-augmentation mammaplasty (RAM). Methods: A retrospective 3-year chart review was conducted on 359 patients (652 breasts) undergoing LAM (n = 125), MAM (n = 188), and RAM (n = 46). Patient demographics, operative details, and revisions were documented. Degree of lift was measured on pre- and postoperative photographs using sternal notch-to-nipple distances (SN-N). Statistical differences were assessed between the groups. Results: The LAM group's mean age and OR time (37 years, 46 minutes) were significantly lower than those of MAM (43 years, 90 minutes) and RAM (42 years, 106 minutes). Mean BMIs and revision rates were uniform between the LAM and MAM groups (24, 2.5%), but significantly higher for RAM (28, 4.6%). Aspirate volumes and resection weights averaged 151 cc and 307 g (left breast) and 173 cc and 298 g (right breast). Minimum follow up was 12 months. The LAM group's mean SN-N reduction (~6%) was statistically significant, albeit much lower than MAM (~16%) and RAM (~22%). Conclusions: LAM is a safe, facile, reliable solution for the ptotic, fatty breast. Patients can direct their volumetric outcome and enjoy lower costs and shorter downtime. Level of Evidence 3: |
0 | Early Subsidence Predicts Failure of a Cemented Femoral Stem With Minor Design Changes | Hip Fx in the Elderly 2019 | Background: Radiostereometry (RSA) measurements of early micromotion can predict later failure in hip and knee prostheses. In hip implants, RSA has been particularly helpful in the evaluation of composite-beam stem designs. The Spectron EF Primary stem (Smith & Nephew, London, UK) has shown inferior performance compared with its predecessors in both clinical studies and registry reports. Early RSA studies have shown somewhat greater subsidence for the Spectron EF Primary stem compared with the earlier Spectron EF, but still within boundaries considered to be safe. Questions/purposes: Our primary research question was whether stem subsidence and rotation for this stem design measured with RSA at 2 years can predict later stem failure. A secondary question was whether high femoral stem offset and small stem sizes, both features specific to the Spectron EF Primary stem compared with its predecessors, are associated with stem failure rate. Methods: Two hundred forty-seven hips (209 patients with median age 63 years [range, 29â??80 years], 65% female, and 77% primary osteoarthritis) with a valid RSA examination at 2 years were selected from four different RSA studies (totaling 279 hips in 236 patients) in our department. The studies were primarily aimed at evaluating cup fixation, bone cement, and polyethylene types. All study patients received a cemented Spectron EF Primary stem. The selected hips had complete followup until stem failure, death, or the end of the followup period. Stem failure was defined as revision of a loose femoral stem or radiological failure with significant osteolysis in Gruen zones 2 to 6. Cox regression analyses were performed to evaluate if stem subsidence and rotation after 2 years, adjusted for age, sex, stem size, standard/high stem offset, and conventional/highly crosslinked polyethylene, could predict later clinical aseptic failure of the stem. We identified 32 stem failures (27 revisions, five radiological failures) at 14 years median followup (range, 3â??18 years). Ten-year stem survival was 94% (95% confidence interval [CI], 90%â??96%). Results: Stem subsidence at 2 years (adjusted hazard ratio [HR], 6.0; 95% CI, 2.5â??15; p < 0.001) and retrotorsion of the stem (adjusted HR, 1.7; 95% CI, 1.1â??2.5; p = 0.018) were associated with later stem failure. Further risk factors were male sex (subsidence analysis HR, 6.9; p > 0.001), use of the two smallest stem sizes (HRsize 1, 8.0; p > 0.001, HRsize 2, 1 [reference], HRsize 3+, 0.06; p = 0.035), and the high offset option (HR, 3.1; p = 0.005). Conclusions: Stem subsidence and retrotorsion at 2 years can predict later failure in the Spectron EF Primary stem, consistent with earlier findings on composite-beam cemented stems. Small stem size and high-offset stems comprise the main group of underperforming stems. We recommend that premarket small-scale RSA studies be performed after any design change to a THA femoral component, because even seemingly minor design changes may unexpectedly result in inferior performance. Level of Evidence: Level III, therapeutic study. |
0 | Understanding resilience: New approaches for preventing and treating PTSD | DoD PRF (Psychosocial RF) | All individuals experience stressful life events, and up to 84% of the general population will experience at least one potentially traumatic event. In some cases, acute or chronic stressors lead to the development of posttraumatic stress disorder (PTSD) or other psychopathology; however, the majority of people are resilient to such effects. Resilience is the ability to adapt successfully in the face of stress and adversity. A wealth of research has begun to identify the genetic, epigenetic, neural, and environmental underpinnings of resilience, and has indicated that resilience is mediated by adaptive changes encompassing several environmental factors, neural circuits, numerous neurotransmitters, and molecular pathways. The first part of this review focuses on recent findings regarding the genetic, epigenetic, developmental, psychosocial, and neurochemical factors as well as neural circuits and molecular pathways that underlie the development of resilience. Emerging and exciting areas of research and novel methodological approaches, including genome-wide gene expression studies, immune, endocannabinoid, oxytocin, and glutamatergic systems, are explored to help delineate innovative mechanisms that may contribute to resilience. The second part reviews several interventions and preventative approaches designed to enhance resilience in both developmental and adult populations. Specifically, the review will delineate approaches aimed to bolster resilience in individuals with PTSD. Furthermore, we discuss novel pharmacologic approaches, including the N-methyl-d-aspartate (NMDA) receptor ketamine and neuropeptide Y (NPY), as exciting new prospects for not only the treatment of PTSD but as new targets to enhance resilience. Our growing understanding of resilience and interventions will hopefully lead to the development of new strategies for not just treating PTSD but also screening and early identification of at-risk youth and adults. Taken together, efforts aimed at dissemination and implementation of novel interventions to enhance resilience will have to keep pace with the growth of new preventive and treatment strategies. |
1 | Tobacco use results in inferior outcomes after anatomic total shoulder arthroplasty | Glenohumeral Joint OA | Background: This study examined the effect of tobacco use on outcomes of primary anatomic total shoulder arthroplasty (TSA). Methods: A retrospective search identified 59 nonsmokers, 29 former smokers, and 14 current smokers with primary anatomic TSA and at least 2 yr of follow-up. At mean follow-up of 3 yr, patients were assessed with a visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES), and Single Assessment Numeric Evaluation (SANE) scores and range-of-motion testing. Results: Smokers were significantly younger than nonsmokers or former smokers; there were no other statistically significant differences. VAS scores were significantly higher in current smokers and ASES scores were significantly lower. Complication rates were 36% in current smokers, 15% in nonsmokers, and 7% in former smokers (P = 0.05). Conclusions: Current smokers had significantly worse pain and functional scores and more complications. Former smokers had results similar to nonsmokers, suggesting improved outcomes are possible in patients who quit smoking preoperatively. |
1 | Use of Graft Jacket as an Augmentation for Massive Rotator Cuff Tears | Optimizing the Management of Full-Thickness Rotator Cuff Tears | Tendon healing and improved strength in the face of massive rotator cuff tear repair remains a daunting challenge. Seventeen consecutive patients with massive rotator cuff tears were treated with a standardized open repair technique and the repair augmented with Graft Jacket (Wright Medical, Memphis, Tennessee). Mean follow-up was 1.2 years (438 days). Pain scores improved with 11 patients (64%) reporting no pain or occasional and slight pain. Functional status improved with 12 patients (70%) reporting normal function or slight restriction only. Active forward flexion improved with 10 patients (59%) having greater than 150(degrees). UCLA scores improved significantly from a mean 9.06 preoperatively to 26.12 (P value < 0.001). Three recurrent tears were observed on 11 available postoperative MRI scans and one CT arthrogram. The recurrent tears were smaller than preop MRI scans and 2 of 3 patients were satisfied with surgery. There was no change in muscle trophicity. No other complications were observed, including no infections or sterile inflammatory reactions. Open repair of massive rotator cuff tears with Graft Jacket augmentation appears to be an effective and safe treatment option. Our surgical technique is described as well as the early results. (copyright) 2007 Elsevier Inc. All rights reserved |
0 | Advances in arthroscopic surgery: Indications and outcomes | Diagnosis and Treatment of Osteochondritis Dissecans AUC | PURPOSE OF REVIEW: To examine recent trends in the use of arthroscopic surgical techniques to address musculoskeletal problems. The review is particularly timely given the rapidly expanding range of indications for diagnostic and therapeutic arthroscopic procedures involving virtually every peripheral joint. RECENT FINDINGS: We focus on arthroscopic approaches to problems of the hip, wrist, elbow and ankle. Hip arthroscopy is permitting novel, minimally invasive approaches to the management of femoral acetabular impingement, labral tears, loose bodies and chondral lesions. Wrist arthroscopy has provided novel approaches to ligament tears, synovitis and fractures. Ankle arthroscopy has been especially helpful with soft tissue impingement syndromes, synovitis and fracture. Elbow arthroscopy has been especially helpful in the management of synovitis and osteoarthritis due to osteophytosis. Complications of arthroscopic procedures occur very rarely. Virtually all the literature on arthroscopy outcomes comes from small uncontrolled studies. SUMMARY: Arthroscopy provides a safe alternative to arthrotomy in the management of a wide range of clinical problems. The generally weak designs of studies performed to date compromises the strength of recommendations that can be made about the role of these procedures in clinical practice. (copyright) 2007 Lippincott Williams & Wilkins, Inc |
0 | CD20 antigen expression by lymphoproliferative disorders after kidney transplant is independently associated with a poor outcome: PTLD.Int survey | MSTS 2022 - Metastatic Disease of the Humerus | OBJECTIVES: Antigen expression by neoplastic cells is important because of its effects on the behavior and survival of patients. We sought to gather data on renal transplant recipients who had developed posttransplant lymphoproliferative disorders in their posttransplant era, and had a documented report on CD20 antigen testing.
MATERIALS AND METHODS: A comprehensive search of the literature was done for reports that indicate test results for the CD20 antigen in kidney recipients having lymphoproliferative disorders after transplant. Their demographics, disease characteristics, and prognoses were analyzed.
RESULTS: CD20-positive posttransplant lymphoproliferative disorder patients had a significantly shorter time from transplant to developing posttransplant lymphoproliferative disorder (P < .001). None of patients who had early onset posttransplant lymphoproliferative disorder was CD20 negative. Bone marrow involvement was significantly more prevalent among CD20-negative patients (P < .05) with no CD20-positive patient developing a bone marrow metastasis. Log-rank test showed a relatively worse survival for renal recipients expressing the CD20 antigen (P = .07).
CONCLUSIONS: CD20-positive posttransplant lymphoproliferative disorder lesions in kidney transplant patients are significantly more likely to develop early after transplant and represent an inferior outcome. We suggest that all renal transplant recipients who develop posttransplant lymphoproliferative disorder within their early time after surgery should be given anti-CD20 therapy. Future prospective studies are required to confirm our conclusions. |
0 | Expression and localization of connective tissue growth factor (CTGF/Hcs24/CCN2) in osteoarthritic cartilage | Management of Hip Fractures in the Elderly | OBJECTIVE: The investigation of the expression and localization of connective tissue growth factor/hypertrophic chondrocyte-specific gene product 24/CCN family member 2 (CTGF/Hcs24/CCN2) in normal and osteoarthritic (OA) cartilage, and quantification of CTGF/Hcs24-positive cells. METHODS: Cartilage samples of patients (n=20) with late stage OA were obtained at total joint replacement surgery. Morphologically normal cartilage was harvested for comparison purposes from the femoral heads of 6 other patients with femoral neck fracture. Paraffin-embedded sections were stained by Safranin O. The severity of the OA lesions was divided into four stages (normal, early, moderate, and severe). The localization of protein and mRNA for CTGF/Hcs24 was investigated by immunohistochemistry and in situ hybridization, respectively. The population of CTGF/Hcs24-positive chondrocytes in OA cartilage and chondro-osteophyte was quantified by counting the number of the cells under light microscopy. RESULTS: Signals for CTGF/Hcs24 were detected in a small percentage of chondrocytes throughout the layers of normal cartilage. In early stage OA cartilage, the CTGF/Hcs24-positive chondrocytes were localized mainly in the superficial layer. In moderate to severe OA cartilage, intense staining for CTGF/Hcs24 was observed in proliferating chondrocytes forming cell clusters next to the cartilage surface. In chondro-osteophyte, strong signals were found in the chondrocytes of the proliferative and hypertrophic zones. CONCLUSION: CTGF/Hcs24 expression was detected in both normal and OA chondrocytes of human samples. The results of the current study suggested that expression of CTGF/Hcs24 was concomitant with development of OA lesions and chondrocyte differentiation in chondro-osteophyte |
0 | Dental treatment and orthopedic implants--a malpractice case | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | A patient who required a revision of a six-year-old hip prosthesis five months following root canal therapy and removal of a root tip subsequently sued his dentist for malpractice. The alleged torts were the presence of a positive culture for lactobacillus--presumably an "oral organism" from the infected hip site one week following the dental procedures--and improper use of antibiotics by the dentist. This case underscores the need for the medical and dental communities to agree on what constitutes proper treatment for dental infections. In addition, the arbitrary use of antibiotics, which has led to increasing numbers of bacterial-resistant organisms and other side effects, needs to be addressed. The guidelines for prophylactic antibiotic administration prior to dental treatment in orthopedic implant patients must be revised significantly, based upon risk-to-benefit ratio, documented research, and the literature |
0 | Surgical management and strategies in the treatment of hypothermia and cold injury | DOD - Acute Comp Syndrome CPG | Increased participation in outdoor activities and the epidemic of homelessness have caused the incidence of cold injuries in the civilian population to rise dramatically over the last 20 years. Knowledge of the treatment is crucial for emergency physicians in rural and urban areas. Recent developments have significantly advanced the understanding of the pathophysiology of hypothermic and frostbite injuries. Together with improved rewarming techniques and use of radiological assessment of tissue viability, future advancements should allow for a more aggressive and active approach to the management of these injuries. |
0 | Giant synovial cyst of thigh: a rare entity | PJI DX Updated Search | Synovial cyst occurs secondary to traumatic, degenerative, or inflammatory conditions. Synovial cysts represent abnormal distension of bursae, which communicate with the joint. Giant synovial cysts are typically due to rheumatoid arthritis, other causes being trauma and synovial pseudoarthrosis. A 33-year-old male presented to an outpatient clinic with a massive swelling on his posterolateral aspect of right thigh extending from upper one-third to the knee joint which had been increasing in size over the past six months. This was associated with dull aching pain. All laboratory investigations were within normal parameters. Even FNAC was inconclusive. With time, swelling was increasing in size. Ultrasound revealed the cystic nature of swelling. MRI showed large cystic lesion 24 x 10 x 12 cm in posterolateral aspect of thigh extending up to knee joint. Following the MRI, an excision was planned. After excision, histological examination confirmed the synovial nature of the cyst, which had a collagenous wall and dense chronic inflammatory cells. As the disease is extremely rare and asymptomatic, precise diagnosis is difficult and often delayed. We consider that open surgical excision should be reserved for cases of large synovial cysts because it can provide a complete resection of the lesion and minimize the risk of recurrence |
0 | Isolation of anaerobic and aerobic bacteria from clean surgical wounds: an experimental and clinical study | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | A pad imprint method was evaluated for quantitative sampling of anaerobic and aerobic bacteria from clean surgical wounds. The best recovery of bacteria from the pads was obtained when they were treated with a rinsing solution in a 'Stomacher' apparatus. Pads of three different fabrics were compared, but no difference was noted in their efficiency in sampling anaerobic and aerobic bacteria from clean surgical wounds. Sampling of known quantities of Staphylococcus aureus from experimental wounds in rabbits performed with the pad method gave a threefold better recovery than with a swab. The pad method was superior to the wound wash-out method when sampling wounds in hip surgery |
0 | Prevention of infection in open fractures: Where are the pendulums now? | DoD SSI (Surgical Site Infections) | Soft tissue management and fracture fixation including initial external fixation in Gustilo-Anderson type II and type III open fractures are cornerstones in the treatment but details on timing and type of wound closure, irrigation and debridement, systemic and local antibiotics, antimicrobial-coated implants and the use of Bone Morphogenetic Protein-2 remain controversial. This article looks at current clinical evidence of these items for the management of open fractures. Timing of debridement and wound closure remains critical. Early debridement by an experienced team within 24 h seems adequate while gross contamination, a devascularized limb, a multi-injured patient and compartment syndrome require immediate surgical intervention. Wound closure during the first surgery was shown to result in reduced rates for infections and nonunion. If soft-tissue reconstruction is needed, it should be performed within the first 7 days. Regarding types of irrigation fluid, antiseptic and antibacterial solutions did not prove to be superior to saline. High pressure irrigation has not been demonstrated to be beneficial whereas antibiotic administration as soon as possible has been proven to be favorable. Administration of more than 72h was not superior to shorter systemic antibiotic intervals. For Gustilo-Anderson type I and II, broad spectrum antibiotic therapy is reasonable. Additional aminoglycosides for broader coverage are recommended in Gustilo-Anderson type III fractures. There is newer literature on the beneficial effects of the use of local antibiotics, e.g. by antibiotic beads. Coating of internal fixation devices is a modern approach to improve infection prophylaxis and gentamicin-coated implants have been demonstrated to be safe in clinical application. Vacuum assisted closure (VAC) could not evidence negative pressure wound therapy to reduce infection risk, improve self-rated disability or quality of life in open fractures, however, enhance treatment costs. Recombinant human bone morphogenetic proteins (rhBMP)-2 showed promising data in Gustilo-Anderson type III open tibial shaft fractures with lower rates of invasive secondary procedures. In conclusion, there is evidence for thorough debridement and irrigation with saline, early soft tissue coverage and the use of systemic and local antibiotics. Except for a short-term soft tissue coverage VAC seems not to be beneficial and rhBMP-2 is an additional tool in Gustilo-Anderson type III open fractures. |
0 | Clinicopathological characteristics and survival outcomes in patients with synchronous lung metastases upon initial metastatic breast cancer diagnosis in Han population | MSTS 2022 - Metastatic Disease of the Humerus | BACKGROUND: We investigated the clinicopathological characteristics and survival of breast cancer lung metastases (BCLM) patients at initial diagnosis of metastatic breast cancer (MBC) in the Han population.
METHODS: We attained clinical data of 3155 MBC patients initially diagnosed between April 2000 and September 2019 from the China National Cancer Center and finally included 2263 MBC patients in this study, among which 809 patients presented with lung metastases at first MBC diagnosis. The risk factors for BCLM were determined using multivariate logistic regression analysis and the prognostic factors of BCLM patients were assessed by univariate and multivariate Cox regression analyses.
RESULTS: Patients with triple-negative subtype (42.3%) harbored the highest incidence proportions of lung metastases. Age >= 50 years, Eastern Cooperative Oncology Group (ECOG) 2, M1, hormone receptor-negative (HR-)/human epidermal growth factor receptor 2-positive (HER2) + subtype, triple-negative subtype and disease-free survival (DFS) > 2 years were remarkably associated with higher incidence of lung metastases, while invasive lobular carcinoma (ILC) and bone metastases were significantly correlated with lower odds of lung metastases at diagnosis. The median survival of BCLM patients was 41.7 months, with triple-negative subtype experiencing the worst prognosis of 26.8 months. ECOG 2, triple-negative subtype, liver metastases, multi-metastatic sites and DFS <= 2 years were significantly correlated with poor survival of BCLM patients.
CONCLUSIONS: Our study provides essential information on clinicopathological features and survival outcomes of BCLM patients at initial diagnosis of MBC in China. |
0 | Loose bodies of the temporomandibular joint: arthrographic and CT findings in five patients | Diagnosis and Treatment of Osteochondritis Dissecans AUC | We report a series of five patients with symptoms of internal derangements of the temporomandibular joint (TMJ), in whom intraarticular loose bodies were found. Three patients with a single loose body had osteochondrosis dissecans of the temporal part of the joint; one trauma patient had two loose bodies (including a bony and a meniscal fragment). The fifth patient presented with a loose meniscal fragment and a complete meniscal rupture, complicating a long-lasting TMJ dysfunction due to non-reducible anterior meniscus displacement. The diagnosis was made by arthrotomography (3 cases), CT (one case) and by CT and arthrotomography (one case). Surgical confirmation was obtained in all patients. Arthrography and CT are accurate in diagnosing TMJ loose bodies; characteristic findings disclosed in both examinations are described |
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