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0 | Statins Are Associated With Reduced Mortality in Multiple Myeloma | MSTS 2018 - Femur Mets and MM | Purpose The 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) have activity in one of the pathways influenced by nitrogen-containing bisphosphonates, which are associated with improved survival in multiple myeloma (MM). To understand the benefit of statins in MM, we evaluated the association between statin use and mortality in a large cohort of patients with MM. Patients and Methods From the Veterans Administration Central Cancer Registry, we identified patients diagnosed with MM between 1999 and 2013. We defined statin use as the presence of any prescription for a statin within 3 months before or any time after MM diagnosis. Cox proportional hazards regression assessed the association of statin use with mortality, while controlling for known MM prognostic factors. Results We identified a cohort of 4,957 patients, of whom 2,294 received statin therapy. Statin use was associated with a 21% decrease in all-cause mortality (adjusted hazard ratio, 0.79; 95% CI, 0.73 to 0.86; P < .001) as well as a 24% decrease in MM-specific mortality (adjusted hazard ratio, 0.76; 95% CI, 0.67 to 0.86; P < .001). This association remained significant across all sensitivity analyses. In addition to reductions in mortality, statin use was associated with a 31% decreased risk of developing a skeletal-related event. Conclusion In this cohort study of US veterans with MM, statin therapy was associated with a reduced risk of both all-cause and MM-specific mortality. Our findings suggest a potential role for statin therapy in patients with MM. The putative benefit of statin therapy in MM should be corroborated in prospective studies. |
0 | Fatal acute pancreatitis associated with reactive AA amyloidosis in rheumatoid arthritis with end-stage renal disease: A report of three cases | PJI DX Updated Search | We report three cases of fatal pancreatitis associated with systemic AA amyloidosis in rheumatoid arthritis (RA). All of the patients showed end-stage renal failure, and hemodialysis was introduced during the course of treatment. Autopsy was performed on two of the three patients, and this revealed amyloid deposition on the vascular walls in the pancreas. It was strongly suggested that the acute pancreatitis in all three patients was attributable to deposition of amyloid in vascular and pancreatic tissues. Acute pancreatitis is considered to be a rare complication of end-stage amyloidosis associated with RA, and is frequently fatal. It is important to treat RA patients intensively to avoid such deposition of amyloid. é 2011 The Japanese Society of Internal Medicine |
0 | The Attenborough and Gallannaugh knee prostheses for total knee arthroplasty: A comparison and survival analysis | Surgical Management of Osteoarthritis of the Knee CPG | The characteristic feature of the Attenborough knee prosthesis was a stabilizing link rod, designed to act in place of the cruciate ligaments and to supplement the function of the collateral ligaments when damaged by disease. However, the reported long-term results obtained with this prosthesis have not been satisfactory, and survival analysis of 505 arthroplasties in which this prosthesis was used demonstrates a cumulative 14-year success rate of only 44.9%. In 1982, a new design incorporating the link rod was developed and the results of 149 knees in which this prosthesis was used show a cumulative seven-year success rate of 98.4%, compared with 70.1% in the Attenborough series. The clinical results of the Gallannaugh series are presented in this study. Knee function has been separated from patient activity, the patients being categorized in groups according to their physical state. Thus, the result of the knee operation can be assessed even in those disabled by age and infirmity. The Gallannaugh prosthesis is of particular value in circumstances where the use of an unconstrained prosthesis would be impractical |
0 | Rehabilitation and Return to Play Following Meniscal Repair | AMP (Acute Meniscal Pathology) | The outcome of meniscal repair has been good to excellent with regard to functional restoration and return to play (RTP). Athletes represent the most demanding subgroup of patients as they have high expectations to return to their preinjury level of activity and in doing so they place maximum stress on any meniscal repair. Physical therapy rehabilitation protocols and RTP decision-making remains controversial in the setting of meniscal repair. Protective protocols had been the mainstay of treatment for many years, however, newer research has shown no harm and quicker RTP for longitudinal and bucket-handle tears located close to the outer vascular zone of the periphery of the meniscus using accelerated rehabilitation. Protective protocols and slower RTP remain the most prudent choice in complex, horizontal and radial tears or those extending into the middle to central third of the more avascular zone of the meniscus. The authors have therefore, with evidence from current publications, developed 2 separate protocols to treat both peripheral and complex tears. One accelerated and one protective protocol is established. During the preoperative planning, it would be helpful for the surgeon, patient, and family to know what can be expected with regard to the surgical success of meniscal repair and the likelihood of RTP in this active population. A literature review on the outcome of meniscal repair related to RTP was performed and revealed that the majority of patients succeed to RTP at the same or similar to their preinjury level, between 4 and 6 months following meniscal repair. Factors that may affect the outcome and RTP along with rehabilitative considerations following meniscal repair are discussed. |
0 | Early results of a domed tibia, mobile bearing lateral unicompartmental knee arthroplasty from an independent centre | Surgical Management of Osteoarthritis of the Knee CPG | AIM: The aim of this study is to determine the short-term outcome of lateral unicompartmental knee arthroplasty (UKA) using a domed tibia, mobile bearing prosthesis. The primary outcome measure was revision due to bearing dislocation and the secondary measure was functional outcome. METHODS: From 2005 to 2009, a total of 64 knees, in 58 patients, were identified as having the domed tibia, mobile bearing lateral UKA with a minimum 2-year follow-up. Forty-one females and 17 males with a mean age of 71years (range 44 to 92, median 72) were reviewed. The mean follow-up period was 38months (range 24 to 61, median 36). The primary outcome measure was re-operation and revision rate, particularly due to bearing dislocation. The secondary outcome assessed was a patient reported outcome measure (PROM) using the Oxford Knee Score (OKS) and compared using Student's Paired T-test. RESULTS: There were four knees that underwent further surgery for any reason. Two patients required revision of the implant (3.1%). There were no cases of bearing dislocation in this series. The mean pre-operative OKS was 24 (range 9 to 36) and the mean post-operative score was 42 (range 23 to 48 p<0.0001). CONCLUSION: This study from an independent centre, reporting on the short-term results of the domed tibia, mobile bearing lateral UKA supports the safety and efficacy of the procedure as a treatment option in the patients with lateral compartment osteoarthritis (OA) of the knee. LEVEL OF EVIDENCE: This is a level 4; case series study |
0 | Acute compartment syndromes of the foot | DoD - ACS - Interrater Reliability | The early recognition and treatment of impending compartmental ischemia in the foot in the context of severe injuries will prevent the late sequelae of myoneural necrosis. When suspected, simple tests will confirm the diagnosis. If the clinical findings are equivocal, compartment pressure monitoring is an essential diagnostic tool. Methods of measuring compartment pressures in the foot are outlined. Prompt decompression of the compartment syndrome with appropriate fasciotomies either by medial or dorsal longitudinal incisions is indicated to preserve function and form of the foot. [References: 21] |
0 | Vascularized bone grafts for the treatment of carpal bone pathology | Distal Radius Fractures | Primary bone healing fails to occur in 5-15 % of scaphoid bones that undergo fracture fixation. Untreated, occult fractures result in nonunion up to 12 % of the time. Conventional bone grafting is the accepted management in the treatment algorithm of scaphoid nonunion if the proximal pole is vascularized. Osteonecrosis of the proximal scaphoid pole intuitively suggests a need for transfer of the vascularized bone to the nonunion site. Scaphoid nonunion treatment aims to prevent biological and mechanical subsidence of the involved bone, destabilization of the carpus, and early degenerative changes associated with scaphoid nonunion advanced collapse. Pedicled distal radius and free vascularized bone grafts (VBGs) offer hand surgeons an alternative treatment option in the management of carpal bone nonunion. VBGs are also indicated in the treatment of avascular necrosis of the scaphoid (Preiser's disease), lunate (Kienbock's disease), and capitate. Relative contraindications to pedicled dorsal radius vascularized bone grafting include humpback deformity, carpal instability, or collapse. The free medial femoral condyle bone graft has offered a novel treatment option for the humpback deformity to restore geometry of the carpus, otherwise not provided by pedicled grafts. In general, VBGs are contraindicated in the setting of a carpal bone without an intact cartilaginous shell, in advanced carpal collapse with degenerative changes, and in attempts to salvage small or collapsed bone fragments. Wrist salvage procedures are generally accepted as the more definitive treatment option under such circumstances. This manuscript offers a current review of the techniques and outcomes of VBGs to the carpal bones. |
0 | Arthroscopic assessment of human cartilage stiffness of the femoral condyles and the patella with a new tactile sensor | Diagnosis and Treatment of Osteochondritis Dissecans AUC | We measured the stiffness of the cartilage of the human femoral condyles via an ultrasonic tactile sensor under arthroscopic control. The stiffness and the degeneration of articular cartilage were assessed in 105 knees in 74 patients (39 men, 35 women, age: 9-72 years) who underwent arthroscopic observation or surgery. Twenty-five knees suffered from traumatic cartilage injury, 14 from osteochondritis dissecans, 13 from osteoarthritis, 11 from meniscal injury and six from ligamentous injury, bipartita patellae (three knees), and symptomatic plica synovialis (two knees). The degeneration of cartilage was classified according to Outerbridge's grading system. The relationships between the stiffness and the grade of cartilage degeneration, and gender were analyzed. The stiffness of grade I (softening) and II (fissuring less than 0.5 inches in length) was significantly lower than that of intact cartilage. In contrast, the stiffness of grade IV (exposed subchondral bone) was significantly higher than that of any other group. The cartilage stiffness of the patella in women was significantly lower than that in men. The tactile sensor was useful for determining the intraoperative stiffness of healthy and diseased human cartilage in all grades. (copyright) 2002 IPEM. Published by Elsevier Science Ltd. All rights reserved |
0 | Perioperative complication rate of one-stage bilateral total hip arthroplasty using the direct anterior approach | OAK 3 - Non-arthroplasty tx of OAK | BACKGROUND: To date, details of the surgical and clinical outcomes of one-stage bilateral total hip arthroplasty using the direct anterior approach have not been widely available. The purpose of this study was to report the perioperative blood management and investigate the perioperative complication rate of one-stage bilateral total hip arthroplasty using the direct anterior approach.
METHODS: We retrospectively assessed 325 consecutive patients (650 hips) who underwent one-stage bilateral total hip arthroplasty through the direct anterior approach.
RESULTS: The mean intraoperative blood loss and operating time were 412 g and 87.2 min, respectively. One patient (0.3%) required postoperative transfusions of allogeneic blood. Post-operative local major complications occurred in 6 hips (0.9%) in 6 patients, including 2 (0.3%) dislocations, 2 (0.3%) early cup migrations, and 2 (0.3%) peri-prosthetic femoral fractures. No systemic major complication was detected.
CONCLUSION: We conclude that the low rate of systemic complications in this study was due to supine positioning and the minimally invasive aspect of the direct anterior approach, and that the approach is therefore a reasonable choice for one-stage bilateral THA. |
0 | Range of flexion after primary TKA: the effect of soft tissue release and implant design | Surgical Management of Osteoarthritis of the Knee CPG | Range of motion following total knee arthroplasty (TKA) is a crucial measure of clinical outcome. The purpose of this randomized, controlled study was to determine which factors are predictive of postoperative range of flexion. Fifty-six patients received either a standard or a high-flexion design NexGen Legacy Posterior-Stabilized TKA (Zimmer, Warsaw, Indiana). The relationship between preoperative flexion, intraoperative flexion, and range of flexion 1 year postoperatively was determined. The influence of soft tissue release and the type of femoral component was also investigated. A significant correlation existed between preoperative flexion, intraoperative flexion, and maximum flexion 1 year postoperatively. Patients who had a preoperative range of flexion less than the mean range of flexion for the overall group gained flexion, whereas patients with a preoperative range of flexion greater than the mean range of flexion lost flexion. The degree of soft tissue release performed and the type of implant used had no influence on maximum flexion at 1 year. The principal predictive factor of postoperative range of flexion, regardless of the degree of soft tissue release or implant design, is the preoperative and intraoperative range of flexion |
0 | Health-related quality of life of patients with hip fracture before and after rehabilitation therapy: discrepancies between physicians' findings and patients' ratings | Management of Hip Fractures in the Elderly | BACKGROUND AND AIMS: Health-related quality of life (HrQoL) is broadly accepted as an evaluation criterion of medical therapy effects. The major objectives of this work are a) measuring of the effects of rehabilitation therapy on the HrQoL of elderly patients after hip fracture, and b) study of discrepancies between the physician's findings on one hand and subjective ratings of patients on the other, and their influence on HrQoL, depression, and independence in activities of daily living. METHODS: The study sample consisted of 95 patients surgically treated after a fall-induced hip fracture (mean age=82 years; range=61-97). Using the median as splitting criterion, ratings of patients and physicians concerning disturbance-specific functional capacity were subdivided into positive and negative. This led to separation of the sample into four subgroups: the fortunate (congruent positive ratings), satisfaction paradox (positive subjective, negative objective ratings), dissatisfaction dilemma (negative subjective, objective positive ratings), and the unfortunate (congruent negative ratings). RESULTS: The four patient subgroups diverged in their estimations. The subgroups of the fortunate and satisfaction paradox have had the highest subjective gains in HrQoL. The subgroups of dissatisfaction dilemma and the unfortunate estimated their gains as similarly low on most of the tested scales. CONCLUSIONS: Results stress the importance of subjective factors in processes concerning therapy evaluations and their influence on HrQoL. The objective success of therapy is not of primary importance for the extent of the HrQoL, but subjective evaluation of it is |
0 | Optimizing Pain and Rehabilitation After Knee Arthroplasty | AAHKS (8) Anesthetic Infiltration | This will be a prospective, randomized, double blind study. Patients will be randomized using a computerâ?generated sequence to one of three groups: Group 1: Continuous femoral nerve block group (cFNB) Group 2: Single injection femoral nerve block group (sFNB) Group 3: Local infiltration analgesia group (LIA) Inclusion criteria: Patients between the ages of 18 and 85 having primary triâ?compartmental total knee arthroplasty. Exclusion criteria: Allergy, intolerance, or contraindication to any study medication (see below), inability to walk independently prior to TKA, inability to comprehend French or English, use of major tranquilizers, ASA 4 or 5, BMI > 40, opioid tolerance (opioid consumption > 30mg oral morphine or equivalent per day), pregnancy |
1 | The kinematic total knee arthroplasty. A 10- to 15-year follow-up and survival analysis | Surgical Management of Osteoarthritis of the Knee CPG | In 86 patients 102 consecutive cemented Kinematic total knee arthroplasties were reviewed 10-15 years after surgery to determine the clinical and radiographic results and to assess the survival rate. The average age of the 65 female and 21 male patients at the time of surgery was 63 years. Forty-six knees were affected by rheumatoid arthritis (RA), 46 by osteoarthritis (OA), 7 by haemophilic arthropathy and 3 by osteonecrosis. One patient (1 knee) was lost to follow-up, and 31 patients (38 knees) died. Eleven knees had been revised for deep infection (4), wear (4), malposition (2) or persistent pain (1). Fifty-two knees were examined at an average follow-up period of 12 years. The mean Knee Society Score of 89 points was the same for RA and AO knees. Also, 92% of the knees caused no pain or only occasional mild pain. There were no cases of aseptic loosening of any component. Progressive radiolucent lines were not seen on the follow-up radiographs (43 knees, mean follow-up 12 years) The 10- and 14-year survival rates with revision as the end-point were 90% (confidence interval, CI: 81%-95%) and 82% (CI: 67%-92%), respectively. In the worst case scenario, with knees lost to follow-up and knees with moderate pain considered as failures, the 10- and 14-year survival rates were 80% (CI: 69%-88%) and 62% (CI: 46%-77%), respectively. The Kinematic total knee arthroplasty yields equally good long-term results in patients with RA and those with OA. Deep infection and wear were the main reasons for revision |
0 | Parenting practices as potential mechanisms for child adjustment following mass trauma | DoD PRF (Psychosocial RF) | Trauma research has identified a link between parental adjustment and children's functioning and the sometimes ensuing intergenerational impact of traumatic events. The effects of traumatic events on children have been demonstrated to be mediated through their impact on children's parents. However, until now, little consideration has been given to the separate and more proximal mechanism of parenting practices as potential mediators between children's adjustment and traumatic events. To shed some light in this arena, we review literature on trauma, adversity, and resilience, and discuss how parenting practices may mediate trauma and adverse environmental contexts. Using a social interaction learning perspective (Forgatch & Knutson, 2002; Patterson, 2005), we propose a prevention research framework to examine the role that parenting practices may play in influencing children's adjustment in the wake of trauma exposure. The article concludes by providing a specific model and role for evidence-based parenting interventions for children exposed to mass trauma. [References: 108] |
0 | Self-Complementary Adeno-Associated Virus-Mediated Interleukin-1 Receptor Antagonist Gene Delivery for the Treatment of Osteoarthritis: Test of Efficacy in an Equine Model | OAK 3 - Non-arthroplasty tx of OAK | The authors are investigating self-complementary adeno-associated virus (scAAV) as a vector for intra-articular gene-delivery of interleukin-1 receptor antagonist (IL-1Ra), and its therapeutic capacity in the treatment of osteoarthritis (OA). To model gene transfer on a scale proportional to the human knee, a frequent site of OA incidence, studies were focused on the joints of the equine forelimb. Using AAV2.5 capsid and equine IL-1Ra as a homologous transgene, a functional ceiling dose of ~5 x 10<sup>12</sup> viral genomes was previously identified, which elevated the steady state levels of eqIL-1Ra in synovial fluids by >40-fold over endogenous production for at least 6 months. Here, using an osteochondral fragmentation model of early OA, the functional capacity of scAAV.IL-1Ra gene-delivery was examined in equine joints over a period of 12 weeks. In the disease model, transgenic eqIL-1Ra expression was several fold higher than seen previously in healthy joints, and correlated directly with the severity of joint pathology at the time of treatment. Despite wide variation in expression, the steady-state eqIL-1Ra in synovial fluids exceeded that of IL-1 by >400-fold in all animals, and a consistent treatment effect was observed. This included a 30-40% reduction in lameness and ~25% improvement in total joint pathology by both magnetic resonance imaging and arthroscopic assessments, which included reduced joint effusion and synovitis, and improved repair of the osteochondral lesion. No vector-related increase in eqIL-1Ra levels in blood or urine was noted. Cumulatively, these studies in the equine model indicate scAAV.IL-1Ra administration is reasonably safe and capable of sustained therapeutic IL-1Ra production intra-articularly in joints of human scale. This profile supports consideration for human testing in OA. |
0 | Effects of epidural anesthesia on incidence of venous thromboembolism following joint replacement | Surgical Management of Osteoarthritis of the Knee CPG | Deep vein thrombosis (DVT) and pulmonary embolism are serious complications following hip and knee replacement surgery. Both surgical procedures have significantly high postoperative rates of DVT. In total hip replacement, the rate of proximal thrombi tends to be higher. However, total knee replacement produces a high rate of calf thrombi and a higher overall rate of thrombosis. In a search for innovative ways to reduce the risk of thrombosis, three types of anesthesia were examined: general anesthesia, epidural anesthesia, and hypotensive epidural anesthesia in which a controlled hypotension is provided. The hypotension commonly exists with epidural anesthesia also, unless blood pressure is maintained with an agent such as ephedrine. When blood pressure is allowed to drop in a controlled fashion, hypotensive anesthesia is effected |
0 | Management of osteoarthritis of the wrist and hand | Distal Radius Fractures | Osteoarthritis of the wrist and hand can cause significant functional impairment and disability. Its management is as much an art as it is science, as one has to consider increasing patient expectations, functional demands, pain relief and preserving motion. A sound knowledge of the wrist and hand anatomy, biomechanics, appreciation of the specific location and grade of wrist and hand joints arthritis and various treatment options and their pros and cons is important to successfully manage patients with this condition. Wrist osteoarthritis can be idiopathic, however more commonly it is secondary to distal radius and/or carpal fractures and ligamentous injuries. A small proportion still can occur due to avascular necrosis of carpus or congenital and developmental causes. Osteoarthritis of the hand is often idiopathic with a high familial tendency, especially in younger patients but can be secondary to other causes such as trauma, gout and ligamentous laxity. Once the non-surgical management options such as analgesia, activity modifications, steroid injections and splints have been exhausted, then there are various surgical options available for wrist and hand osteoarthritis. These are tailored to the exact location of arthritis and patient factors. For the wrist, these include anterior and posterior interosseous nerve neurectomy, arthroscopic debridement, selective bony excisions, wrist arthroplasty and focal or total fusion. Whilst for finger osteoarthritis, surgical options include arthroplasty and arthrodesis. This article aims to describe the pathology of wrist and hand arthritis and various treatment options available. |
0 | Short-day-like body weight changes do not prevent fat pad compensation after lipectomy in Siberian hamsters | Panniculectomy & Abdominoplasty CPG | Long-day (LD)-housed Siberian hamsters show compensatory increases in white adipose tissue (WAT) weight after lipectomy, whereas hamsters exposed to short days (SDs) for a long duration (22 wk) do not. We tested whether SD-induced body weight changes prevent fat pad compensation after lipectomy. In experiment 1, hamsters with lesions of the paraventricular nucleus of the hypothalamus (PVNx) rapidly increased body weight similarly to 22-wk SD-exposed hamsters. In experiment 2, LD-housed hamsters were food restricted for 22 wk and then pair fed with SD-housed hamsters for 12 wk to produce body weight changes mimicking those of ad libitum-fed SD-exposed animals. Epididymal WAT (EWAT) lipectomy (EWATx) of PVNx or food-restricted hamsters elicited compensatory increases in retroperitoneal and inguinal WAT (RWAT and IWAT) weights. Unlike other fat pads, EWAT was less affected by food restriction or PVNx than by SD exposure. In general, food restriction decreased adipocyte number, whereas SD exposure decreased adipocyte size. PVNx increased RWAT adipocyte size and IWAT adipocyte number. These results suggest that the lack of body fat compensation by EWATx hamsters exposed to SDs for a long duration is due to SD-associated responses other than body weight changes per se. |
1 | Patient-reported Outcomes after ADM-assisted Implant-based Breast Reconstruction: A Cross-sectional Study | Acellular Dermal Matrix | BACKGROUND: Although the use of acellular dermal matrices (ADMs) in implant-based reconstruction increases, there is a lack of studies evaluating patient-reported outcome measures after this reconstruction method. We aim to evaluate the patient satisfaction after ADM-assisted implant-based breast reconstruction (IBBR) in 1 of the largest series of patients undergoing ADM-assisted IBBR. METHODS: Patients with ADM-assisted IBBR were invited to fill out the BREAST-Q, a validated and standardized questionnaire to measure patient satisfaction after a breast reconstruction. A retrospective chart review was performed to identify patient and surgical characteristics. RESULTS: In total, 208 patients (38.4%) responded and reported a mean satisfaction of 70.6?±?20.2 with their breasts and 78.0?±?20.5 with the outcome. An overall complication rate of 7.7% was noted, with 1.5% severe complications leading to hospital readmission (0.5%) and implant removal (0.5%). Patients with complications and unilateral reconstruction for oncological reasons reported overall less satisfaction rates compared with patients with bilateral, preventive surgery, and an uncomplicated postoperative course. Strongly related domains indicate the importance of patient satisfaction with their breasts and outcome on psychosocial and sexual functioning and satisfaction with information on satisfaction with breasts, outcome, and surgeon. CONCLUSION: There is an increased demand for patient-reported outcome measures in a changing practice to which the opinion of the patient assumes a larger role. With high satisfaction rates, ADM-assisted IBBR is a valuable reconstruction method, provided that complication rates remain low. Hence, it should only be performed in a selected group of women. |
0 | Correlation of insulin-like growth factor 1 and osteoarthritic cartilage degradation: a spontaneous osteoarthritis in guinea-pig | OAK 3 - Non-arthroplasty tx of OAK | OBJECTIVE: The pathogenesis of osteoarthritis centers on the imbalance between catabolic and anabolic processes in cartilage metabolism. Insulin growth factor 1 (IGF-1) has been shown to have anabolic effects in cartilage in vitro. This study aim to determine whether IGF-1 on cartilage is associated with loss of chondrocyte and extracellular matrix breakdown using the Hartley guinea pig model. MATERIALS AND METHODS: Cartilage from the medial and lateral tibial plateau of 6-month and 12-month old Hartley guinea pigs were used for this study. Histological analysis was performed with hematoxylin-eosin (HE) and toluidine blue staining. Safranin-O staining was used to quantify proteoglycan (PG) loss and the extent of cartilage damage by Modified Mankin score. Distribution of IGF-1 was demonstrated with in situ hybridization techniques. IGF-1 mRNA levels were assessed using Real-time PCR. RESULTS: Histological loss of chondrocytes, and cartilage matrix and decreased IGF-1 distribution were demonstrated in a temporal and spatial manner. Compared to the 6-month old samples, the 12-month specimens had significantly cartilage degeneration and less cartilage matrix and PGs staining. Decreased level of IGF-1 was also observed in the 12-month samples. These observations were more pronounced in the medial tibial plateau when compared to the lateral plateau. CONCLUSIONS: The decreased level of IGF-1 may play a critical role for maintaining the balance between catabolic and anabolic processes in cartilage metabolism during the development of osteoarthritis. Thus, the increase of IGF-1 may be applicable to developing OA therapy. |
0 | The "Trauma Signature:" understanding the psychological consequences of the 2010 Haiti earthquake | DoD PRF (Psychosocial RF) | The 2010 Haiti earthquake was one of the most catastrophic episodes in history, leaving 5% of the nation's population killed or injured, and 19% internally displaced. The distinctive combination of earthquake hazards and vulnerabilities, extreme loss of life, and paralyzing damage to infrastructure, predicts population-wide psychological distress, debilitating psychopathology, and pervasive traumatic grief. However, mental health was not referenced in the national recovery plan. The limited MHPSS services provided in the first eight months generally lacked coordination and empirical basis.There is a need to customize and coordinate disaster mental health assessments, interventions, and prevention efforts around the novel stressors and consequences of each traumatic event. An analysis of the key features of the 2010 Haiti earthquake was conducted, defining its "Trauma Signature" based on a synthesis of early disaster situation reports to identify the unique assortment of risk factors for post-disaster mental health consequences. This assessment suggests that multiple psychological risk factors were prominent features of the earthquake in Haiti. For rapid-onset disasters, Trauma Signature (TSIG) analysis can be performed during the post-impact/pre-deployment phase to target the MHPSS response in a manner that is evidence-based and tailored to the event-specific exposures and experiences of disaster survivors. Formalization of tools to perform TSIG analysis is needed to enhance the timeliness and accuracy of these assessments and to extend this approach to human-generated disasters and humanitarian crises. |
0 | Laser Therapy on Pain Intensity of patients with advanced knee Osteoarthritis | OAK 3 - Non-arthroplasty tx of OAK | INTERVENTION: Device E02.774 Sixty participants of both genders diagnosed with grade 4 of knee osteoarthritis according to radiological features will be selected to participate in the study. They will be randomly distributed into two groups: Placebo group and Photobiomodulation Group. Treatment will consist on a three times a week application of AsGaAl laser (830 nm, 100 mW, 4J per point, 80J per knee) during four weeks along with exercises to enhance the participantsâ?? balance. To analyse the effect of photobiomodulation on this health condition, Knee injury and Osteoarthritis Outcome Score (KOOS), World Health Organization Quality of Lifeâ?BREF (WHOQOLâ?bref), Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), and also quantitative sensory testing such as pressure pain threshold using an algometer and temporal summation with a 300g Von Frey filament and a Numeric Rating Scale (NRSâ?11) will be performed at baseline, sixth and twelfth session. At eighth and twelfth week after the start of treatment, all the analysis will be performed to understand the continuity of results. CONDITION: C05.550.114.606.500 Knee Osteoarthritis; Gonarthrosis [arthrosis of knee] ; C05.550.114.606.500 ; M17 M00â?M99 PRIMARY OUTCOME: Diminish of pain using numerical rating scale in activities with 40% variations between pre and post treatment. SECONDARY OUTCOME: Improvement of KOOS questionnaire (kneeâ?related quality of life, activities of daily living, sport and recreation function, symptoms, and pain) of 10 points after intervention. INCLUSION CRITERIA: Age between 55â?85 years old; diagnosed with knee osteoarthritis (unilateral or bilateral) for at least 2 years; have pain in at least 3 of the following actions: go up and down at stairs, kneeling, sit and stand up, running, and standing up for at least 2 minutes; more than 4 points (moderate) at numeric rating scale; and have grade 4 at Kellgrenâ?Lawrence grading system. |
0 | Paraphilic Thoughts, Behaviors and Sex Addiction in a Sample of Persons Who Use Drugs: A Cross-Sectional Study | DoD PRF (Psychosocial RF) | OBJECTIVE: The aim of this study was to evaluate the prevalence of paraphilic thoughts/behaviors (including paraphilic disorders) with and without sexual addiction and sexual-related conditions in a sample of substance disorder patients.
METHODS: This was a cross-sectional study of substance-dependent individuals who sought outpatient treatment in Sao Paulo, Brazil. Data included sociodemographic information, drug of choice, responses to questions about sexual behavior, and to the following standardized questionnaires: (a) Sexual Addiction Screening Test, and (b) Childhood Trauma Questionnaire.
RESULTS: The sample comprised 134 persons who use drug, predominantly men (76.1%), 39.6% were aged between 18 and 29 years, and 54.9% were single. Most were persons who use polydrug, 73.9% were alcohol and cocaine users, 63.4% marijuana users, 81.1% tobacco users, and 5.2% steroid users. Prevalence of paraphilic thoughts/behaviors (including paraphilic disorders) with and without sexual addiction was 47%. The HPV/herpes and hepatitis B rates were 7.9% (P = 0.021) and 6.3% (P = 0.046) respectively. Paraphilic and nonparaphilic thoughts/behaviors were associated to the presence of childhood physical neglect (odds ratios [OR] = 4.7, 95% confidence interval [CI] 1.0 to 21.9), low educational level (OR = 7.2, 95% CI 1.4 to 36), heterosexuality (OR = 3.8, 95% CI 1.1 to 12.8) and youth (age 18 to 20 years) (OR = 5.6, 95% CI 1.4 to 11.8).
CONCLUSIONS: The high prevalence of paraphilic thoughts/behaviors with or without sex addiction in persons who use drugs may be related to the experience of physical and emotional neglect during childhood and this possibility should routinely be investigated in clinical practice. |
0 | The role of bone-seeking radionuclides in the palliative treatment of patients with painful osteoblastic skeletal metastases | MSTS 2018 - Femur Mets and MM | Background: Pain from skeletal metastases represents a major burden of advanced disease from solid tumors. Analgesic medications, bisphosphonates, hormonal agents, cytotoxic chemotherapy, and external beam radiotherapy are all effective treatments. However, patients often suffer from diffuse painful metastases and respond poorly to these standard therapies. Bone-seeking radionuclides can specifically target osteoblastic lesions to offer palliation of pain. Methods: This article offers a narrative review of bone-seeking radionuclides, examines the evidence of safety and efficacy for the treatment of painful skeletal metastases, and presents guidelines for their appropriate use in this patient population. Results: Seven bone-seeking radionuclides have shown evidence of both safety and efficacy in reducing pain from diffuse skeletal metastases. 153Sm-EDTMP and 89Sr are most commonly used in the United States and have been safely utilized for both repeat dosing as well as concurrent dosing with cytotoxic chemotherapy. Conclusions: Targeted bone-seeking radionuclides are underutilized in the treatment of painful diffuse osteoblastic metastases. Several new agents are in active clinical investigation, and the pending approval of the first alpha-emitting radionuclide (223Ra) may offer a new class of agents that provide greater efficacy and less toxicity than those currently available for routine clinical use. |
0 | Study protocol--resilience in individuals and families coping with the impacts of alcohol related injuries in remote indigenous communities: a mixed method study | DoD PRF (Psychosocial RF) | BACKGROUND: Alcohol Management Plans (AMPs) were first implemented by the Queensland Government a decade ago (2002-03). In 2008, further stringent controls were implemented and alcohol was effectively prohibited in some of the affected remote Indigenous communities. With the Queensland Government currently reviewing AMPs, prohibitions may be lifted making alcohol readily available once more in these communities. As yet no work explores the impact of alcohol related injuries in relation to individual, family and community resilience in Indigenous Australians. A resilience model recognises individuals and families for their strengths rather than their deficits. By revealing how some individuals and families survive and thrive, new ways of working with families who need support may be identified and adopted. The research will explore in detail the long-term impact of this kind of injury on individuals, families and communities.
METHODS/DESIGN: This project will use a sequential explanatory mixed method design. Four discrete Indigenous communities in Cape York, far north Queensland are included in this program of research, chosen because there is previous data available regarding injury and alcohol related injuries. Four sequential studies will be conducted in order to address the research questions and provide a rich description of the impact of alcohol related injuries and resilience in these populations. The time period January 2006 to December 2011 was chosen because it captures the three years before and three years after 2008 when tight alcohol restrictions were implemented in the four communities.
DISCUSSION: Long term effects of the AMPs are as yet unknown and only fragmented attempts to look at the impact of injury related to alcohol have been conducted. A well-structured research program that explores the long-term impact of alcohol related injuries in these communities will help inform policy development to capture the current situation and so that appropriate benchmarking can occur.The project has been approved by the James Cook University Human Research Ethics Committee H5618 & H5241. |
1 | Tibial plateau fracture with compartment syndrome: a complication of higher incidence in Taiwan | DOD - Acute Comp Syndrome CPG | BACKGROUND: Compartment syndrome after tibial plateau fracture has been described, solely as case reports in previously published articles, as a relatively rare complication.
METHODS: A retrospective review of 106 patients with 107 tibial plateau fractures was undertaken from January 1996 to June 1997 at a level I trauma center, and the incidence of compartment syndrome was 10.3%. The diagnosis was based on characteristic clinical symptoms and signs of acute compartment syndrome and/or by measurement of intracompartment pressures. The treatment included fasciotomy of the 4 compartments.
RESULTS: There was a high correlation between the incidence of compartment syndrome and the fracture pattern as well as the mechanism of trauma. Higher-energy traumas (Schatzker's type IV, V, and VI) were associated with a higher incidence of compartment syndrome (30.4% in type VI).
CONCLUSION: The incidence of compartment syndrome after tibial plateau fracture is more common than what has been reported in the literature, especially after high-energy trauma. |
0 | Arthroscopic Subscapularis Augmentation of Bankart Repair in Chronic Anterior Shoulder Instability With Bone Loss Less Than 25% and Capsular Deficiency: Clinical Multicenter Study | Glenohumeral Joint OA | PURPOSE: To assess the short-term outcomes of the arthroscopic subscapularis augmentation (ASA) technique, consisting of a tenodesis of the upper third of the subscapularis tendon and a Bankart repair, and its effect on shoulder external rotation.
METHODS: Patients selected for this study were involved in contact sports, with a history of traumatic recurrent shoulder dislocations and a minimum of 2-year follow-up. Inclusion criteria were patients with glenoid bone loss (GBL) ranging from 5% to 25%, anterior capsular deficiency, and Hill-Sachs lesion who underwent ASA technique. Exclusion criteria were GBL >25%, multidirectional instability, preexisting osteoarthritis, and overhead sports activities. Visual analog scale (VAS) scale for pain, Rowe score, and American Shoulder and Elbow Surgeons (ASES) scores were used to assess results. Loss of shoulder external rotation was measured with the arm at the side (ER1 position) or 90degree in abduction (ER2 position). Analysis of variance and Fisher tests were used for data evaluation. Significance was established at P <= .05.
RESULTS: One hundred ten patients (84 men and 26 women, mean age 27 years) were evaluated with a mean follow-up of 40.5 months (range: 24 to 65 months). In 98 patients, a Hill-Sachs lesion was observed and in 57 patients a capsular deficiency was present. Three patients (2.7%) had a traumatic redislocation. At final follow-up, the mean scores were as follows: VAS scale decreased from a mean of 3.5 to 0.5 (P = .015), Rowe score increased from 57.4 to 95.3 (P = .035), and ASES score increased from 66.5 to 96.5 (P = .021). The mean deficit of external rotation was 8degree +/- 2.5degree in the ER1 position and 4degree +/- 1.5degree in the ER2 position.
CONCLUSIONS: The ASA procedure has been shown to be effective in restoring joint stability in patients practicing sports, affected by chronic anterior shoulder instability associated with anterior GBL (<25%), capsular deficiency, and Hill-Sachs lesions, with mild restriction of external rotation.
LEVEL OF EVIDENCE: Level IV, therapeutic case series. |
0 | Three-dimensional reconstruction of subject-specific knee joint using computed tomography and magnetic resonance imaging image data fusions | AMP (Acute Meniscal Pathology) | Three-dimensional reconstruction of human body from a living subject can be considered as the first step toward promoting virtual human project as a tool in clinical applications. This study proposes a detailed protocol for building subject-specific three-dimensional model of knee joint from a living subject. The computed tomography and magnetic resonance imaging image data of knee joint were used to reconstruct knee structures, including bones, skin, muscles, cartilages, menisci, and ligaments. They were fused to assemble the complete three-dimensional knee joint. The procedure was repeated three times with respect to three different methods of reference landmarks. The accuracy of image fusion in accordance with different landmarks was evaluated and compared with each other. The complete three-dimensional knee joint, which included 21 knee structures, was accurately developed. The choice of external or anatomical landmarks was not crucial to improve image fusion accuracy for three-dimensional reconstruction. Further work needs to be done to explore the value of the reconstructed three-dimensional knee joint for its biomechanics and kinematics. |
0 | Standard plan for nutrition treatment in hip fracture patients: Room for improvement | Management of Hip Fractures in the Elderly | Rationale: Patients with hip fracture are most commonly frail elderly people. Fasting regimes, pain, medication and immobilisation increase nutritional risk. The aim of this study was to introduce a standard plan to improve nutrition intake. Methods: A standard plan was made including better logistics, peroral maltodextrin on days with fasting and peripheral parenteral nutrition (800 kcal/38 gr. protein). A two-week recording of food intake of all patients with fracture of the femoral neck, was made before and after introduction. Setting: 30 beds for acute and elective lower limb orthopaedic surgery. Statistics: Students T-test and Chi-squared test. Results: Nutrition registrations were made in 37 patients, 11 M, 25 F (185 registration days) pre-measurement group (pre-g), and 33 patients, 8 M, 25 F (144 reg. days) post measurement group (post-g). Mean energy-intake (e): 1116 kcal (SD 334.7) and mean protein-intake (p): 36 g (SD 1.8) pre-g, while the post-g had a mean e-intake of 1190 kcal (SD 465.9) and 42 g p (SD 19.9). The post-g showed a tendency to increased intake compared to the pre-g (ns). Nutrition intake in both groups was low compared to requirements (p < 0.001). In the pre-g, e-intake covered 61% (SD 19.5) of requirements, vs. 67% (SD 29.6) post-g, and p-requirements in 44% (SD 14.1) before vs. 53% (SD 25.2) after. Individually, 38% had less than 50% of e-requirements before vs. 27% after the intervention. No significant difference was seen regarding LOS or six months survival. Maltodextrin and parenteral nutrition was to a higher degree used, however randomly, compared to the strict standard. Conclusion: Implementation of a standard plan including maltodextrin and parenteral nutrition in hip fracture patients failed to increase intake significantly. Focus on the implementation procedure is mandatory |
0 | 7-Tesla MRI Evaluation of the Knee, 25 Years after Cartilage Repair Surgery: The Influence of Intralesional Osteophytes on Biochemical Quality of Cartilage | AMP (Acute Meniscal Pathology) | Objective: To evaluate the morphological and biochemical quality of cartilage transplants and surrounding articular cartilage of patients 25 years after perichondrium transplantation (PT) and autologous chondrocyte transplantation (ACT) as measured by ultra-high-field 7-Tesla (7T) magnetic resonance imaging (MRI) and to present these findings next to clinical outcome. Design: Seven PT patients and 5 ACT patients who underwent surgery on the femoral condyle between 1986 and 1996 were included. Patient-reported outcome measures (PROMs) were assessed by the clinical questionnaires: Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC), and Visual Analogue Scale (VAS) for knee pain. The morphological (MOCART score) and biochemical quality (glycosaminoglycans [GAGs] content and collagen integrity) of cartilage transplants and surrounding articular cartilage were analyzed by 7T MRI. The results of the PT and ACT patients were compared. Finally, a detailed morphological analysis of the grafts alone was performed. Results: No statistically significant difference was found for the PROMs and MOCART scores of PT and ACT patients. Evaluation of the graft alone showed poor repair tissue quality and high prevalence of intralesional osteophyte formation in both the PT and ACT patients. Penetration of the graft surface by the intralesional osteophyte was related to biochemically damaged opposing tibial cartilage; GAG content was significantly lower in patients with an osteophyte penetrating the graft surface. Conclusions: Both PT and ACT patients have a high incidence of intralesional osteophyte formation 25 years after surgery. The resulting biochemical damage to the opposing tibial cartilage might be dependent on osteophyte morphology. |
0 | Stress fracture of the fifth metatarsal bone as a late complication of total knee arthroplasty | PJI DX Updated Search | A 64-year-old man had undergone a right total knee arthroplasty (TKA) as treatment for osteoarthritis of the knee. Six months after the TKA, the patient sustained a stress fracture of the left fifth metatarsal bone, which was a contralateral side of the TKA, without any apparent trauma or cause. The fracture was treated with internal fixation using a screw and low-intensity pulsed ultrasound treatment was added. During two-year followup after internal fixation of the fifth metatarsal fracture, he had no complaints in the knee or foot. The patient felt anxiety of breakage or loosening of the implant of TKA and the patient had been walking bearing mainly on his left leg and foot which was a contralateral side of the TKA. The cause of the stress fracture of the fifth metatarsal bone was speculated to be excessive stress of weight bearing to the left foot during walking. The physicians should be aware of the risk of stress fracture of the fifth metatarsal bone as one of a rare late complication associated with TKA. It is very important to educate the patients, explaining the risk of breakage or loosening of the implant of TKA and instructing the adequate physical and mental benefits of walking |
1 | Primary total hip arthroplasty with an uncemented femoral component: two- to seven-year results | Management of Hip Fractures in the Elderly | This prospective study reports the midterm outcome of total hip arthroplasty performed in a consecutive series of patients using a tapered uncemented femoral component. The cohort consists of 631 patients (700 hips). The clinical records and the routine serial radiographs of these patients were monitored closely over a 5-year period. Follow-up averaged 4.35 years. There was a significant improvement in functional outcome of these patients as measured by Harris hip score and short-form 36.There were 4 revisions for aseptic loosening of the femoral component in this series, accounting for an overall survivorship of 99.4%. The study confirms that the midterm outcome of this stem is excellent, with a low revision rate |
0 | Synovial and systemic pharmacokinetics (PK) of triamcinolone acetonide (TA) following intra-articular (IA) injection of an extended-release microsphere-based formulation (FX006) or standard crystalline suspension in patients with knee osteoarthritis (OA) | OAK 3 - Non-arthroplasty tx of OAK | OBJECTIVE: Intra-articular (IA) corticosteroids relieve osteoarthritis (OA) pain, but rapid absorption into systemic circulation may limit efficacy and produce untoward effects. We compared the pharmacokinetics (PK) of IA triamcinolone acetonide (TA) delivered as an extended-release, microsphere-based formulation (FX006) vs a crystalline suspension (TAcs) in knee OA patients.
METHOD: This Phase 2 open-label study sequentially enrolled 81 patients who received a single IA injection of FX006 (5 mL, 32 mg delivered dose, N = 63) or TAcs (1 mL, 40 mg, N = 18). Synovial fluid (SF) aspiration was attempted in each patient at baseline and one post-IA-injection visit (FX006: Week 1, Week 6, Week 12, Week 16 or Week 20; TAcs: Week 6). Blood was collected at baseline and multiple post-injection times. TA concentrations (validated LC-MS/MS, geometric means (GMs)), PK (non-compartmental analysis models), and adverse events (AEs) were assessed.
RESULTS: SF TA concentrations following FX006 were quantifiable through Week 12 (pg/mL: 231,328.9 at Week 1; 3590.0 at Week 6; 290.6 at Week 12); post-TAcs, only two of eight patients had quantifiable SF TA at Week 6 (7.7 pg/mL). Following FX006, plasma TA gradually increased to peak (836.4 pg/mL) over 24 h and slowly declined to <110 pg/mL over Weeks 12-20; following TAcs, plasma TA peaked at 4 h (9628.8 pg/mL), decreased to 4991.1 pg/mL at 24 h, and was 149.4 pg/mL at Week 6, the last post-treatment time point assessed. AEs were similar between groups.
CONCLUSION: In knee OA patients, microsphere-based TA delivery via a single IA injection prolonged SF joint residency, diminished peak plasma levels, and thus reduced systemic TA exposure relative to TAcs. |
0 | Comminuted intra-articular fracture of the distal radius--results of early open reduction and internal fixation | Distal Radius Fractures | Comminuted intra-articular fracture of the distal radius remains a challenging problem. This article reviews the results of 15 consecutive cases which were treated with open reduction and internal fixation with T-plate after failing to achieve articular congruency with closed reduction. The follow-up ranges from 20 months to 28 months. In thirteen cases, articular congruency was restored. However, 4 of these 13 cases later lost some of the articular congruency. This suggests the need for supplementary bone grafting. Reduction of the extra-articular portion of distal radius was generally well maintained. There was an average of 2.4 mm loss in styloid height, an increase of 1.2 mm in ulnar variance and loss of 12.5 degrees of volar tilt. Seven patients (46%) were completely pain-free, with the remaining 8 patients (53%) experiencing mild pain associated with forceful activities involving the wrist. All patients achieved a functional range of motion. Grip strength averaged 81% of the uninjured side. Of the 12 patients who were engaged in active employment, 10 returned to their previous job within 4 months of injury (average 8.5 weeks). The only complication in this series was the development of reflex sympathetic dystrophy in a 68-year-old housewife. We recommend open reduction and internal fixation if closed reduction fails to achieve articular congruency in comminuted distal radius fractures. |
0 | Obese patients undergoing total knee arthroplasty have distinct preoperative characteristics: an institutional study of 4718 patients | Surgical Management of Osteoarthritis of the Knee CPG | Obesity affects a disproportionate proportion of total knee arthroplasty (TKA) patients. Our study explores pre-operative characteristics between obese and non-obese patients undergoing TKA surgery. A cohort of 4718 osteoarthritic patients, undergoing primary TKA, was studied. Patients were stratified according to BMI classes. Each class was compared in terms of age, race, gender, level of education, insurance status, pre-operative WOMAC, SF-36, and Elixhauser comorbidities. There was a positive relationship between BMI and female gender, non-white race, Medicaid, private insurance, and self-pay. A negative relationship was observed between BMI and age, Medicare, WOMAC and SF-36. Obese TKA candidates differ from their non-obese counterparts in a number of demographic, socioeconomic, and clinical characteristics |
1 | Acute traumatic hemarthrosis of the knee. Is routine arthroscopic examination necessary? A study of 320 consecutive patients | Anterior Cruciate Ligament Injuries CPG | BACKGROUND AND AIMS: Distortions and contusions of the knee are common. Fairly often they will result in hemarthrosis. The purpose of this study was to evaluate the findings in patients with acute traumatic hemarthrosis of the knee and based on these findings estimate the necessity of acute arthroscopic examination. MATERIAL AND METHODS: A total of 320 patients were examined arthroscopically between the years 1994 to 96 in the Turku University Hospital. Patients with other than chondral or osteochondral fractures were excluded. RESULTS: The most common arthroscopic findings were rupture of the ACL (45%), dislocation of the patella (23%) and meniscal tear (21%). In only 113 (35%) cases an immediate therapeutic procedure was performed in addition to the arthroscopic examination. CONCLUSIONS: Based on our findings we believe that routine arthroscopic examination is not necessary in patients with acute traumatic hemarthrosis of the knee. In our opinion the patient should be examined and followed by an orthopedic surgeon and if a lesion requiring operative treatment is diagnosed or suspected, an arthroscopic examination should be scheduled. The timing of the procedure should be such that all possible lesions encountered can be treated in the same operation |
0 | Cartilage Surgery in Overweight Patients: Clinical and MRI Results after the Autologous Matrix-Induced Chondrogenesis Procedure | AMP (Acute Meniscal Pathology) | Modern orthopaedic surgery provides a variety of techniques for cartilage repair. The Autologous Matrix-Induced Chondrogenesis (AMIC) procedure is a single-step technique with a collagen I/III scaffold for the treatment of full-thickness cartilage lesions. The aim of the study was to analyze the outcome of the AMIC procedure in overweight patients with knee cartilage defects. Overweight patients treated with AMIC surgery were followed up by clinical and MRI examination. 9 patients with a cartilage defect of the knee with a mean lesion size of 2.1±1.2 cm2 and an average body mass index (BMI) of 29.3 were available for the follow-up. The Lysholm Score was significantly improved by the AMIC procedure (38 to 67, p=0.008). The VAS Score was significantly lower after the procedure (9 to 3, p=0.018). In the postoperative MOCART Scale, the scaffold reached defect covering of 80%. However, 2 patients had to be revised due to persisting knee pain. The AMIC procedure enhances pain reduction and gain of knee function for cartilage defects of overweight patients. However, in cases of an increased BMI, the patient had to be informed that success rate is reduced despite good defect covering. |
1 | Half-body single photon emission computed tomography with resolution recovery for the evaluation of metastatic bone disease: Implementation into routine clinical service | MSTS 2018 - Femur Mets and MM | Objectives Typically, scintigraphic evaluation of metastatic bone disease uses planar imaging. Although single photon emission computed tomography (SPECT) offers increased clinical utility, the acquisition time necessary to cover the required scan range (at our centre, skull vertex to mid-femur) has made its use in place of planar imaging impracticable. Recently, reconstruction with resolution recovery (RR) has allowed SPECT acquisition times to be shortened while maintaining acceptable image quality. This study was carried out to establish whether half-body SPECT with RR could replace planar scintigraphy in routine practice. Methods A series of reduced acquisition time SPECT scans were reconstructed retrospectively and reviewed to establish optimal reconstruction parameters. Twenty patients referred for evaluation of bone metastases underwent planar imaging, followed by half-body SPECT, reconstructed using the optimized parameters. SPECT and planar images were reported by an experienced radiologist, who reviewed image quality and recorded the number of lesions observed, their location, clinical significance and reporter confidence. Results SPECT images of acceptable quality and covering the range from skull vertex to mid-femur were acquired in 33 min. Audit indicated that SPECT identified clinically significant lesions not reported from planar views and improved lesion localization and reporter confidence. Conclusion Reduced acquisition times together with RR allowed half-body SPECT for the evaluation of bone metastases to be accommodated within our department's schedule. Audit indicated that SPECT delivered the expected clinical advantages. Half-body SPECT has replaced planar imaging for the routine evaluation of metastatic bone disease at our centre, with â?¼2500 studies carried out to date. |
0 | Atypical bilateral pedicle fracture in long-term bisphosphonate therapy | Management of Hip Fractures in the Elderly | Study Design: A case report with review of the literature. Objective: To present a first case of an atraumatic bilateral pedicle fracture of L5 in a patient with long-term risedronate therapy and without any previous history of surgery or fracture. Summary of Background Data: A few cases of bilateral osteoporotic pedicle fractures have been reported. All were associated with previous or concomitant corporeal compression fractures. Atypical femoral fractures were recently described with long-term bisphosphonate treatment. To our knowledge, there are no previous reports of isolated bilateral pedicle fracture associated with prolonged bisphosphonate therapy. Methods: A 66-year-old woman treated with risedronate for 10 years and without any history of trauma presented with exacerbation of low back pain. No fracture was noted in her past medical history. Results: A complete workup showed an isolated bilateral recent fracture of the L5 pedicles without evident etiology. Consolidation was achieved after 3 months of bracing. Conclusion: We reported the first case of isolated bilateral pedicle fracture in a patient treated with risedronate for 10 years. This may be another atypical fracture in long-term bisphosphonate treatment. (copyright) 2011 Lippincott Williams & Wilkins |
1 | Non-operative treatment of ACL rupture with mild instability | Anterior Cruciate Ligament Injuries CPG | PURPOSE: This study examined whether or not conservative treatment of an acutely injured anterior cruciate ligament (ACL) could be successful in a select group of patients. Routine ACL reconstruction surgery in all acute ACL-injured patients should be avoided. We hypothesize that acutely injured ACL with mild instability at the initial physical examination could be improved even if there is disruption of ACL fibers on magnetic resonance images (MRI). MATERIALS AND METHODS: Among 232 acute ACL-injured patients who visited our institution from March 1997 to April 2006, 48 were treated non-operatively. Patients diagnosed with an acute ACL injury by MRI with Lachman test < or =grade 1 were treated non-operatively. In this study, 30 male and 18 female patients with a mean age of 31.8 years were enrolled. The initial and follow-up Lachman test and pivot shift test were performed 3 weeks after the injury. The Lysholm knee scoring scale, International Knee Documentation Committee (IKDC) score and KT-2000 were obtained at the last follow-up. RESULTS: There were 12 complete (25%) and 36 incomplete ACL ruptures (75%). The patients were followed up clinically and with MRI for 21.5 and 11.3 months, respectively. The follow-up Lachman test improved to grade 0 in 41 patients (87%). Thirty-six patients (76%) showed no laxity in the follow-up pivot shift test. The last follow-up IKDC score was a mean value of 91.1 points. KT 2000 was performed in 40 patients with a mean side-to-side difference of 2.85 mm. Of 48 patients, 46 showed restored ACL continuity and 39 (84%) showed restored low signal intensity on MRI. CONCLUSION: A selective group of ACL tears with mild instability (Lachman < or =grade 1), though these seem to be complete tears on MRI, can show restoration of their continuity and signals on the MRI. Joint laxity on physical examination was improved at follow-up. These results suggest that a select group of patients with an acute ACL injury can successfully undergo non-operative treatment. In addition, unnecessary early ACL reconstruction surgery should be avoided |
0 | Modification of vertical scar in vertical mammaplasty technique | Reduction Mammoplasty for Female Breast Hypertrophy | Vertical mammaplasty is a simple and safe procedure that relies on an upper pedicle to the areola with lower central breast reduction and glandular shaping. We applied this technique to six patients adding a modification of the vertical scar which distributed skin tension both to the areola and vertical suture line. It prevented an unacceptable puckering vertical scar and enlargement of areola. This modification also provided satisfactory breast shape with a good vertical scar especially at the early postoperative period. |
0 | Does the Addition of a Vascularized Fibula Improve the Results of a Massive Bone Allograft Alone for Intercalary Femur Reconstruction of Malignant Bone Tumors in Children? | Hip Fx in the Elderly 2019 | BACKGROUND: Massive bone allograft with or without a vascularized fibula is a potentially useful approach for femoral intercalary reconstruction after resection of bone sarcomas in children. However, inadequate data exist regarding whether it is preferable to use a massive bone allograft alone or a massive bone allograft combined with a vascularized free fibula for intercalary reconstructions of the femur after intercalary femur resections in children. Because the addition of a vascularized fibula adds to the time and complexity of the procedure, understanding more about whether it reduces complications and improves the function of patients who undergo these resections and reconstructions would be valuable for patients and treating physicians.
QUESTIONS/PURPOSES: In an analysis of children with bone sarcomas of the femur who underwent an intercalary resection and reconstruction with massive bone allograft with or without a vascularized free fibula, we asked: (1) What was the difference in the surgical time of these two different surgical techniques? (2) What are the complications and number of reoperations associated with each procedure? (3) What were the Musculoskeletal Tumor Society scores after these reconstructions? (4) What was the survival rate of these two different reconstructions?
METHODS: Between 1994 and 2016, we treated 285 patients younger than 16 years with a diagnosis of osteosarcoma or Ewing sarcoma of the femur. In all, 179 underwent resection and reconstruction of the distal femur and 36 patients underwent resection and reconstruction of the proximal femur. Additionally, in 70 patients with diaphyseal tumors, we performed total femur reconstruction in four patients, amputation in five, and a rotationplasty in one. The remaining 60 patients with diaphyseal tumors underwent intercalary resection and reconstruction with massive bone allograft with or without vascularized free fibula. The decision to use a massive bone allograft with or without a vascularized free fibula was probably influenced by tumor size, with the indication to use the vascularized free fibula in longer reconstructions. Twenty-seven patients underwent a femur reconstruction with massive bone allograft and vascularized free fibula, and 33 patients received massive bone allograft alone. In the group with massive bone allograft and vascularized fibula, two patients were excluded because they did not have the minimum data for the analysis. In the group with massive bone allograft alone, 12 patients were excluded: one patient was lost to follow-up before 2 years, five patients died before 2 years of follow-up, and six patients did not have the minimum data for the analysis. We analyzed the remaining 46 children with sarcoma of the femur treated with intercalary resection and biological reconstruction. Twenty-five patients underwent femur reconstruction with a massive bone allograft and vascularized free fibula, and 21 patients had reconstruction with a massive bone allograft alone. In the group of children treated with massive bone allograft and vascularized free fibula, there were 17 boys and eight girls, with a mean +/- SD age of 11 +/- 3 years. The diagnosis was osteosarcoma in 14 patients and Ewing sarcoma in 11. The mean length of resection was 18 +/- 5 cm. The mean follow-up was 117 +/- 61 months. In the group of children treated with massive bone allograft alone, there were 13 boys and eight girls, with a mean +/- SD age of 12 +/- 2 years. The diagnosis was osteosarcoma in 17 patients and Ewing sarcoma in four. The mean length of resection was 15 +/- 4 cm. The mean follow-up was 130 +/- 56 months. Some patients finished clinical and radiological checks as the follow-up exceeded 10 years. In the group with massive bone allograft and vascularized free fibula, four patients had a follow-up of 10, 12, 13, and 18 years, respectively, while in the group with massive bone allograft alone, five patients had a follow-up of 10 years, one patient had a follow-up of 11 years, and another had 13 years of follow-up. In general, there were no important differences between the groups in terms of age (mean difference 0.88 [95% CI -0.6 to 2.3]; p = 0.26), gender (p = 0.66), diagnosis (p = 0.11), and follow up (mean difference 12.9 [95% CI-22.7 to 48.62]; p = 0.46). There was a difference between groups regarding the length of the resection, which was greater in patients treated with a massive bone allograft and vascularized free fibula (18 +/- 5 cm) than in those treated with a massive bone allograft alone (15 +/- 4 cm) (mean difference -3.09 [95% CI -5.7 to -0.4]; p = 0.02). Complications related to the procedure like infection, neurovascular compromise, and graft-related complication, such as fracture and nonunion of massive bone allograft or vascularized free fibula and implant breakage, were analyzed by chart review of these patients by an orthopaedic surgeon with experience in musculoskeletal oncology. Survival of the reconstructions that had no graft or implant replacement was the endpoint. The Kaplan-Meier test was performed for a survival analysis of the reconstruction. A p value less than 0.05 was considered significant.
RESULTS: The surgery was longer in patients treated with a massive bone allograft and vascularized free fibula than in patients treated with a massive bone allograft alone (10 +/- 0.09 and 4 +/- 0.77 hours, respectively; mean difference -6.8 [95% CI -7.1 to -6.4]; p = 0.001). Twelve of 25 patients treated with massive bone allograft and vascularized free fibula had one or more complication: allograft fracture (seven), nonunion (four), and infection (four). Twelve of 21 patients treated with massive bone allograft alone had the following complications: allograft fracture (five), nonunion (six), and infection (one). The mean functional results were 26 +/- 4 in patients with a massive bone allograft and vascularized free fibula and 27 +/- 2 in patients with a massive bone allograft alone (mean difference 0.75 [95% CI -10.6 to 2.57]; p = 0.39). With the numbers we had, we could not detect a difference in survival of the reconstruction between patients with a massive bone allograft and free vascularized fibula and those with a massive bone allograft alone (84% [95% CI 75% to 93%] and 87% [95% CI 80% to 94%], respectively; p = 0.89).
CONCLUSION: We found no difference in the survival of reconstructions between patients treated with a massive bone allograft and vascularized free fibula and patients who underwent reconstruction with a massive bone allograft alone. Based on this experience, our belief is that we should reconstruct these femoral intercalary defects with an allograft alone and use a vascularized fibula to salvage the allograft only if a fracture or nonunion occurs. This approach would have resulted in about half of the patients we treated not undergoing the more invasive, difficult, and risky vascularized procedure.Level of Evidence Level III, therapeutic study. |
1 | Abdominoplasty: the use of stapled prolene mesh in severe musculoaponeurotic laxity | Panniculectomy & Abdominoplasty CPG | We have evaluated the role of stapled Prolene mesh for reinforcement of the midline abdominal wall plication in patients with advanced musculoaponeurotic laxity. Twenty-one multiparous women underwent a standard abdominoplasty with wide longitudinal rectus sheath plication, followed by stapling of the mesh to the external oblique fascia and anterior rectus sheath. All patients were followed up for at least 6 months and 10 of them for 1 year. None of the patients had a major complication. All patients except one maintained an appreciable improvement in their abdominal contour when evaluated at 6 months. The technical aspects, possible advantages, and complications of using such a procedure in this particular group of patients are described. |
0 | Validation of a quality of life questionnaire measuring the subjective fear of falling in nursing home residents | Management of Hip Fractures in the Elderly | A quality of life scale was developed to measure the subjective fear of falling in nursing home residents. We assessed the dimensions fear of falling, daily living and social life within a randomized controlled trial of hip protector use. The Nottingham Health Profile (NHP) was used for validation. Statistical analysis covered factor analysis, internal consistency of subscales, construct and discriminant validity. Factor analysis revealed three reliable components (Cronbach's Alpha): fear of falling (0.92), social restriction due to limited mobility (0.74) and restriction by clothes due to the hip protector (0.72). The subscales fear of falling and social restriction were significantly intercorrelated with all subscales of the NHP. The new tool is a reliable and valid measure of fear of falling in nursing home residents. However, generalizability and applicability are limited by the small proportion of subjects able to complete the tests |
1 | The correlation between the OTA/AO classification system and compartment syndrome in both bone forearm fractures | DOD - Acute Comp Syndrome CPG | Objective:To evaluate the efficacy of using the Orthopaedic Trauma Association (OTA/AO) classification for both bone forearm fractures in predicting compartment syndrome.Design:Retrospective cohort.Setting:Level 1 Academic Trauma Center.Patients/Participants:One hundred fifty-one patients 18 years of age and older, with both bone forearm fractures diagnosed from 2001 to 2016 were categorized based on the OTA/AO classification. Patients with both bone fractures caused by gunshot wounds were excluded.Main Outcome Measurements:The endpoint for our study was whether forearm fasciotomies were performed based on the presence of compartment syndrome.Results:Of a total of 151 both bone forearm fractures, 15% underwent fasciotomy. Six of 80 (7.5%) grouped 22-A3, 8 of 44 (18%) grouped 22-B3, and 9 of 27 (33%) grouped 22-C underwent fasciotomies for compartment syndrome (P = 0.004). The relative risks of developing compartment syndrome for group 22-B3 versus 22-A3 was 2.42 (P = 0.08), 22-C versus 22-B3 was 1.83 (P = 0.15), and 22-C versus 22-A3 was 4.44 (P = 0.002).Conclusions:There is a significant correlation between the OTA/AO classification and the need for fasciotomies, with group C fractures representing the highest risk. Clinicians can use this information to have a higher index of suspicion for compartment syndrome based on OTA/AO classification to help minimize the risk of a missed diagnosis.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. |
1 | Using only MRI is moderately reliable in the prediction of meniscal tear reparability | AMP (Acute Meniscal Pathology) | PURPOSE: The purpose of this study was to evaluate the role of surgeons' experience with meniscal repairs and meniscectomy decisions, and to determine the factors affecting the disagreement between meniscal repairs and meniscectomy decisions.
METHODS: In total, 223 patients with meniscal tears, 106 meniscal repairs, and 117 meniscectomies were included. Six orthopedic surgeons (3: > 5 years; 3: < 5 years' arthroscopy experience) were blinded, and they independently reviewed all preoperative MR images for over a month. Their reviews were compared with arthroscopic interventions performed by a surgeon with > 10 years' arthroscopy experience. Reparability-associated factors were also evaluated using multivariate logistic regression.
RESULTS: The first and second evaluation results did not differ significantly between groups (n.s.). There was good agreement between MRI predictions and arthroscopic interventions for both groups (< 5 years' experience: k = 0.248, agreement 62.3%; > 5 years' experience: k = 0.351, agreement 67.3%). Sex, side, and distance of tear from the meniscocapsular junction were not significantly different between agreements and disagreements. Disagreement regarding meniscectomy was significantly higher than those regarding meniscus repair (p = 0.002). Concomitant anterior cruciate ligament (ACL) injury, osteochondral lesions, and medial meniscal tear increased the likelihood of meniscal repair (p = 0.0063, p = 0.0010, and p = 0.0369, respectively). An increased risk of disagreement between MRI and surgical procedure was found in the presence of bucket-handle, horizontal or complex tear, chronic tear, high sports activity and expectation level.
CONCLUSION: Surgeon's experience level may influence the prediction of meniscus reparability. Concomitant ACL injury, osteochondral lesions, and presence of medial meniscal tear increase the likelihood of meniscal repair. Tear type, tear chronicity, patient's activity and expectation level may influence the surgeon's operative decision in addition to MRI.
Level of evidence: Iii. |
0 | MR imaging of the knee menisci | AMP (Acute Meniscal Pathology) | MR imaging of the knee is highly accurate for the noninvasive diagnosis of meniscal tears and other meniscal pathology. Familiarity with the normal anatomy and common pitfalls reduces errant interpretations, but does not eliminate them entirely. The two MR imaging signs of a meniscal tear are abnormal intrameniscal signal on a short-TE image that unequivocally contacts the meniscal surface, and abnormal meniscal morphology in the absence of prior meniscal surgery. To help guide the treatment of meniscal injuries, which continues to evolve, the MR imaging report should thoroughly describe tears, and not simply indicate whether a meniscal tear is present. In the patient with an ACL tear, the accuracy of MR imaging examination for meniscal tears, especially lateral tears, diminishes but still surpasses that of physical examination. The MR imaging criteria for meniscal tears need to be modified in patients who have undergone meniscal surgery. [References: 79] |
1 | Occupational soft-tissue and tendon disorders | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | Reports of work-related musculoskeletal disorders have increased. The cause of the problem has yet to be determined. Thus far, only cross-sectional case and controlled studies exist. It is important for the physician to develop a thought process to separate patients with subjective complaints and real objective findings from those with unreasonable subjective complaints and minimal or no findings |
0 | Mediators linking childhood adversities and trauma to suicidality in individuals at risk for psychosis | DoD PRF (Psychosocial RF) | Suicidality is highly prevalent in patients at clinical high risk (CHR) for psychosis. Childhood adversities and trauma are generally predictive of suicidality. However, the differential effects of adversity/trauma-domains and CHR-criteria, i.e., ultra-high risk and basic symptom criteria, on suicidality remain unclear. Furthermore, the underlying mechanisms and, thus, worthwhile targets for suicide-prevention are still poorly understood. Therefore, structural equation modeling was used to test theory-driven models in 73 CHR-patients. Mediators were psychological variables, i.e., beliefs about one's own competencies as well as the controllability of events and coping styles. In addition, symptomatic variables (depressiveness, basic symptoms, attenuated psychotic symptoms) were hypothesized to mediate the effect of psychological mediators on suicidality as the final outcome variable. Results showed two independent pathways. In the first pathway, emotional and sexual but not physical adversity/trauma was associated with suicidality, which was mediated by dysfunctional competence/control beliefs, a lack of positive coping-strategies and depressiveness. In the second pathway, cognitive basic symptoms but not attenuated psychotic symptoms mediated the relationship between trauma/adversity and suicidality. CHR-patients are, thus, particularly prone to suicidality if adversity/trauma is followed by the development of depressiveness. Regarding the second pathway, this is the first study showing that adversity/trauma led to suicidality through an increased risk for psychosis as indicated by cognitive basic symptoms. As insight is generally associated with suicidality, this may explain why self-experienced basic symptoms increase the risk for it. Consequently, these mediators should be monitored regularly and targeted by integrated interventions as early as possible to enhance resilience against suicidality. |
0 | Oral Health Literacy and Oral Health Status among Adults Attending Dental College Hospital in India | Dental Implant Infection | BACKGROUND: Low health literacy is one among many reasons why preventable diseases remain so common and why people often do not adopt healthy practices. It is important to detect patients with inadequate oral health literacy (OHL) and to improve the level of communication between the provider and the patient. This study was aimed to determine the relationship between OHL with selected socio-demographic variables and oral health status among adults in Virajpet, Karnataka, India., MATERIALS AND METHODS: A convenience sample of 187 subjects from the out-patient department of Coorg-Institute of Dental Sciences Hospital administered the Rapid Estimate of Adult Literacy in Dentistry (REALD-30). The demographic variables and the oral health status were recorded for every participant using World Health Organization oral health survey proforma (1997). Data were analyzed using t-tests, analysis of variance, correlations and Kruskal-Wallis test., RESULTS: The associations between REALD-30 scores and gender, age, and ethnicity were not statistically significant. Significant associations were found between REALD scores and the following oral-health related variables: Temperomandibular joint problems, prevalence of prosthetic need, CPI (Community Periodontal Index) and loss of attachment scores. REALD-30 scores were negatively correlated with DMFT (Decayed, Missing and Filled Teeth) scores and DAI (Dental Aesthetic Index) scores., CONCLUSION: OHL was not associated with sex, age, or ethnicity in this sample of the Virajpet population. OHL was associated with oral health status. Lower OHL was associated with poorer oral health status. OHL instruments can be considered to be included as screening tools to identifying individuals or groups with poor oral health outcomes. |
0 | Improving evaluation and treatment for osteoporosis following distal radial fractures. A prospective randomized intervention | Distal Radius Fractures | BACKGROUND: Fragility fractures are associated with a significant increase in the risk of future fracture, but the rates of evaluation to identify osteoporosis after such injuries are low. The purpose of this study was to determine the rates of evaluation and treatment of osteoporosis following distal radial fractures and to test two interventions in the outpatient clinic to improve evaluation and treatment rates.
METHODS: In the first part of the study, the medical records of 298 consecutive patients treated for a fragility fracture of the distal part of the radius were reviewed. Primary outcome measures were a bone mineral density examination and treatment with osteoporosis medication within six months after the fracture. In the second part of the study, fifty patients with a fragility fracture of the distal part of the radius were prospectively randomized to receive one of two interventions. These consisted of (1) the orthopaedic surgeon ordering a bone mineral density examination and forwarding the results to the primary care physician or (2) the orthopaedic surgeon sending a letter to the primary care physician outlining guidelines for osteoporosis screening. Patients were contacted at six months after the fracture to determine the rates of evaluation and treatment for osteoporosis.
RESULTS: The first part of the study revealed that, following a distal radial fracture, 21.3% of 240 patients had a bone mineral density examination and 78.7% were never screened. Osteopenia was the most common diagnosis among those screened (57%). Most (72.5%) of the 240 patients received no medication, whereas 6.7% received calcium and vitamin D; 11.3%, bisphosphonates; 2.5%, hormone replacement therapy; and 7.1%, a combination regimen. The treatment rate for the patients who had undergone a bone mineral density examination was 2.5-fold higher than the rate for those who had not had bone mineral density testing (53% compared with 21%, p < 0.001). In the second part of the study, the patients randomized to Intervention 1 had two to threefold greater rates of bone mineral density testing (93% compared with 30%, p < 0.001), discussion of osteoporosis with their primary care physician (89% compared with 35%, p < 0.001), and initiation of osteoporosis therapy (74% compared with 26%, p < 0.001) compared with patients randomized to Intervention 2.
CONCLUSIONS: Rates of evaluation and treatment for osteoporosis after fragility fractures remain low (21.3% and 27.5%, respectively). Patients who undergo a bone mineral density examination are more likely to receive treatment. Ordering a bone mineral density examination in the orthopaedic clinic can dramatically improve osteoporosis evaluation and treatment rates following fragility fractures of the distal part of the radius. |
0 | Osteoarthrosis and late growth | Management of Hip Fractures in the Elderly | To examine the hypothesis that late growth of bone may occur, pelvic radiographs taken during 1990 to 1992 of patients born between 1901 and 1972 were studied. All radiographs were taken using the same equipment with constant exposure techniques. Films showing osteoarthrosis (obviously decreased joint space) or hip fracture were discarded. The remaining films of 116 women and 100 men divided into 3 age groups (18-39 years old, 40-59 years old, and > 60 years old) were measured. With a millimeter ruler and a circle template, the center and 5 radii of each femoral head, the width of the acetabulum, and the pelvic diameters, the femoral neck, and the height of the superior joint space were determined. Most of the measurements increased significantly with age, including those of the femoral head, the acetabulum, the femoral neck in women, and the pelvic diameters. The increase in superior joint space (the combined heights of the cartilage of the femoral head and acetabulum) with age was not significant, but in men between 50 and 70 years old there were cartilage measurements that were higher than in other age groups, and in women > 80 years of age there were significantly more single high values. The results are discussed against the background that growth of bone and of cartilage can hypothetically cause injuries of the cartilage |
1 | Prospective Randomized Trial Comparing Femoral Nerve Block With Intraoperative Local Anesthetic Injection of Liposomal Bupivacaine in Total Knee Arthroplasty | AAHKS (9/10) Regional Nerve Blocks | BACKGROUND: Postoperative pain after total knee arthroplasty (TKA) may impact long-term results and incidence of complications. Femoral nerve block (FNB) provides excellent pain relief after TKA, although associated risks include weakness, delayed participation in therapy, and nerve injury. Liposomal bupivacaine (LB) is a potentially longer acting local anesthetic that may reduce postoperative pain.
METHODS: We performed a prospective, randomized, double-blind study of 373 TKA patients randomized to receive either an FNB (control group), or an intraoperative periarticular injection (PAI) with LB and a placebo saline FNB (experimental group). Patients were evaluated with visual analog scores for pain, range of motion, performance of straight leg raise (SLR), walking distance, and Short Form-12 up to 1 year postoperatively.
RESULTS: Twelve and 24 hours postoperatively, the control group had significantly lower pain scores (mean 3.24 vs 3.87; P = .02) and higher range of motion (84.54degree vs 78degree; P < .001). The patients receiving LB PAI were significantly more likely to perform a straight leg raise 12 hours postoperatively (73% vs 50%; P = .0003). Patients in the LB (experimental) group scored better in the physical function component of the Short Form-12 (-23 vs -27, P = .01) 3 months postoperatively.
CONCLUSION: While pain scores were slightly lower in the control group in the first 24 hours after TKA compared with LB PAI, the magnitude of the difference was small, and excellent pain relief was provided by both interventions. Use of LB PAI in TKA is a reasonable alternative to FNB, which avoids the additional weakness and other risk associated with FNB procedures. |
0 | Return to knee-strenuous sport after anterior cruciate ligament reconstruction: a report from a rehabilitation outcome registry of patient characteristics | OAK 3 - Non-arthroplasty tx of OAK | PURPOSE: To characterise patients who returned to knee-strenuous sports after an anterior cruciate ligament (ACL) reconstruction.
METHODS: Data from isotonic tests of muscle function and patient-reported outcome measures, Tegner activity scale (Tegner and Lysholm in Clin Orthop Relat Res 198:43-49, 1985), physical activity scale, knee injury and osteoarthritis scale and knee self-efficacy scale were extracted from a registry. The 157 included patients, 15-30 years of age, had undergone primary ACL reconstruction and were all involved in knee-strenuous sports, i.e. pre-injury Tegner of 6 or higher. Return to sport was studied in two different ways: return to pre-injury Tegner and return to knee-strenuous sport (Tegner 6).
RESULTS: Fifty-two patients (33 %), who returned to pre-injury Tegner, 10 months after surgery, were characterised by better subjective knee function measured with the knee injury and osteoarthritis outcome score (p < 0.05), compared with patients who did not. These patients also had higher perceived self-efficacy of knee function (p < 0.01), measured with knee self-efficacy scale. Eighty-four patients (54 %) who returned to knee-strenuous sports, i.e. Tegner 6 or higher, were characterised by higher goals for physical activity (p < 0.01) and higher self-efficacy of future knee function (p < 0.05). Strength measurements showed that women who returned to sports were stronger in leg extension than women who did not. No differences were found in Limb Symmetry Index for knee strength or jumping ability.
CONCLUSION: Patients who returned to sports after ACL reconstruction had better subjective knee function and higher self-efficacy of knee function. Results highlight that further emphasis should be placed at psychological factors during rehabilitation of patients after ACLR.
Level of evidence: Ii. |
1 | Health-related quality of life after paediatric supracondylar humeral fractures | Pediatric Supracondylar Humerus Fracture 2020 Review | AIMS: We aimed to evaluate the health-related quality of life (HRQoL) in children with supracondylar humeral fractures (SCHFs), who were treated following the recommendations of the Paediatric Comprehensive AO Classification, and to assess if HRQoL was associated with AO fracture classification, or fixation with a lateral external fixator compared with closed reduction and percutaneous pinning (CRPP). METHODS: We were able to follow-up on 775 patients (395 girls, 380 boys) who sustained a SCHF from 2004 to 2017. Patients completed questionnaires including the Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH; primary outcome), and the Pediatric Quality of Life Inventory (PedsQL). RESULTS: An AO type I SCHF was most frequent (327 children; type II: 143; type III: 150; type IV: 155 children). All children with type I fractures were treated nonoperatively. Two children with a type II fracture, 136 with a type III fracture, and 141 children with a type IV fracture underwent CRPP. In the remaining 27 children with type III or IV fractures, a lateral external fixator was necessary for closed reduction. There were no open reductions. After a mean follow-up of 6.3 years (SD 3.7), patients with a type I fracture had a mean QuickDASH of 2.0 (SD 5.2), at a scale of 0 to 100, with lower values representing better HRQoL (type II: 2.8 (SD 10.7); type III: 3.3 (SD 8.0); type IV: 1.8 (SD 4.6)). The mean function score of the PedsQL ranged from 97.4 (SD 8.0) for type I to 96.1 (SD 9.1) for type III fractures, at a scale of 0 to 100, with higher values representing better HRQoL. CONCLUSION: In this cohort of 775 patients in whom nonoperative treatment was chosen for AO type I and II fractures and CRPP or a lateral external fixator was used in AO type III and IV fractures, there was equally excellent mid- and long-term HRQoL when assessed by the QuickDASH and PedsQL. These results indicate that the treatment protocol followed in this study is unambiguous, avoids open reductions, and is associated with excellent treatment outcomes. Cite this article: Bone Joint J 2020;102-B(6):755-765. |
0 | Location-specific hip joint space width for progression of hip osteoarthritis: Predictive validity and responsiveness of a new computerized measure | Surgical Management of Osteoarthritis of the Knee CPG | Purpose: Responsive measures of radiographic joint space width (JSW) in hip osteoarthritis (OA) are important for the evaluation of treatment interventions. To date, quantitative measures of JSW have only shown a weak relationship with symptoms and predictive validity and moderate responsiveness. One problem may be that these measures rely primarily on identifying the site of minimum JSW (mJSW), which can vary within and between readers and can be at different locations on serial radiographs. At the knee, location-specific measures of JSW have overcome these problems and can outperform mJSW. A similar method is now evaluated at the hip. The primary purpose of this study was to evaluate predictive validity and responsiveness for hip JSW measured at 3 fixed locations in the superior hip joint by a semi-automated quantitative software tool. Methods: A nested case-control study was conducted among subjects from the Osteoarthritis Initiative (OAI), a longitudinal cohort study of knee OA. OAI participants also had standing AP pelvis radiographs at baseline and 48 month visits using a standardized protocol. We examined baseline to 48 month responsiveness in two groups of subjects who had AP pelvis films at 0 and 48 months. First, we identified subjects who had a total hip replacement (THR) after the 48 month visit (at 60 and 72 months) (n = 27). Second, a larger sample of cases was selected that included all subjects who had a THR at any point (12-72 months) after baseline. For this group, the contralateral (CL) hip from the THR was designated the case hip. In both groups, subjects were matched (1:1) on age and gender with subjects who did not receive a THR and reported no hip pain. In addition, the CL hip group (n = 79) were examined for the presence of pain from baseline to 48 months, in order to compare JSW change in those with and without pain. Measurements of superior hip JSW were made at 3 fixed locations. Location 1 was in the superior-lateral hip joint space and was 10(degrees) from a reference line that extended fromthe femoral head centre to the outer edge of the acetabular roof (lateral line in Fig. 1). Location 2 was 30(degrees) (superiormiddle) and location 3 (superior-medial) was 50(degrees) from the reference line. Measurement was facilitated by software that delineated the femoral head and found the acetabular margin along each of the 3 lines. A reader used software to correct the output if needed. Statistical analysis. Sensitivity to change was estimated by the standardized response mean for change from baseline to 48 months. Paired t-tests were used to test statistical significance between cases and controls. Results: The overall sample was 47% male, 91% Caucasian had a mean age of 64.2 and BMI of 27.9. Significant differences in responsiveness were observed between cases and controls in both case-control groups. The superior-medial (10(degrees) from the reference line) and superior- lateral location (50(degrees) from the reference line) were the most responsive to change in JSW. Reading time was approximately 1 minute per hip. Of the 79 subjects how underwent THR during the 6- year study period, 17 reported pain in the contra-lateral hip. Those with pain had significantly greater baseline to 48 month change in JSW and responsiveness at locations 1 and 3 than those without pain (Table 1, Fig. 2). Conclusion: This study provides evidence that a new computerassisted rapid method of hip JSW has predictive validity and good responsiveness. It is also rapid, taking approximately one minute per hip. In addition to detecting large 4-year changes in those undergoing subsequent THR (compared to controls), the method showed statistically significant differences in 4-year change in the contralateral hip of THR cases. Lastly, amongst the contralateral hip group, the method detected significant JSW changes in those with pain versus those without pain. Location 1 (superior-lateral hip joint) and location 3 (superior-medial hip joint) were the most responsive in all groups and warrant further study. Location-specific measures of JSW are a rapid and possibly improved method to assess hip OA. (Figure Presented) |
0 | Comparison of Cellular Alterations in Fat Cells Harvested With Laser-Assisted Liposuction and Suction-Assisted Liposuction | Panniculectomy & Abdominoplasty CPG | OBJECTIVE: The aim of the present study was to evaluate the viability and proliferative capacity of adipose-derived stem cells obtained by laser-assisted liposuction (LAL). METHODS: Fat tissue was obtained from 7 male patients treated surgically for gynecomastia. On one side, harvesting was made before LAL, while it was implemented after LAL on the contralateral side. Viability, cell surface antigens, pluripotency, and apoptosis were assessed and compared in these samples. RESULTS: Cells harvested before and after LAL did not exhibit any significant difference in terms of surface cell markers. Number of viable stem cells was lower initially after exposure to laser, while this difference was reversed at the end of 72 hours. Genetic indicators of cellular differentiation were similar in both groups. Apoptosis indicators were increased remarkably after laser exposure in the first 24 hours, but this increase was absent 72 hours after LAL procedure. CONCLUSION: The authors' results have promising clinical relevance since mesenchymal stem cells harvested during LAL have maintained appropriate cellular features to be used for autologous fat transfer and fat grafting. |
0 | Our experience with the so-called pull-through technique combined with liposuction for management of gynecomastia | Panniculectomy & Abdominoplasty CPG | Gynecomastia is a benign enlargement of male breast, common in adolescents and adults. To treat this deformity, we have been carrying out liposuction through small cutaneous incisions placed in the axilla and on the sternum. If necessary, we performed a surgical excision of glandular tissue through a periareolar incision. From 1995, we started to perform surgical excision of glandular tissue, if necessary, through the small incisions made for liposuction, thus avoiding the periareolar scars. We describe our experience with this technique, which we believe excellent for the correction of glandular and fatty glandular gynecomastia, obtaining excellent esthetic results and minimal local scarring. |
0 | Knee Articular Cartilage Repair and Restoration Techniques: A Review of the Literature | Osteochondritis Dissecans 2020 Review | CONTEXT: Isolated chondral and osteochondral defects of the knee are a difficult clinical challenge, particularly in younger patients for whom alternatives such as partial or total knee arthroplasty are rarely advised. Numerous surgical techniques have been developed to address focal cartilage defects. Cartilage treatment strategies are characterized as palliation (eg, chondroplasty and debridement), repair (eg, drilling and microfracture [MF]), or restoration (eg, autologous chondrocyte implantation [ACI], osteochondral autograft [OAT], and osteochondral allograft [OCA]). EVIDENCE ACQUISITION: PubMed was searched for treatment articles using the keywords knee, articular cartilage, and osteochondral defect, with a focus on articles published in the past 5 years. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 4. RESULTS: In general, smaller lesions (<2 cm(2)) are best treated with MF or OAT. Furthermore, OAT shows trends toward greater longevity and durability as well as improved outcomes in high-demand patients. Intermediate-size lesions (2-4 cm(2)) have shown fairly equivalent treatment results using either OAT or ACI options. For larger lesions (>4 cm(2)), ACI or OCA have shown the best results, with OCA being an option for large osteochondritis dissecans lesions and posttraumatic defects. CONCLUSION: These techniques may improve patient outcomes, though no single technique can reproduce normal hyaline cartilage. |
0 | Osteoporosis and aging. Current update | Management of Hip Fractures in the Elderly | Osteoporosis is 1 of the most prevalent musculoskeletal disorders afflicting the elderly population today. Together with a propensity for falls, it can lead to a life-threatening condition such as a hip fracture, making prevention a key concept. In this article, the pathophysiology of bone loss in the elderly is reviewed and current methods for diagnosis and treatment are summarized. In recently postmenopausal women with significant bone loss, estrogen therapy is the preferred treatment. In the older population, adequate nutrition, calcium supplementation, and weightbearing exercise are the mainstays of treatment. With the development of newer pharmaceutical agents, eventually it may be possible to reduce significantly, and even reverse, bone loss in older postmenopausal women |
0 | Risk factors for osteomyelitis | DoD SSI (Surgical Site Infections) | An approach that is useful in classifying the risk factors for the development of acute osteomyelitis is the same as one commonly employed to discuss the mechanisms responsible for pathogenesis: hematogenous dissemination, direct inoculation, and contiguous spread from an adjacent area of soft tissue infection. Acute hematogenous osteomyelitis is predominantly a disease of children. Factors that favor the development of acute bone infection are those that predispose to bacteremia. These include indwelling intravascular catheters, distant foci of infection, and intravenous drug abuse. The distant sites of focal infection that are most commonly associated with acute osteomyelitis include the skin as well as urinary and respiratory tracts. Two patient groups with an usual susceptibility to acute skeletal infections are those with sickle cell anemia and chronic granulomatous disease. The second major mechanism for the development of acute osteomyelitis is by direct inoculation. Injuries due to penetrating bites and puncture wounds of the food may serve to infect bone directly. Diagnostic procedures (lumbar puncture, fetal monitoring electrodes, suprapubic aspiration, and heel sticks) may result inadvertently in the inoculation of a neighboring osseous structure. Surgical procedures such as internal fixation of long bone fractures and skeletal traction may cause an infection of the bone. Osteomyelitis may develop as a consequence of contiguous spread of infection from adjacent soft tissue, particularly if vascular insufficiency complicates the clinical picture. Infection of the mandible, maxilla, and frontal or mastoid bones may result from persistent or neglected infection of the teeth, paranasal sinuses, or middle ear cavity, respectively. The major risk factor for chronic infection of bone is inadequate or delayed management of acute osteomyelitis or completely unrecognized bone infection. [References: 59] |
0 | Sensitivity and specificity of clinical examination, magnetic resonance imaging and arthroscopy in the diagnosis of chronic knee joint injury | AMP (Acute Meniscal Pathology) | Objective: To compare the accuracy of clinical examination and magnetic resonance imaging (MRI) findings versus arthroscopy findings in chronic knee injuries. Methods: During the years 2003 to 2007, we evaluated 60 patients (58 male,2 female) with an average age of 28.5 years ( range 17 to 52 years ) with chronic knee injuries. All patients were admitted to Al-Jala Hospital, Benghazi, Libya. After clinical examination, MRI reports reviewed and arthroscopy performed, .Statistical analysis including specificity, sensitivity,accuracy, positive and negative predictive values were calculated. Results: By comparing the positive results, for medial meniscal tears, lateral meniscal tears, and anterior cruciate ligament in clinical findings, MRI, and arthroscopic findings we found no significant difference between the three type (x2=2.16 p > 0.05). This study reveled that there was a significant difference between the accuracy of clinical examination and MRI in the diagnosis of medial and lateral meniscal tears ( McNemar's test x2 =0.022, p<0.05), were it was higher in clinical examination (93.3%) and (71.7% ) in MRI for medial meniscus tears. Conclusion: Although MRI is an accurate, noninvasive method of evaluating knee pathologies, it was, no more accurate than clinical examination in this study. The experienced surgeon can safely rely on clinical skills. Routine ordering of an MRI is not needed. MRI can be useful adjunct to clinical examination in selected cases, but the surgeon must be aware of its limitatations. |
0 | SOR cutaneous melanoma | Reconstruction After Skin Cancer | Cutaneous melanoma is a highly malignant tumour. The incidence has increased dramatically over the last few decades and is now estimated at between 45000 new cases per year in France. The term naevus, unless otherwise specified, refers to an acquired or congenital benign melanocytic tumour (commonly known as a naevus, naevi or mole). A melanoma can develop de novo, or within a pre-existing benign naevus. A melanoma can arise in any area containing melanocytes, but approximately 90% are cutaneous tumours. These recommendations refer to localized primary tumours, those presenting with regional nodes and those with distant metastases. The management of mucosal, visceral and ophthalmic melanomas is not covered. These recommendations are based on literature published until the end of 1998. Data published since does not change these recommendations. An update is planned for early 2001. |
0 | The Impact of the COVID-19 Pandemic on the Radiology Research Enterprise: Radiology Scientific Expert Panel | Coronavirus Disease 2019 (COVID-19) | The current COVID-19 crisis continues to grow and has resulted in marked changes to clinical operations. In parallel with clinical preparedness, universities have shut down the majority of scientific research activities. Radiology researchers are currently grappling with these challenges that will continue to affect current and future imaging research. The purpose of this article is to describe the collective experiences of a diverse international group of academic radiology research programs in managing their response to the COVID-19 pandemic. The acute response at six distinct institutions will first be described, exploring common themes, challenges, priorities, and practices. This will be followed by reflections about the future of radiology research in the wake of the COVID-19 pandemic. |
0 | Algorithm for establishing the indication for knee arthroscopy in children: a comparison of adolescent and preadolescent children | AMP (Acute Meniscal Pathology) | The aim of this study was to select children with pathological lesions of the intra-articular structures from children with identical complaints but with no pathological intra-articular changes. The younger the child, the more difficult it is to make the diagnosis, and the expected distribution of pathology changes increasingly. This is particularly stressed in children aged younger than 13 years. Synovial inflammatory alterations are more frequent, and osteochondral and chondral fractures appear to be more problematic than meniscal and cruciate ligament lesions. Before establishing the indication for knee arthroscopy it is mandatory to implement the algorithm of diagnostic and conservative therapeutic procedures. The indication for knee arthroscopy is considered in cases when complaints persist after conservative treatment, a lesion of intra-articular segments is suspected, and the pathological condition is deemed arthroscopically treatable. Arthroscopy before conservative treatment is justified only in acute cases. |
0 | Twenty-year evaluation of meniscal bearing and rotating platform knee replacements | Surgical Management of Osteoarthritis of the Knee CPG | Clinical results of the initial cemented and cementless series of 373 New Jersey Low Contact Stress total knee replacements in 282 patients surviving at least 10 years were analyzed using a strict knee scoring scale. The study showed excellent, good, fair, or poor results in 68.1%, 29.8%, 2.1%, or 0% of primary posterior cruciate-retaining meniscal bearing knee replacements, 46.7%, 53.3%, 0%, or 0% results in primary cemented rotating platform knee replacements, and 68.1%, 29.8%, 2.1%, or 0% results in primary cementless rotating platform knee replacements, respectively. Radiographic evaluation at minimum 10-year followup showed stable fixation of all components, no gross migration but significant osteolysis requiring bearing exchange and bone grafting in three cementless rotating platform knee replacements (1.8%) in three patients who underwent previous surgeries at an average of 10.2 years from the index surgery. Survivorship of the patients who underwent primary cementless posterior cruciate-retaining meniscal bearing knee replacements with an end point of revision for any mechanical reason was 97.4% at 10 years and 83% at 16 years; using an end point of a poor clinical knee score the survivorship was 98.9% at 10 years and at 16 years. Survivorship of the patients who underwent primary cemented rotating platform knee replacements with end points of revision for any mechanical reason or a poor clinical knee score was 97.7% at 10 years and at 20 years. Survivorship of the patients who underwent cementless rotating platform knee replacements with end points of revision for any mechanical reason or a poor clinical knee score was 98.3% at 10 years and at 18 years |
0 | Median nerve compression in the proximal forearm | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | Thirty-nine limbs in 36 patients underwent surgical decompression of the median nerve in the proximal forearm. Seventeen patients with 19 limbs had prior ipsilateral carpal tunnel releases, and 24 had workers' compensation claims related to heavy labor or repetitive tasks. The most common presenting complaints were paresthesias/numbness in the distribution of the median nerve and pain in the forearm or hand. The most common physical finding was a positive pronator compression test, followed by median nerve hypesthesia. Elbow to wrist nerve conduction tests were obtained in 37 of 39 limbs and were abnormal in 12. Intraoperatively, the nerve was compressed at the flexor digitorum superficialis tendon in 22 limbs, pronator teres in 13 limbs, and both in 4 limbs. Postoperatively, 30 limbs had complete or partial relief of symptoms; in a sub-group of 19 limbs that had a prior failed carpal tunnel release, 14 had complete or partial relief. Although there was a trend toward better results in patients with normal preoperative nerve conduction tests and intraoperative compression at the flexor digitorum superficialis, the difference was not significant |
1 | Predictability of salvage and outcome of Gustilo and Anderson type-IIIA and type-IIIB open tibial fractures using Ganga Hospital Scoring system | DoD LSA (Limb Salvage vs Amputation) | Although numerous scoring systems are designed for lower limb open injuries, most of them are based on orthopaedic and vascular injuries and can define only an amputation score. These scoring system lack specificity and sensitivity in predicting the salvage and outcome. Ganga Hospital Scoring system was found to have good specificity in predicting the outcome in Gustilo type-IIIA and type-IIIB injuries. We have validated in our study the Ganga Hospital Scoring system which grades the open injuries based on severity of injury to covering structures, functional and the skeletal units. The score was validated in 40 open injuries of tibia, 11 type-IIIA and 29 type-IIIB. Predictability of salvage and outcome was measured based on this scoring system. Results of our study correlated well with outcome of Ganga hospital study. 38 of 40 limbs with score below 14 and 1 with score above 14 were salvaged. The sensitivity and specificity for the threshold score of 14 was 100% and 95% respectively. Requirement of flaps, number of surgical procedures, time to bony union and infection rates in different groups were similar to original study. The Ganga scoring system was found to have good specificity and sensitivity and reliable in prognosticating the outcome in open injuries of the tibia. |
0 | Posttraumatic stress disorder six months after an earthquake: findings from a community sample in a rural region in Italy | DoD PRF (Psychosocial RF) | BACKGROUND AND AIMS: Various studies assessed rates of post-traumatic stress disorder (PTSD) following natural disasters including earthquakes. Yet, samples were often non-representative or small or both. This study aims to assess the prevalence of PTSD and predictors of PTSD 6 months after an earthquake in a rural region of Italy.
METHODS: A questionnaire was handed out to a representative sample of approximate 3,000 people in the region of Molise in Italy 6 months after an earthquake in October/November 2002. The questionnaire assessed socio-demographic characteristics, aspects of the event, the experience of symptoms immediately after the earthquake, and symptoms of PTSD.
RESULTS: Questionnaires of 2,148 people were returned, representing a response rate of 73.7%. The final analysis was based on 1,680 people. The screening tool provided a PTSD prevalence rate of 14.5%. Male gender, age under 55 years, and better school education predicted lower rates of PTSD. More variance was explained when psychological symptoms of immediately after the event were also included as predictors.
CONCLUSION: The findings on predictors are consistent with the literature. Whilst personal characteristics explain only a small variance of PTSD six months after the event, early psychological distress allows a better prediction of who is likely to have PTSD 6 months later. |
0 | Acute carpal tunnel syndrome produced by anomalous flexor digitorum superficialis indicis muscle | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | A 23 year old female nurse developed acute sensory symptoms of median nerve compression. Early exploration revealed abnormal flexor superficialis indicis muscle as the compressing structure. Symptoms were relieved by freeing the muscle from the nerve |
0 | Incidence and prevention of osteoradionecrosis after dental extraction in irradiated patients: A systematic review | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | This systematic review aims to identify and review the best available evidence to answer the clinical question 'What are the incidence and the factors influencing the development of osteoradionecrosis after tooth extraction in irradiated patients?'. A systematic review of published articles on post-irradiation extraction was performed via electronic search of the Medline, Ovid, Embase and Cochrane Library databases. Additional studies were identified by manual reference list search. Evaluation and critical appraisal were done in 3 stages by two independent reviewers and any disagreement was resolved by discussion with a third party. 19 articles were selected for the final analysis. The total incidence of osteoradionecrosis after tooth extraction in irradiated patients was 7%. When extractions were performed in conjunction with prophylactic hyperbaric oxygen, the incidence was 4% while extraction in conjunction with antibiotics gave an incidence of 6%. This systematic review found that while the incidence of osteoradionecrosis after post-irradiation tooth extractions is low, the extraction of mandibular teeth within the radiation field in patients who received a radiation dose higher than 60 Gy represents the highest risk of developing osteoradionecrosis. Based on weak evidence, prophylactic hyperbaric oxygen is effective in reducing the risk of developing osteoradionecrosis after post-radiation extractions. (copyright) 2010 International Association of Oral and Maxillofacial Surgeons |
0 | Effects of qigong exercise on upper limb lymphedema and blood flow in survivors of breast cancer: A pilot study | Pediatric Supracondylar Humerus Fracture 2020 Review | Hypothesis. Qigong exercise is a popular method for relieving the side effects of conventional cancer treatments in survivors of breast cancer, yet its effects are not empirically assessed. This study aimed to investigate the effects of qigong exercise on upper limb lymphedema, arterial resistance, and blood flow velocity in survivors with breast cancer and mastectomy. Study Design. This study was conducted as a prospective clinical trial. Methods. Eleven survivors of breast cancer with qigong experience (mean age = 58.3 ± 10.1 years) were assigned to the experimental group and 12 survivors of breast cancer without qigong experience (mean age = 53.8 ± 4.2 years) were assigned to the control group. They all had breast cancer-related lymphedema. All procedures were completed within one session. After baseline measurements were taken, the experimental group performed 18 Forms Tai Chi Internal Qigong for approximately 6 minutes while the control group rested for similar duration in a sitting position. Both groups were then reassessed. All participants were measured on their affected upper limb circumference (by using tape measures), peripheral arterial resistance, and blood flow velocities (using a Doppler ultrasound machine). Results. The between-group differences were not significant for all outcome measures at baseline (P >.05). The circumferences of the affected upper arm, elbow, forearm and wrist decreased after qigong exercise (P <.05). However, no significant difference was found in the circumference measures between the 2 groups posttest (P >.0125). In terms of vascular outcomes, the resistance index decreased and the maximum systolic arterial blood flow velocity (SV) and minimum diastolic arterial blood flow velocity (DV) increased significantly after qigong exercise (P <.05). The between-group difference was close to significant for SV (P =.018) and was significant for DV (P <.001) posttest. Conclusion. Qigong exercise could reduce conventional cancer therapy side effects such as upper limb lymphedema and poor circulatory status in survivors of breast cancer. However, such effects may be temporary, and further studies must be conducted to explore longer term effects. © The Author(s) 2013. |
0 | Dental implications of narcotic addiction | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | The nature of dental problems peculiar to narcotic addicts is discussed. A high caries rate and severe periodontal disease are common and can be attributed to a combination of dietary considerations and oral neglect. Loss of customary accompanying analgesia may complicate an attempted withdrawal programme. An approach to dental treatment of the narcotic addict is suggested. This should aim primarily at relief of pain and be carried out in consultation with the drug treatment centre. The risk posed by these patients of transmission of Hepatitis B is emphasized |
0 | Fatal massive adrenal hemorrhage after bilateral total knee arthroplasty | Surgical Management of Osteoarthritis of the Knee CPG | Adrenal hemorrhage can occur in association with postoperative stress, trauma, myocardial infarction, infection, and chronic medical illness. Other risk factors for the development of spontaneous adrenal hemorrhage include a thromboembolic state and anticoagulation therapy, although it has rarely been observed following orthopedic surgery. The authors report the case of an otherwise healthy 61-year-old woman who died suddenly 9 days after bilateral total knee arthroplasty. The only abnormality found on postmortem examination was massive bilateral adrenal hemorrhage with destruction of nearly all adrenal tissue. Surgeons should be aware of this complication that, if recognized early, can be treated with steroid replacement |
0 | Failed unicompartmental knee replacement to total knee replacement conversion: Can you achieve a primary outcome? | PJI DX Updated Search | This review provides an overview of aetiology, diagnosis and management of failed UKRs and highlights key aspects of the decision making process and operative technique to ensure satisfactory outcome after UKR revision surgery.With correct diagnosis and management, in the majority of revision UKR cases outcome similar to primary TKR can be achieved. Unexplained pain, aseptic loosening, infection, progression of arthritis and bearing dislocation are the commonest reasons needing further intervention after UKR. Key messages are about how to reduce the revision risk, methods to critically analyze a painful UKR and when and how to revise a UKR |
1 | COVID-19 infection and diffusion among the healthcare workforce in a large university-hospital in northwest Italy | Coronavirus Disease 2019 (COVID-19) | Backgroud: Since the beginning of the coronavirus disease 2019 (COVID-19) outbreak, healthcare workers (HCWs) have been the workers most likely to contract the disease. Intensive focus is therefore needed on hospital strategies that minimize exposure and diffusion, confer protection and facilitate early detection and isolation of infected personnel. METHODS: To evaluate the early impact of a structured risk-management for exposed COVID-19 HCWs and describe how their characteristics contributed to infection and diffusion. Socio-demographic and clinical data, aspects of the event-exposure (date, place, length and distance of exposure, use of PPE) and details of the contact person were collected. RESULTS: The 2411 HCWs reported 2924 COVID-19 contacts. Among 830 HCWs who were at 'high or medium risk', 80 tested positive (9.6%). Physicians (OR=2.03), and non-medical services -resulted in an increased risk (OR=4.23). Patient care did not increase the risk but sharing the work environment did (OR=2.63). There was a significant time reduction between exposure and warning, exposure and test, and warning and test since protocol implementation. HCWs with management postitions were the main source of infection due to the high number of interactions. DISCUSSION: A proactive system that includes prompt detection of contagious staff and identification of sources of exposure helps to lower the intra-hospital spread of infection. A speedier return to work of staff who would otherwise have had to self-isolate as a precautionary measure improves staff morale and patient care by reducing the stress imposed by excessive workloads arising from staff shortages. |
1 | Fine needle aspiration in infected hip replacements | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | Ninety painful prosthetic hips from 88 consecutive patients underwent fine needle aspiration and the results compared with clinical progress, operative findings and culture. Fourteen of the 15 cases proven to be infected at operation were correctly identified by fine-needle aspiration. The one hip with a false negative aspirate had an arthrogram which showed a cavity suggesting infection. There were three false positive aspirates. One grew a different organism at surgery from the original aspirate. The other two had no growth on surgical culture. Both had had pre-operative antibiotics. Eleven cultures of doubtful significance were repeated or regarded as negative and the patients carefully followed-up. One repeat culture confirmed infection emphasizing the importance of repeating doubtful aspirates. The sensitivity of aspiration is 93%, specificity is 96%. The accuracy is 95% confirming that aspiration is a simple and reliable method of diagnosing infection in hip prostheses |
0 | Mediated effects of physical risk factors, leaderâ??member exchange and empowerment in predicting perceived injury risk | DoD PRF (Psychosocial RF) | In the context of conservation of resources theory, we examine the indirect (mediated) effects of physical risk factors, leaderâ??member exchange (LMX) and empowerment on perceived injury risk in a heterogeneous sample (N = 226) of individuals employed in occupations related to production, construction and installation/maintenance. Positioning work role stressors and upward safety communications as two important mediating variables, as predicted, LMX and empowerment demonstrated significant indirect effects on perceived injury risk. Results from our model also provide preliminary evidence that an asymmetrical dualistic process exists in terms of the effect physical risk factors have on perceived injury risk via depletion of both psychological (i.e. role stressors) and physical resources (i.e. physical symptoms). Theoretical and practical implications based on the results of our model are also discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved) |
0 | Clinical outcomes in the revision of unicondylar arthoplasties to bicondylar arthroplasties. A matched-pair study | Surgical Management of Osteoarthritis of the Knee CPG | INTRODUCTION: The aim of the following study was to find out how much a previously implanted unicondylar prosthesis affects the clinical and functional outcome of a total knee arthroplasty in case of revision surgery. MATERIALS AND METHODS: A matched-pair comparative analysis was performed on 28 patients (group A) who required bicondylar knee arthroplasty following failed unicondylar arthroplasty and 28 patients (group B) with primary bicondylar knee arthroplasty. Both groups were matched according to age, sex, weight, height, type of prosthesis, and follow-up time after bicondylar arthroplasty. The patients' evaluation was based on the Knee Society Score and the WOMAC Score. Radiographs (AP weight-bearing and lateral) were taken of the knee. The average follow-up time after bicondylar arthroplasty was 55+/-15 months in group A and 56+/-13 months in group B. RESULTS: The knee score was 71.8+/-18 and 80.4+/-10 points (p=0.01) and the function score 56.1+/-15 and 64.1+/-19 points (p=0.1) for group A and group B, respectively. The subjective assessment according to the WOMAC Score was statistically significant in terms of the functional outcome. Increased postoperative range of motion of 109 degrees +/-11 degrees was noticed for group B in comparison with group A (101 degrees +/-8 degrees ; p=0.004). Patients revised from an unicondylar arthroplasty required a significantly thicker polyethylene inlay (12.9+/-3 mm) compared with the primarily implanted group (10.3+/-3 mm; p=0.004). CONCLUSION: Revision of an unicondylar to a bicondylar knee replacement showed inferior functional results in comparison to primary bicondylar knee arthroplasty. Patients are satisfied after conversion of an unicondylar to bicondylar prosthesis, but not quite as much as patients who received a primary bicondylar arthroplasty. However, in the small number of patients where revision surgery after failed unicondylar prosthesis is required, the patient had already been successfully treated for many years |
0 | Controversies in the management of intra-articular fractures of distal humerus in adults | The Treatment of Pediatric Supracondylar Humerus Fractures AUC | BACKGROUND: The surgical approach, type of olecranon osteotomy, method of stabilization of osteotomy, type of fracture stabilization, orthogonal vs parallel plate fixation, need for transposition of ulnar nerve, place for primary total elbow replacement, and type of rehabilitation schedule after surgical fracture treatment are the controversial issues in the treatment of complex intra-articular distal humerus fractures (C2 and C3) in adults. Severe comminution, bone loss, and osteoporosis at the site of distal articular fractures of humerus often lead to unsatisfactory results due to inadequate fixation. We hereby report the outcome of a series of intracondylar fractures of the humerus treated by open reduction and internal fixation and discuss the controversies in light of published literature. MATERIALS AND METHODS: One hundred and eighty-four patients of intra-articular fractures of distal humerus (C2 and C3) were operated by posterior transolecranon approach between January 1980 and December 2008. Initially, in the first part Chevron intra-articular osteotomy (n=108) was performed out of which 94 have been published in another publication. In later second part (1993 onward), extra-articular olecranon osteotomy (n=76) was routinely performed. Both columns were stably fixed by orthogonal methods; (n=174) however, during the last 2 years, in 10 patients with severe comminution with bone loss, stabilization was achieved by parallel plating. The osteotomy was routinely stabilized by tension band wiring with two parallel K-wires introduced up to the anterior ulnar cortex. The results were evaluated by the staging system of Caja et al. at a minimum follow-up of 2 years. RESULTS: In the first part of the study (n=94), there was delayed union in 4% (n=4), with the fracture taking more than 20 weeks for union. There was delayed union of ulnar osteotomy (n=3) and failure of one tension band wiring, requiring revision. Some loss of motion was seen in 20% of cases and these patients did not achieve full flexion and extension. However, all these patients had useful range of function, with 20 degrees -110 degrees of flexion and full pronation-supination. As per the staging system of Caja et al., the results were in the range of excellent to good in 72% cases (n=67), fair in 19% (n=18), and poor in 9% patients (n=9). In the second part of study (n=90) dual plate fixation of both columns by orthogonal methods (n=80) and parallel plate fixation in 10 patients was performed. The results were excellent to good in 78 patients (86%). CONCLUSIONS: The high rate of union can be achieved in complex intra-articular fractures of distal humerus if the proper principles of stable fracture fixation are followed, i.e., a posterior transolecranon approach and dual fixation of both columns and restoration of the continuity of articular surface. The stability achieved by this technique permits institution of early intensive physiotherapy to restore elbow function |
0 | Latissimus dorsi tendon transfer for irreparable postero-superior cuff tears: current concepts, indications, and recent advances | Glenohumeral Joint OA | Latissimus dorsi tendon transfer is a method for surgical treatment of massive irreparable posterosuperior cuff tears. It partially restores active anteflexion, external rotation, and function of the shoulder but does not significantly increase strength of the shoulder. It is contraindicated in case of pseudoparalytic shoulder; associated irreparable subscapularis tear, deltoid palsy, and in case of associated osteoarthritis, as an isolated procedure. |
0 | Evolution in Management of Tibial Pilon Fractures | DoD SSI (Surgical Site Infections) | PURPOSE OF REVIEW: Tibial plafond, or pilon, fractures can be some of the most difficult fractures to manage. As they are often associated with high-energy trauma, both the soft tissue involvement and the comminuted fracture pattern pose challenges to fixation. Furthermore, the complex anatomy and trauma to the cartilage at the time of injury predispose pilon fractures to poor functional outcomes and high rates of posttraumatic arthritis. This review will discuss the recent developments in the treatment of tibial pilon fractures.
RECENT FINDINGS: Historically, surgical management of pilon fractures has been associated with high rates of complications, including wound complications, infections, nonunions, and even the need for amputation. In response, staged protocols were created. However, recent studies have called this into question, demonstrating low wound complications with early definitive fixation. Additional studies are evaluating adjuvants to minimize wound complications, including the use of vancomycin powder and oxygen supplementation, while another study challenges the 7-cm myth regarding the distance needed between skin incisions. Additional research has been focused on alternative methods of managing these complex, and sometimes non-reconstructable, injuries with the use of external fixation, minimally invasive internal fixation, and primary arthrodesis. Tibial pilon fractures remain difficult to treat for even the most skilled orthopedic trauma surgeons. With improvements in surgical techniques and implants, complication rates have declined and outcomes have improved; however, the overall prognosis for these injuries often remains poor. |
0 | Dialysis-related amyloidosis revisited | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | OBJECTIVE: Dialysis-related amyloidosis occurs secondarily to the deposition of beta(2)-microglobulin. Dialysis-related amyloidosis predominantly involves the osteoarticular system and is clinically manifested by erosive and destructive osteoarthropathies, destructive spondyloarthropathy, and carpal tunnel syndrome. This article illustrates the radiographic, sonographic, CT, and MRI findings of dialysis-related amyloid arthropathies. CONCLUSION: Dialysis-related amyloidosis is characterized by various imaging appearances. In evaluating amyloidosis, MRI provides considerably more information than that obtained from conventional radiographic, CT, and sonographic studies |
1 | The diagnostic validity of magnetic resonance imaging in acute knee injuries with hemarthrosis. A single-blinded evaluation in 69 patients using high-field MRI before arthroscopy | Anterior Cruciate Ligament Injuries CPG | Sixty-nine patients with traumatic knee hemarthrosis were evaluated an average of 3 days after trauma by high field (1.5T) magnetic resonance imaging (MRI) using sagittal T1, T2-weighted and coronal 3D-gradient echo images. All knees were arthroscopically examined shortly afterwards. The diagnostic validity of MRI for intraarticular pathology was determined using arthroscopy as golden standard. All patients had pathological findings on arthroscopy. The injuries were sports-related in 77% of the cases. MRI was highly sensitive (86%) and specific (92%) for diagnosis of anterior cruciate ligament tears. Diagnosis of medial meniscal tears showed a 74% sensitivity and 66% specificity. MRI detected lateral meniscal tears in 50% with an 84% specificity. As such, MRI missed 10 significant meniscus ruptures requiring surgical treatment. The sensitivity for partial or total medial collateral ligament tears was 56%, the specificity 93%. Rupture of the medial retinaculum in cases with patellar dislocation or significant damage of articular cartilage were only detected by MRI in a few cases (27% and 20% sensitivity, respectively). MRIs low diagnostic validity for intraarticular pathology with hemarthrosis may be attributed to the shifting paramagnetic properties of the blood remains and catabolic processes in meniscal and chondral tissues during the hemoglobin degradation process. Accordingly, MRI, with the technique used, could neither replace arthroscopy in the diagnosis and screening of acute knee injuries, nor select patients with need for immediate arthroscopic meniscal surgery |
1 | Value of modern sonography in the assessment of meniscal lesions | AMP (Acute Meniscal Pathology) | The aim of this prospective study was to assess the accuracy of modern ultrasonography in diagnostic imaging of meniscal tears. One hundred and sixty menisci were evaluated in 80 patients (42 females, 38 males, mean age=36.2 years, range=16-70 years). Inclusion criteria for the study were twofold: clinical suspicion of meniscal injury and clinical indication for arthroscopy. Knee examination was performed with the Voluson 730 Expert ultrasound system (General Electric). After sonographic examination, all patients underwent arthroscopic procedures within 1-4 days. The final diagnosis of meniscal tears was taken from surgical reports. The overall sensitivity, specificity, positive predictive value and negative predictive value of sonographic examination in the assessment of meniscal tears amounted to 85.4%, 85.7%, 67.3% and 94.4%, respectively. The statistical parameters were not statistically different in medial and lateral menisci. Age, sex, body mass index (BMI), weight, physical activity, mechanism on injury, and time lapse from injury did not have a statistically significant impact on the usefulness of ultrasonography. The highest sensitivity (>90%) was obtained in medial menisci and in patients with a BMI>25. The highest specificity (>90%) was obtained in lateral menisci, in patients after twisting injuries, in sports injuries, and in recent injuries (time lapse from the injury <1 month). The positive predictive value (PPV) of sonographic examination was higher than 90% only in recent injuries (<1 month), however, the negative predictive value of ultrasound is high, being less than 90% in males with lesions of lateral menisci and in sequelae of sports injuries. |
0 | Clinical and electrophysiological presentation of pronator syndrome | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | Median neuropathy at the elbow (pronator syndrome [PS]) is rare compared to compression at the wrist. We sought to evaluate the clinical/electrophysiological parameters of this focal neuropathy. Between 1992 and 2002, we retrospectively reviewed records of eighty-three limbs in seventy-two patients with PS. Electrodiagnostic data as well as clinical symptoms, physical findings, demographic information and treatment modalities were examined. The main symptoms were forearm pain, numbness and weakness. One patient (two limbs) had nocturnal paresthesias. Twenty-five limbs (30%) showed decreased median forearm velocity. Fifty-four (65%) had abnormal median sensory studies of either abnormal conduction velocity or amplitude. Needle exam showed an abnormality of at least one median innervated muscle, abductor pollicis brevis, flexor carpi radialis, or pronator teres, in 70% (58/83). Sixteen limbs were identified as having undergone surgical decompression. In the surgical group, 10/16 (63%) were found to have constriction with a band which was released during surgery. Eight of the sixteen patients who underwent surgery were found to have documented improvement. Eleven patients (13%) had undergone previous surgery for Carpal Tunnel Syndrome (CTS) without benefit. The clinical and electrophysiological features of PS are quite different from patients with CTS. Proper localization is crucial to treatment options. Surgery can provide benefit in selected cases |
0 | Reconstructing facial contour deformities using stereoscopic thoracodorsal artery perforator adipofascial flaps | Panniculectomy & Abdominoplasty CPG | Purpose: Correcting facial contour deformities is a challenge, as it demands thoughtful planning on design, composition of flap, and secondary procedures. The thoracodorsal artery perforator (TDAP) flap has become a workhorse flap for various reconstructions. In this report, we present our experience of reconstructing facial contour deformities using the free TDAP adipofascial flap, focusing on its customized design. Patients and Method: Sixteen patients underwent correction of a facial contour deformity with free TDAP adipofascial flaps from 2002 to 2012. The causes of defects were Romberg disease (n = 7), oncological defects (n = 5), craniofacial microsomia (n = 3), and trauma (n = 1). The flaps were three-dimensionally designed in a contour map fashion to have different thickness according to the defects by adjusting the height of adipose tissue and varying tissue composition. Customized dimension of flaps having reliable perfusion were harvested with minimized sacrifice of overlying skin. Results: Flap size ranged from 6 Ã? 3 cm to 25 Ã? 25 cm. Six flaps were based on two perforators and the other 10 on one. Five flaps were harvested in a chimeric fashion. All flaps survived completely. No donor morbidity developed in any case. Seven patients underwent secondary corrections including fat injection or liposuction. Improved contour and symmetry were achieved in all patients and was confirmed by a photographic evaluation. Mean follow-up period was 37.8months. Conclusions: Our results suggest that the stereoscopic TDAP adipofascial flaps with diligent secondary approaches may be a reliable alternative for aesthetic reconstruction of facial contour deformities. © 2015 Wiley Periodicals, Inc. Microsurgery 37:300â??306, 2017. |
0 | Design of a Clinical Decision Support System for Fracture Prediction Using Imbalanced Dataset | Hip Fx in the Elderly 2019 | More than 1 billion people suffer from chronic respiratory diseases worldwide, accounting for more than 4 million deaths annually. Inhaled corticosteroid is a popular medication for treating chronic respiratory diseases. Its side effects include decreased bone mineral density and osteoporosis. The aims of this study are to investigate the association of inhaled corticosteroids and fracture and to design a clinical support system for fracture prediction. The data of patients aged 20 years and older, who had visited healthcare centers and been prescribed with inhaled corticosteroids within 2002-2010, were retrieved from the National Health Insurance Research Database (NHIRD). After excluding patients diagnosed with hip fracture or vertebrate fractures before using inhaled corticosteroid, a total of 11645 patients receiving inhaled corticosteroid therapy were included for this study. Among them, 1134 (9.7%) were diagnosed with hip fracture or vertebrate fracture. The statistical results showed that demographic information, chronic respiratory diseases and comorbidities, and corticosteroid-related variables (cumulative dose, mean exposed daily dose, follow-up duration, and exposed duration) were significantly different between fracture and nonfracture patients. The clinical decision support systems (CDSSs) were designed with integrated genetic algorithm (GA) and support vector machine (SVM) by training and validating the models with balanced training sets obtained by random and cluster-based undersampling methods and testing with the imbalanced NHIRD dataset. Two different objective functions were adopted for obtaining optimal models with best predictive performance. The predictive performance of the CDSSs exhibits a sensitivity of 69.84-77.00% and an AUC of 0.7495-0.7590. It was concluded that long-term use of inhaled corticosteroids may induce osteoporosis and exhibit higher incidence of hip or vertebrate fractures. The accumulated dose of ICS and OCS therapies should be continuously monitored, especially for patients with older age and women after menopause, to prevent from exceeding the maximum dosage. |
0 | A Randomized Clinical Trial Comparing Posterior Cruciate-Stabilizing vs Posterior Cruciate-Retaining Prostheses in Primary Total Knee Arthroplasty: 10-Year Follow-Up | PJI DX Updated Search | BACKGROUND: This 10-year follow-up compares health-related quality of life (HRQL) and reoperations in 100 subjects who were randomized to receive posterior cruciate ligament substituting (PS) or posterior cruciate ligament retaining (CR) total knee arthroplasty. We previously reported 2-year results. METHODS: Subjects were enrolled preoperatively and randomized at surgery. Subjects completed HRQL questionnaires at all evaluation points. Subjects were re-evaluated at 2 and 10 years with reoperations determined through regional medical record review and patient report. RESULTS: Over 10 years, 25 (25%) subjects died, 2 subjects were revised and withdrew, and 11 (11%) subjects were lost to follow-up. Of survivors, 62 of 75 (83%) were evaluated at 10 years. Twenty-eight (37%) subjects provided HRQL, radiographic, and reoperation status, 28 (37%) subjects completed HRQL evaluations and reoperation status only, and 6 (8%) subjects provided radiographic and reoperation follow-up. Both groups retained good HRQL between 2 and 10 years with no group differences noted (P > .35). One revision (CR subject), secondary to deep joint infection, occurred within 2 years with 1 further revision (PS subject) occurring at 3 years postoperatively. One subject (PS subject) required manipulation under anesthesia within 3 months of surgery. Four subjects required late patellar resurfacing (1 CR subject, 3 PS subjects) but were retained in the 10-year evaluation. Overall, reoperations were not significantly different between groups (P = .26). CONCLUSION: Over 10 years postoperatively, both the PS and CR total knee arthroplasty performed well with subjects reporting acceptable levels of HRQL up to 10 years postoperatively; low levels of revision or reoperation were reported in both groups |
1 | Comparative study on proximal femur locking plate and proximal femoral nail anti-rotation II in treating intertrochanteric fracture in the elderly | Hip Fx in the Elderly 2019 | Objective: To compare and analyse retrospectively the clinical effect of Proximal Femoral Nail AntiRotation II (PFNA-II) and Proximal Femur Locking Plate (PFLP) for the treatment of intertrochanteric fracture in the elderly. Methods: A total of 161 elderly patients with intertrochanteric fracture, who underwent either PFNA or PFLP in our hospital from March 2012 to March 2013, were enrolled in the study. These patients were assigned into PFNP group and PFLP group. The perioperative bleeding, duration of the surgery, mean out-of-bed time after surgery, mean length of stay, complications, mean perioperative loss of hemoglobin, mean healing time of fracture and Harris scores of both groups were evaluated. The postoperative adverse reactions were compared. Results: In comparison with PFLP group, the perioperative bleeding, duration of the surgery, mean length of stay, mean off-bed time after surgery, mean perioperative loss of hemoglobin and mean healing time of fracture were significantly lower in PFNA group, P<0.05. However, the duration of fluoroscopy time and hip function between 2 groups were not significantly different, P>0.05. And there were no significant differences in patient satisfaction, cutting of head and neck, incidence of incision infection, failure rate of internal fixation, and mortality in follow-up period between 2 groups, P>0.05. In comparison with PFNA group, the greater trochanter pain of patients was significantly milder and the rate of loose screws was significantly lower in PFLP group, P<0.05. Conclusion: For the treatment of intertrochanteric fracture in the elderly, surgery methods should be selected appropriately based on the fracture type and degree of osteoporosis. |
0 | Early results of displaced femoral neck fragility fractures treated with supercapsular percutaneous-assisted total hip arthroplasty | Hip Fx in the Elderly 2019 | Background: Total hip arthroplasty (THA) is the preferred treatment for displaced femoral neck fractures in select patients, although dislocation remains a concern. In some studies, the supercapsular percutaneously assisted (SuperPATH) approach has demonstrated early mobilization, short hospital stay, and low dislocation rates in primary THA, but there are little data on its use for fractures. This study describes the perioperative outcomes and early dislocation rate of SuperPATH THA for displaced femoral neck fragility fractures. Methods: A retrospective review was performed of previous ambulatory patients with a displaced femoral neck fragility fracture treated with THA using the SuperPATH approach. Demographic data, time to ambulation, length of stay, and in-hospital complications during the hospital stay and follow-up period were recorded. Phone interviews were conducted to check for dislocations 1 year after surgery. Results: Thirty-seven consecutive patients were included with an average age of 75.0 years. Hospital stay averaged 5.5 days, and patients were discharged on average postoperative day 3.6. About 83.8% of patients were ambulatory by postoperative day 1, and 94.6% ambulatory before discharge. Twenty-seven percent of patients were discharged home, 46% to inpatient rehabilitation, 24% to skilled nursing facility, and 1 patient to hospice. At follow-up, there was no symptomatic heterotopic ossification and no infections. Thirty-two patients were available for telephone interviews at 1 year, with no dislocations reported. Conclusions: In this small cohort, the SuperPATH approach for THA appears to be safe and effective for use in femoral neck fragility fractures, resulting in early ambulation and a low dislocation rate. |
0 | A comparison of intraarticular morphine and bupivacaine for pain control and outpatient status after an arthroscopic knee surgery under a low dose of spinal anaesthesia | Surgical Management of Osteoarthritis of the Knee CPG | Effective pain control is important after an outpatient arthroscopic knee surgery to permit early discharge and improve outcome. The aim of this study was to compare intraarticular morphine and bupivacaine with placebo for postoperative pain control and outpatient status after a knee arthroscopic surgery under a low dose of spinal anaesthesia. After obtaining the ethic committee's approval and written informed consents from 60 adult outpatients undergoing knee arthroscopy, patients were enrolled in this prospective, randomized, double-blinded, placebo-controlled clinical study. All patients received spinal anaesthesia with 1.4 ml of hyperbaric bupivacaine 0.5%. Patients were randomly divided into three groups as morphine (group M, n =20), bupivacaine (group B, n = 20), and placebo (group C, n = 20). After the surgical procedure, patients received one of the following solutions intraarticularly in a double-blinded randomized manner: 5 mg morphine in 20 ml saline, 20 ml 0.25% bupivacaine, or 20 ml saline. Postoperative pain was assessed using a 10-cm visual analogue scale (VAS). Patient characteristics, hemodynamic values, sensory and motor blocks, VAS values, rescue analgesics, discharge time, and patient satisfaction were recorded. There were no significant differences in patient characteristics, surgery and tourniquet time, hemodynamic values, and sensory and motor blocks. The VAS values at 30, 60, and 90 min were similar among the three groups. The VAS values at rest and during move were higher in group C than in groups M and B at 120, 150, 180 min, and 24 h (P < 0.001). There was no difference in VAS values between the groups M and B. Rescue analgesics used and discharge time were significantly different in the placebo group when compared to groups M and B (P < 0.001). Side effects were similar among the groups. Patient satisfaction scores were high in the groups M and B. Administration of 5 mg morphine and 20 ml of 0.25% bupivacaine intraarticularly provides better pain relief and shorter discharge time without increasing the side effects than placebo for an outpatient arthroscopic knee surgery performed under a low dose of spinal anaesthesia |
0 | Osteoarthritis management: the role of cyclooxygenase-2-selective inhibitors | SR for PM on OA of All Extremities | BACKGROUND: Cyclooxygenase (COX)-2-selective inhibitors are a new type of nonsteroidal anti-inflammatory drug (NSAID) for the management of pain caused by osteoarthritis (OA). The most recent OA guidelines from the American College of Rheumatology were published in 2000 because new therapies such as the COX-2-selective inhibitors had been introduced for the management of OA. OBJECTIVE: Because more data are now available on efficacy and safety issues with COX-2-selective inhibitors, NSAIDs, and acetaminophen, this review focuses on how COX-2-selective inhibitors may change the pharmacologic management of patients with OA. METHODS: References were obtained from MEDLINE, BIOSIS, EMBASE, and Internet searches of the literature. CONCLUSIONS: The safety and efficacy of two COX-2-selective inhibitors, rofecoxib and celecoxib, have been examined in a number of clinical trials, and these agents have been shown to offer efficacy similar to that of NSAIDs. Acetaminophen continues to be the initial drug of choice for the management of OA because of its efficacy, safety, cost, and availability. COX-2-selective inhibitors should be considered in patients with OA who do not respond to or cannot tolerate therapy with acetaminophen. COX-2-selective inhibitors have an improved gastrointestinal (GI) safety profile compared with traditional NSAIDs and should be chosen over NSAIDs if prescription plan access and/or expense is not a concern. COX-2-selective inhibitors are clinically indicated for patients at increased risk of developing NSAID-induced GI complications, a population in whom the use of COX-2-selective inhibitors may be cost-effective because the incidence and mortality associated with serious GI adverse events and use of expensive GI comedications would be reduced |
0 | Managing perioperative risk in the hip fracture patient | Management of Hip Fractures in the Elderly | Patients with hip fracture benefit from a multidisciplinary team approach for preoperative and postoperative care. Team members, consisting of the orthopedic surgeon, internal medicine consultant, and anesthesiologist, should each have a role in determining a patient's readiness for surgery and communicate with one another about appropriate management. How urgently a hip fracture needs repair depends on the type of injury. In general, most injuries should be repaired as soon as the patient can be medically optimized (preferably 24 to 48 hours), keeping in mind that procedures are often lengthy and maximally invasive, and frequently involve complications. Nondisplaced (impacted) femoral neck fractures, however, should be repaired within 6 hours if possible to avert avascular necrosis of the femoral head and the need for total hip replacement. The following interventions are helpful for preventing complications following hip fracture repair: perioperative prophylaxis against infection |
0 | Internal fixation of garden i and II femoral neck fractures: Posterior tilt did not influence the reoperation rate in 382 consecutive hips followed for a minimum of 5 years | DoD SSI (Surgical Site Infections) | OBJECTIVE: To analyze factors influencing the reoperation rate due to fracture healing complications after internal fixation of Garden I and II femoral neck fractures with special reference to a new validated method assessing the preoperative posterior tilt on lateral radiographs. DESIGN: Prospective cohort study. SETTING: Level II trauma center. PATIENTS: A consecutive cohort of 382 hips in 379 patients who underwent internal fixation for a Garden I or II femoral neck fracture. INTERVENTION: The posterior tilt in preoperative radiographs was analyzed with a new validated method. A Cox regression analysis was used to evaluate factors associated with reoperation due to fracture healing complications. Age, gender, cognitive function, ASA classification, time to surgery, and the posterior tilt were tested as independent factors in the model. MAIN OUTCOME MEASURES: Reoperation rate due to fracture healing complications with a minimal follow-up of 5 years. Reoperation data were validated against the National Board of Health and Welfare?s national registry using unique Swedish personal identification numbers. RESULTS: The overall reoperation rate was 19% (72 of 382 hips) and the reoperation rate due to fracture healing complications was 12% (45 of 382 hips). The posterior tilt had no influence on the risk for reoperation due to fracture healing complication, nor had the age, gender, cognitive function, ASA classification, or the time to surgery. CONCLUSIONS: Preoperative posterior tilt measurement on lateral radiographs cannot be used as a discriminator for fracture healing complications in Garden I and II femoral neck fractures. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2013 by Lippincott Williams & Wilkins. |
0 | Ultrasound evaluation of elbow fractures in children | Pediatric Supracondylar Humerus Fracture 2020 Review | PURPOSE: Elbow fractures are a common pathology in any pediatric emergency unit. X-ray of the elbow is the standard diagnostic procedure. Previous studies have shown that fractures can also be visualized by ultrasound (US). The aim of our study was to evaluate the diagnostic accuracy of US in comparison to X-rays in diagnosing pediatric elbow fractures. METHODS: Sixty-seven patients aged 1-13Â years with clinically suspected elbow fracture were first examined by US followed by standard two-plane radiographs. US examination was done with a 12-MHz linear probe from seven longitudinal positions across the distal humerus and additionally from longitudinal positions across the radial head and olecranon. The sonographic and radiological findings were compared in a contingency table, and sensitivity, specificity, and positive and negative predictive values of the US diagnostic procedure were calculated. RESULTS: With X-ray, we found 48 patients with an elbow fracture and 19 patients with no fracture. With US, we found 46 patients with an elbow fracture and 21 patients with no fracture. In comparison to X-ray diagnosis, we calculated for US diagnosis a sensitivity of 97.9Â %, a specificity of 95Â %, a negative predictive value of 95Â %, and a positive predictive value of 97.9Â %. CONCLUSION: Typical elbow fractures in children could also be visualized by US. A positive fat pad sign, in particular, serves as a strong indicator for elbow joint fractures and can be identified very sensitively by US. We confirm US as a valuable primary screening tool for elbow injuries in children. In the absence of US signs of fracture and in sonographically confirmed non-displaced fractures, standard X-rays are dispensable, thereby minimizing the X-ray burden in children without loss of diagnostic safety. |
1 | Functional Outcomes From Inpatient Rehabilitation After Traumatic Brain Injury: How Do Hispanics Fare? | DoD PRF (Psychosocial RF) | Arango-Lasprilla JC, Rosenthal M, DeLuca J, Cifu DX, Hanks R, Komaroff E. Functional outcomes from inpatient rehabilitation after traumatic brain injury: how do Hispanics fare? Objective: To examine the relation between Hispanic ethnicity and rehabilitation outcome in traumatic brain injury (TBI) survivors. Design: Retrospective study. Setting: Longitudinal dataset of the Traumatic Brain Injury Model Systems national database. Participants: Persons (N=3056; 2745 whites vs 311 Hispanics) with moderate to severe TBI hospitalized between 1989 and 2003. Interventions: Not applicable. Main Outcome Measures: Functional outcomes at discharge and 1-year follow-up (Disability Rating Scale [DRS], FIM instrument). Glasgow Outcome Scale-Extended (GOS-E), and the Community Integration Questionnaire (CIQ) were measured at follow-up only. Results: At admission, Hispanics were less educated (P�.001), earned less money (P�.05), and were younger (P�.001) than whites. Hispanics had lower GOS-E scores (P�.01) at acute hospital admission compared with whites. Despite similar functional status at inpatient rehabilitation discharge, Hispanic ethnicity was associated with poorer functional outcomes at 1 year postinjury (DRS, FIM, CIQ), after controlling for age, length of posttraumatic amnesia, injury severity, DRS score at admission, FIM score at admission, and preinjury educational level (P<.05). Conclusions: Hispanics showed significantly reduced long-term functional outcome after rehabilitation relative to whites. Rehabilitation professionals should recognize the possible impact of individual differences and diverse sociodemographic, injury, and rehabilitation characteristics so that differential health outcomes among TBI survivors can be reduced or eliminated. © 2007 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. |
0 | Calcitonin as a marker for bronchogenic cancer: a prospective study | MSTS 2018 - Femur Mets and MM | A prospective study was done of serum calcitonin (HCT) levels in 61 patients with bronchogenic cancer. Initially, 52% of patients had hypercalcitonemia. Hypercalcitonemia was not confined to patients with any particular histologic type. Seventy-eight percent of those with high calcitonin remained normocalcemic. There was no correlation between high calcitonin levels and osseous metastases. Selective thyroid venous sampling delineated two types of hypercalcitonemia: thyroidal and ectopic. To date, the ectopic type has been associated with the small cell bronchogenic carcinoma. High initial calcitonin levels decreased significantly in 75% of patients on antitumor therapy. In 13 evaluable patients calcitonin levels mirrored clinical status changes 67% of the time. Calcitonin may be a useful marker to assess the results of therapy in patients with bronchogenic cancer. |
0 | A novel approach of INTRABEAM intraoperative radiotherapy for nipple-sparing mastectomy with breast reconstruction | Reduction Mammoplasty for Female Breast Hypertrophy | BACKGROUND: Despite the advancement and increasing use of breast-conserving surgery, mastectomies, including nipple-sparing mastectomy (NSM), are still carried out in a portion of breast cancer patients. However, the role of NSM is still controversial, mainly because of concern about the oncologic safety of the nipple-areola complex (NAC). INTRABEAM (Carl Zeiss, Oberkochen, Germany) is the most widely used mobile intraoperative radiotherapy (IORT) device to date. This pilot study aims to broaden the application of the INTRABEAM system for breast cancer, investigating the feasibility of INTRABEAM IORT in NSM with breast reconstruction.
PATIENTS AND METHODS: From December 2012 to June 2013, 7 female patients with breast cancer were enrolled in the study. NSM with or without axillary dissection was performed first. After confirming negative retroareolar frozen section results and no poor local bleeding in the NAC, INTRABEAM IORT was carried out with a single dose of 16 Gy, followed by breast reconstruction. The complications and short-term outcomes were assessed.
RESULTS: The median radiation time was 13 minutes 14 seconds in the 7 cases. One patient complained of mild pain in the radiation field on the skin in the first 2 weeks. All 7 patients were followed for a median of 7 months. No acute radiation injury with symptoms (heart, lung, or hematologic system), NAC necrosis, local recurrence, or metastasis was observed. Although every patient had reduction in NAC sensitivity, the contours of the breasts (including the NAC) were satisfactory.
CONCLUSIONS: INTRABEAM IORT may be a feasible and convenient approach for NSM with breast reconstruction in patients with breast cancer. |
0 | Patient Characteristics, Treatment, and Presenting PROMIS Scores Associated with Number of Office Visits for Traumatic Hand and Wrist Conditions | Pediatric Supracondylar Humerus Fracture 2020 Review | BACKGROUND: Overuse of healthcare resources is burdensome on society. Prior research has demonstrated that many patients with traumatic musculoskeletal injuries continue to seek care long after appropriate healing is well established, suggesting an overuse of services. However, few studies have examined the factors-including patient-reported outcomes-associated with an increased number of clinic visits for traumatic hand and wrist conditions. QUESTIONS/PURPOSES: (1) After accounting for surgical treatment, surgeon, and demographic factors, is a patient's PROMIS Pain Interference score associated with the total number of office visits? (2) Is PROMIS Depression, combination of PROMIS Depression and Pain Interference, or Physical Function scores associated with the number of office visits? METHODS: Between June 2015 and May 2018, 1098 patients presenting for a new patient visit at a single, urban academic medical center for distal radius fracture, wrist or hand sprain, tendon rupture, traumatic finger amputation, or scaphoid fracture were identified. Of those, 823 (75%) patients completed all PROMIS domains and presented before the trailing period and thus were included in this retrospective study. We recorded a number of variables including: Total number of office visits, age, sex, race, marital status, diagnosis, provider, and operative or nonoperative treatment. Multivariable Poisson regression analysis was conducted to determine whether Patient-Reported Outcomes Measurement Information System Pain Interference (PROMIS PI), Physical Function (PROMIS PF), and Depression scores measured at the first visit were associated with the total number of office visits, after accounting for the other factors we measured. RESULTS: Higher PROMIS PI scores were associated with greater number of clinic visits (0.0077; 95% CI, 0.0018-0.014; p = 0.010). Although PROMIS Depression scores were not associated with the number of office visits (0.0042; 95% CI, -0.0099 to 0.0094; p = 0.112), higher PROMIS PF scores were associated with fewer office visits when accounting for confounding variables (-0.0077; 95% CI, -0.0012 to -0.0029; p = 0.001). Additionally, across all individual PROMIS models, there was an association between the variables "operative treatment" (PI: 0.85; 95% CI, 0.72-0.98; p < 0.001; Depression: 0.87; 95% CI, 0.74-1.0; p < 0.001; PF: 0.85; 95% CI, 0.72-0.99; p < 0.001) and "traumatic finger amputation" (PI: 0.22; 95% CI, 0.016-0.42; p = 0.034; Depression: 0.2; 95% CI, 0.086-0.47; p = 0.005; PF: 0.21; 95% CI, 0.014-0.41; p = 0.036) with an increased total number of office visits. Provider team 5 (PI: -0.62; 95% CI, -0.98 to -0.27; p = 0.001; Depression: -0.61; 95% CI, -0.96 to -0.26; p = 0.001; PF: -0.60; 95% CI, -0.96 to -0.25; p = 0.001) was associated with fewer office visits. In both the PROMIS Depression and PROMIS PF regression models, increasing age (Depression: -0.0048; 95% CI, -0.0088 to -0.00081; p = 0.018; PF: -0.0045; 95% CI, -0.0085 to -0.0006; p = 0.024) was also associated with fewer total number of office visits. CONCLUSIONS: This study helps surgeons understand that patients who present at their initial office visit for traumatic hand and wrist conditions displaying worse pain coping strategies and decreased physical function will have more office visits. We recommend that surgeons engage in a comprehensive care approach that is empathetic, fosters effective pain coping strategies (and so might decrease PROMIS PI scores), and educates patients about expectations by providing educational materials and/or including other health professionals (such as, social work, physical therapy, mental health professional) as needed. This may decrease healthcare use in patients with traumatic hand and wrist conditions. LEVEL OF EVIDENCE: Level IV, prognostic study. |
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