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0 | Small subchondral drill holes improve marrow stimulation of articular cartilage defects | Osteochondritis Dissecans 2020 Review | BACKGROUND: Subchondral drilling is an established marrow stimulation technique. HYPOTHESIS: Osteochondral repair is improved when the subchondral bone is perforated with small drill holes, reflecting the physiological subchondral trabecular distance. STUDY DESIGN: Controlled laboratory study. METHODS: A rectangular full-thickness chondral defect was created in the trochlea of adult sheep (n = 13) and treated with 6 subchondral drillings of either 1.0 mm (reflective of the trabecular distance) or 1.8 mm in diameter. Osteochondral repair was assessed after 6 months in vivo by macroscopic, histological, and immunohistochemical analyses and by micro-computed tomography. RESULTS: The application of 1.0-mm subchondral drill holes led to significantly improved histological matrix staining, cellular morphological characteristics, subchondral bone reconstitution, and average total histological score as well as significantly higher immunoreactivity to type II collagen and reduced immunoreactivity to type I collagen in the repair tissue compared with 1.8-mm drill holes. Analysis of osteoarthritic changes in the cartilage adjacent to the defects revealed no significant differences between treatment groups. Restoration of the microstructure of the subchondral bone plate below the chondral defects was significantly improved after 1.0-mm compared to 1.8-mm drilling, as shown by higher bone volume and reduced thickening of the subchondral bone plate. Likewise, the microarchitecture of the drilled subarticular spongiosa was better restored after 1.0-mm drilling, indicated by significantly higher bone volume and more and thinner trabeculae. Moreover, the bone mineral density of the subchondral bone in 1.0-mm drill holes was similar to the adjacent subchondral bone, whereas it was significantly reduced in 1.8-mm drill holes. No significant correlations existed between cartilage and subchondral bone repair. CONCLUSION: Small subchondral drill holes that reflect the physiological trabecular distance improve osteochondral repair in a translational model more effectively than larger drill holes. CLINICAL RELEVANCE: These results have important implications for the use of subchondral drilling for marrow stimulation, as they support the use of small-diameter bone-cutting devices. |
0 | Occurrence of tendon pathologies in metabolic disorders | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | This article reviews the pathogenetic role of metabolic disorders, which are of paramount relevance to the progression of tendon damage. In diabetes, the prevalence of rheumatological diseases is high, mainly because of the deleterious effects of advanced glycation end products that deteriorate the biological and mechanical functions of tendons and ligaments. In heterozygous familial hypercholesterolaemia, most patients develop Achilles xanthomatosis, a marker of high risk for cardiovascular disease caused by cholesterol deposition in the tendons. Tendon degeneration has also been observed in non-familial hypercholesterolaemia. Monosodium urate crystal deposition in soft tissues is a hallmark of chronic gouty arthritis. In this group of diseases, the mobilization of cholesterol and uric acid crystals is presumably followed by low-grade inflammation, which is responsible for tendon degeneration. Adiposity may contribute to tendon disorders via two different mechanisms: increased weight on the load-bearing tendons and systemic dysmetabolic factors that trigger subclinical persistent inflammation. Finally, tendon abnormalities have been observed in some rare congenital metabolism disorders such as alkaptonuria. (copyright) The Author 2013 |
0 | Effects of joint effusion on quadriceps muscles in patients with knee osteoarthritis | OAK 3 - Non-arthroplasty tx of OAK | OBJECTIVES: To evaluate the effect of knee effusion on the quadriceps muscle in patients with knee osteoarthritis (OA).
DESIGN: Single-blind, randomized, controlled clinical trial.
SETTING: Single medical center.
PARTICIPANTS: Forty subjects with knee OA were assigned to a experimental (n = 20) or control (n = 20) group.
MAIN OUTCOME MEASURES: Quadriceps torque and root mean square (RMS) values of surface electromyography (EMG) of the vastus medialis and vastus lateralis muscles were measured during a maximal isometric contraction at 60degree knee flexion. Thereafter, 20 mL of normal saline was injected into the knee joint of the experimental group. Quadriceps torque and RMS values were again measured.
RESULTS: Five subjects did not complete the study. No significant difference in quadriceps peak torque or RMS of EMG activity was observed at baseline, pre-effusion, or post-effusion measures in either group. The experimental group showed no significant change in quadriceps peak torque or RMS of EMG activity in any period compared with the control group.
CONCLUSIONS: These results demonstrate that a 20 ml joint effusion did not affect peak torque or RMS values of the quadriceps muscle in patients with knee OA. |
0 | Proximal femoral allografts for reconstruction of bone stock in revision arthroplasty of the hip. A nine to fifteen-year follow-up | Management of Hip Fractures in the Elderly | BACKGROUND: Revision of a femoral component in a patient who has severe bone loss is a complex problem that is likely to increase with the increasing numbers of patients who have multiple revision hip arthroplasties. A valuable option in such a situation is use of a long-stem prosthesis that is cemented to a proximal femoral allograft but not to the host bone. METHODS: Between April 1984 and December 1989, sixty-three total hip arthroplasties in sixty consecutive patients were revised with a proximal femoral allograft-prosthesis construct. The average length of the allograft was 15 cm. The average age of the patients at the time of the revision was 62.5 years. All patients had undergone at least one previous total hip arthroplasty, and an average of 3.8 previous total hip arthroplasties had been performed in the series. Each patient was assigned a modified Harris hip score. Radiographs were examined for trochanteric union, allograft-host union, endosteal and periosteal resorption, component loosening, and fracture. RESULTS: At an average of eleven years (range, nine years and four months to fifteen years) after the revision, forty-five patients were alive, fourteen patients had died, and one patient had been lost to follow-up. The patients who had died or had been lost to follow-up had had a total of fifteen allografts (24%) and had been followed for an average of five years and seven months (range, two years and four months to eight years). The average preoperative Harris hip score for the sixty-three hips was 30 points (range, 6 to 65 points). At the latest follow-up evaluation, the average score for the hips with the original graft in situ was 71 points (range, 47 to 95 points). Five hips failed because of infection, and four of them were successfully revised. Three hips failed because of aseptic loosening, at an average of ten years and three months; two were successfully revised, and the third was awaiting revision at the time of writing. An additional operation was performed in three hips with allograft-host nonunion and in two with dislocation. Success was defined as a postoperative increase in the Harris hip score of greater than 20 points, a stable implant, and no need for additional surgery related to the allograft at the time of the review. The success rate for all hips was 78% (forty-nine of sixty-three) after an average of nine years of follow-up. The success rate for the patients who were alive at the time of follow-up was 77% (thirty-seven of forty-eight hips) after an average of eleven years of follow-up. CONCLUSIONS: The clinical and radiographic results at an average of eleven years after revision hip arthroplasty with a proximal femoral allograft are encouraging. This report represents our early experience; improvements in the technique have been made. We believe that this technique provides a viable option for treatment of the difficult problem of severe femoral bone loss |
1 | Uncontrolled diabetes as a potential risk factor in tibiotalocalcaneal fusion using a retrograde intramedullary nail | DoD LSA (Limb Salvage vs Amputation) | Background: Tibiotalocalcaneal (TTC) fusion using a retrograde intramedullary (IM) nail is an effective salvage option for terminal-stage hindfoot problems. However, as many patients who receive TTC fusion bear unfavorable medical comorbidities, the risk of nonunion, infection and other complications increases. This study was performed to identify the factors influencing outcomes after TTC fusion using a retrograde IM nail. Methods: Between September 2008 and February 2012, 34 consecutive patients received TTC fusion using a retrograde IM nail for limb salvage. All patients had a minimum follow-up of two years. Throughout follow-up, standard ankle radiography was performed along with clinical outcome assessment using a visual analog scale (VAS) for pain, the American Orthopaedic Foot and Ankle Society Ankle-Hind Foot Scale (AOFAS A/H scale) and the Foot and Ankle Outcome Score (FAOS). For the retrospective analysis, demographic factors, preoperative medical status, laboratory markers, and etiology were comprehensively reviewed using medical records. The success of the index operation was determined using clinical and radiological outcomes. Finally, the effect of each factor on failure after the operation was analyzed using univariate logistic regression. Results: In a mean of seven months, 82% (28/34) achieved union, as evaluated by standard radiography. All clinical outcome parameters improved significantly after the operation, including VAS, AOFAS A/H scale, and FAOS (P < 0.001). At the last follow-up, five cases of nonunion with less than AOFAS A/H scale of 80 and two cases of below knee amputation due to uncontrolled infection were determined to be failures. None of the factors (etiology, demographics, laboratory markers and medical status) significantly influenced failures. However, uncontrolled DM significantly increased the failure rate with an odds ratio of 10 (P = 0.029). Conclusions: TTC fusion with a retrograde intramedullary nail is a successful treatment for complicated hindfoot problems such as traumatic osteoarthritis, Charcot arthropathy and failed TAA. However, it should be used judiciously in patients with uncontrolled DM, as the risk of failure increases. Design: Retrospective cohort study. |
1 | Treatment of distal femur and proximal tibia fractures with external fixation followed by planned conversion to internal fixation | DoD LSA (Limb Salvage vs Amputation) | PURPOSE: To evaluate healing rates and complications in patients treated with temporary external fixation (EF) and subsequent open reduction and internal fixation (ORIF) for high-energy distal femur or proximal tibia fractures. METHODS: Retrospective analysis of prospectively collected data 1999 to 2005. Demographic data and injury severity score were obtained from medical records. Factors reviewed included perioperative complications (nonunion, postoperative infection, loss of fixation) and time to radiographic and clinical union. RESULTS: Forty-seven patients with 16 distal femur and 36 proximal tibia fractures were treated using temporary EF. Patients subsequently underwent ORIF (mean time from EF to ORIF = 5 days, range 1-23 days). Thirty-five fractures were open (Gustilo I = 8, II = 6, IIIA = 3, IIIB = 13, IIIC = 5) and 17 closed. Forty patients with 44 fractures reached 1-year follow-up. Of these, 36 patients with 40 (91%) fractures had healed both radiographically and clinically. The mean postoperative follow-up time was 14 months (range 3-68). Eight (16%) deep infections occurred, all in open fractures (Gustilo I = 2, IIIB = 3, IIIC = 3), with one patient requiring above knee amputation. Other complications included one hematoma, two malunions, one fixation failure, and one pin site infection. One patient died as a result of a stroke. CONCLUSIONS AND SIGNIFICANCE: Temporary bridging EF offers the advantage of early soft tissue and bone stabilization without the potential local risks of immediate ORIF in severely injured soft tissues, or the potential systemic risks in a severely traumatized patient. The 16% infection rate in this study, all occurring in open fractures, falls within the reported range for grade III open fractures (15%-20%). We conclude that the initial treatment of high-energy periarticular knee fractures with bridging EF, followed by planned conversion to internal fixation is a safe option in patients who are unsuitable for initial definitive surgery. |
0 | Physical and Psychosocial Functions of Adults with Lower Limb Congenital Deficiencies and Amputations in Childhood | DoD LSA (Limb Salvage vs Amputation) | Objectives. (1) To describe the epidemiological and medical features of a sample with LLA and LLD in childhood and (2) to explore their relationship with subsequent physical and psychosocial functions in adulthood. Methods. Cross-sectional survey. Demographics, medical data, Locomotor Capabilities Index (LCI), and Discomfort-Engagement in Everyday Activities Involving Revealing the Body Scale (D-EEARB) were collected from thirty-two adults who suffered from LLA in childhood or LLD. Results. Most of the sample (53.1% males) was working (84.4%), living independently (75%), and single (75%). Mean age was 33.16 (SD = 7.64, range 18-50). Leading causes for LLA were traumatic (40.6%) and oncologic (25%). LLD was present in 6 cases (18.8%). LCI scores revealed a high performance among males (t 17,464 = 2.976, p = .008). D-EEARB scores showed that 56.25% stated feeling "quite" or "totally comfortable" in situations which involved revealing their body, but 43.75% stated the contrary ("uncomfortable" or "very uncomfortable"). LLD and traumatic LLA show higher scores in D-EEARB than vascular and oncological LLA (chi (2) = 7.744, df = 3, p = .05). Conclusions. Adults suffering from LLDs and LLAs during childhood seem to perform well once they are adults. However, 43.75% of patients express considerable discomfort in situations that involve revealing the body. |
0 | Primary care for women. Comprehensive assessment of common musculoskeletal disorders | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | This article reviews the common musculoskeletal disorders that are likely to be encountered in the women's primary care setting. Basic anatomy and physiology of the musculoskeletal system are reviewed, and the assessment and treatment of complaints of strains, sprains, low back pain, chest pain, carpal tunnel syndrome, musculoskeletal pain syndrome, fibromyalgia, osteoporosis, and osteoarthritis are discussed. Examples of low-technology treatment strategies are included |
0 | Endoscopic axillary lymphadenectomy without prior liposuction: Development of a technique and initial experience | Panniculectomy & Abdominoplasty CPG | Background: A new technique of endoscopic axillary lymphadenectomy without prior liposuction was developed by our group. Method: A total of 33 patients with early stage breast cancer were treated by breast-conserving therapy and endoscopic axillary lymphadenectomy. Results: The median duration of the operation was 74.9 min (range, 30-130). Operation time was significantly shorter for the last 17 patients (p < 0.05) than for the first 16 patients. There were no intraoperative complications. The median number of removed lymph nodes was 14.5 (range, 2-28). Postoperatively three patients developed a seroma, one of which required evacuation. At postoperative day 5, arm mobility was unrestricted in 26 patients (78.7%); nine patients (27.2%) reported a loss of sensation in the outer side of the upper arm related to dermatome C5. One patient developed a temporary alar scapula, and one patient developed an axillary abscess 9 weeks after axillary lymphadenectomy during radiation therapy. After a median follow-up of 4.6 months seven patients reported persistent impairment of sensation, but all patients had regained full shoulder mobility. Conclusion: Endoscopic axillary lymphadenectomy can be done safely without prior liposuction. |
0 | Rheumatoid arthritis vs osteoarthritis in patients receiving total knee arthroplasty: perioperative outcomes | PJI DX Updated Search | There is a paucity of data available on perioperative outcomes of patients undergoing total knee arthroplasty (TKA) for rheumatoid arthritis (RA). We determined differences in demographics and risk for perioperative adverse events between patients suffering from osteoarthritis (OA) versus RA using a population-based approach. Of 351,103 entries for patients who underwent TKA, 3.4% had a diagnosis of RA. RA patients were on average younger [RA: 64.3 years vs OA: 66.6 years; P<0.001] and more likely female [RA: 79.2% vs OA: 63.2%; P<0. 001]. The unadjusted rates of mortality and most major perioperative adverse events were similar in both groups, with the exception of infection [RA: 4.5% vs. OA: 3.8%; P<0.001]. RA was not associated with increased adjusted odds for combined adverse events |
0 | Long-term results and costs of muscle flap coverage with Ilizarov bone transport in lower limb salvage | DoD SSI (Surgical Site Infections) | OBJECTIVES: To determine long-term outcomes and costs of Ilizarov bone transport and flap coverage for lower limb salvage.
DESIGN: Case series with retrospective review of outcomes with at least 6-year follow-up.
SETTING: Academic tertiary care medical center.
PATIENTS: Thirty-four consecutive patients with traumatic lower extremity wounds and tibial defects who were recommended amputation but instead underwent complex limb salvage from 1993 to 2005.
INTERVENTION: Flap reconstruction and Ilizarov bone transport.
MAIN OUTCOME MEASUREMENTS: Outcomes assessed were flap complications, infection, union, malunion, need for chronic narcotics, ambulation status, employment status, and need for reoperations. A cost analysis was performed comparing this treatment modality to amputation.
RESULTS: Thirty-four patients (mean age: 40 years) were included with 14 acute Gustilo IIIB/C defects and 20 chronic tibial defects (nonunion with osteomyelitis). Thirty-five muscle flaps were performed with 1 flap loss (2.9%). The mean tibial bone defect was 8.7 cm, mean duration of bone transport was 10.8 months, and mean follow-up was 11 years. Primary nonunion rate at the docking site was 8.8% and malunion rate was 5.9%. All patients achieved final union with no cases of recurrent osteomyelitis. No patients underwent future amputations, 29% required reoperations, 97% were ambulating without assistance, 85% were working full time, and only 5.9% required chronic narcotics. Mean lifetime cost per patient per year after limb salvage was significantly less than the published cost for amputation.
CONCLUSIONS: The long-term results and costs of bone transport and flap coverage strongly support complex limb salvage in this patient population. |
0 | A modified two-incision minimally invasive total hip arthroplasty: Technique and short-term results | Hip Fx in the Elderly 2019 | Between 2003 and 2005, a total of 425 consecutive cases with a modified two-incision minimally invasive total hip arthroplasty (THA) were performed at our hospital. We analysed 225 cases with greater than 12 months follow-up clinically and radiographically. The mean operative time was 70 minutes. Patients could walk on crutches at 1.5 days and discontinued crutch use at an average of 3 weeks. Patients were able to walk upstairs without support at 4 weeks. Radiographic analysis showed the mean lateral opening angle and anteversion of the acetabular components were 43.0° and 17.3°, and 97% of the femoral stems were in neutral alignment. There was no radiographic evidence of component migration or subsidence at the most recent follow-up. Therefore, from these early results, a modified two-incision THA was found to be an excellent surgical modality, which allows early rehabilitation and does not increase complications when compared to other MIS two-incision THA technique. © Wichtig Editore, 2006. |
1 | A preliminary study of the effect of closed incision management with negative pressure wound therapy over high-risk incisions | DoD SSI (Surgical Site Infections) | BACKGROUND: Certain postoperative wounds are recognised to be associated with more complications than others and may be termed high-risk. Wound healing can be particularly challenging following high-energy trauma where wound necrosis and infection rates are high. Surgical incision for joint arthrodesis can also be considered high-risk as it requires extensive and invasive surgery and postoperative distal limb swelling and wound dehiscence are common. Recent human literature has investigated the use of negative pressure wound therapy (NPWT) over high-risk closed surgical incisions and beneficial effects have been noted including decreased drainage, decreased dehiscence and decreased infection rates. In a randomised, controlled study twenty cases undergoing distal limb high-energy fracture stabilisation or arthrodesis were randomised to NPWT or control groups. All cases had a modified Robert-Jones dressing applied for 72 h postoperatively and NPWT was applied for 24 h in the NPWT group. Morphometric assessment of limb circumference was performed at six sites preoperatively, 24 and 72 h postoperatively. Wound discharge was assessed at 24 and 72 h. Postoperative analgesia protocol was standardised and a Glasgow Composite Measure Pain Score (GCPS) carried out at 24, 48 and 72 h. Complications were noted and differences between groups were assessed. RESULTS: Percentage change in limb circumference between preoperative and 24 and 72 h postoperative measurements was significantly less at all sites for the NPWT group with exception of the joint proximal to the surgical site and the centre of the operated bone at 72 h. Median discharge score was lower in the NPWT group than the control group at 24 h. No significant differences in GCPS or complication rates were noted. CONCLUSIONS: Digital swelling and wound discharge were reduced when NPWT was employed for closed incision management. Larger studies are required to evaluate whether this will result in reduced discomfort and complication rates postoperatively. |
0 | Long-term trends in the epidemiology and resistance of childhood bacterial enteropathogens in Crete | Patrick’s pharmacoepidemiology project | In this study, we investigated the long-term trends in the epidemiology and susceptibility of bacterial enteropathogens among children in a well-defined area of adequate health standards. The study included all children younger than 14 years of age treated for enteritis at Heraklion University General Hospital on the island of Crete during the 18-year period from January 1993 to December 2010. Stool specimens were tested for Salmonella, Shigella, Campylobacter, enteropathogenic Escherichia coli (EPEC), Yersinia, and Aeromonas species. Of the 33,032 stool samples from patients of any age, 2,912 (8.82%) were positive for bacterial enteropathogens. The 1,597 isolates from children were identified as S. enterica (42.3%), Campylobacter spp. (33.6%), EPEC (17.4%), Y. enterocolitica (5.82%), A. hydrophila (0.44%), and Shigella spp. (0.38%). A decline in prevalence was observed for all bacterial enteropathogens. Taken as a total, enteropathogens were susceptible to gentamicin, ceftriaxone, ciprofloxacin, co-trimoxazole, and amoxicillin in 98.8%, 88.0%, 83.0%, 67.1%, and 59.6%, respectively. During the study period, the susceptibility rates decreased for co-trimoxazole (p<0.0001) and ciprofloxacin (p<0.001), and increased for amoxicillin (p<0.0001). Our findings suggest declining long-term trends in the prevalence of bacterial enteropathogens and changes in susceptibility rates to first-line antibacterial agents. These changing trends in the long-term morbidity and susceptibility call for ongoing surveillance and tailored management |
0 | Potential markers of tongue tumor progression selected by cDNA microarray | MSTS 2018 - Femur Mets and MM | Squamous cell carcinoma (SCC), the most frequent malignant tumor of the oral cavity, generally exhibits a poor prognosis and metastases are the main cause of death. This tumor often arises from pre-malignant lesions. To date, it is difficult to predict if and which pre-malignant lesions may progress into oral SCC using traditional methods. For these reasons, several studies are trying to identify markers useful in the progression of pre-malignant lesions and tumors. To define the genetic expression profile of tongue tumor progression we compared 9 dysplasias (DS), 8 tumors without metastasis (TWM), 11 metastasizing SCCs (MT) of the tongue, and a baseline of 11 normal tissues by using cDNA microarray containing 19.2 K clones. We initially applied hierarchical agglomerative clustering based on information from all 6026 clones. Results were obtained by performing a two steps analysis: a Significance Analysis of Microarray (SAM) and a Gene Ontology search. One hundred and five clones have statistically significant different expression levels (FDR < 0.01) between DS and TWM, whereas 570 genes have statistically significant difference expression levels between TWM and MT (FDR < 0.01) as detected by SAM. By filtering with FatiGo only 33 genes were differentially expressed in TWN, respect to DS, whereas 155 genes were differentially expressed in MT respect to TWM. We detected some genes which encode for oncogenes, transcription factors and cell cycle regulators as potential markers of DS progression. Examples are BAG4, PAX3 and CCNI, respectively. Among potential markers of metastases are some genes related to cell mobility (TSPAN-2 and SNTA1), intercellular adhesion (integrin alpha 7) or extracellular matrix components (ADAMTS2 and cathepsin O). Additionally, under-expressed genes encoded apoptosis-related proteins (PDCD4 and CASP4). In conclusion, we identified several genes differentially expressed in tumor progression which can potentially help in better classifying pre-malignant lesions and tongue SCCs. |
0 | Total knee replacement after fractures about the knee | Surgical Management of Osteoarthritis of the Knee CPG | We reviewed 17 cases of posttraumatic arthritis after fractures about the knee. All patients underwent total knee replacement; one had a distal femoral osteotomy to correct a deformity prior to arthroplasty. Thirteen patients had a minimum one-year follow-up, with an average follow-up of 27 months (range, one to four years). Of these, eight were considered to have a successful clinical result. All five patients with unsuccessful results had major intraoperative and/or postoperative complications. In malunions of intra-articular fractures of the proximal tibia, the important technical consideration for planned total knee replacement is preoperative tilt of the tibial plateau in the antero-posterior (AP) and lateral radiographic views. Tibial plateau tilt should be recognized during preoperative planning, and intraoperative adjustments are required. In malunions of extra-articular fractures of the distal femur or proximal tibia, a varus or valgus deformity is an important consideration. Prearthroplasty osteotomy may be considered in a patient with a significant bony deformity above or below the joint line. Incisions should be carefully planned, especially when a previous lateral distal femoral approach has been performed. The results may resemble revision rather than primary arthroplasty |
0 | Oral health status and oral hygiene practices of patients with peptic ulcer and how these affect Helicobacter pylori eradication from the stomach | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | Background: Helicobacter pylori eradication from the oral cavity is more difficult than from the stomach. Thus, if the bacterium survives the antibacterial therapy in the oral cavity, it would be able to re-infect the stomach within a few weeks. Since oral health status could correspond to oral infection with H. pylori, the aim of the study was to determine whether oral health and oral hygiene practices affect the efficacy of H. pylori eradication from the stomach. Material and Methods: The study was performed in 137 patients with peptic ulcer who had undergone a 7-day course of eradication treatment with one of two sets of drugs: 1, omeprazole, amoxicillin, and tinidazole or 2, omeprazole, clarithromycin, and tinidazole. The efficacy of H. pylori eradication from the stomach was evaluated at the second gastroscopy 4 weeks after cessation of eradication therapy by means of two methods: rapid urease test and histology. The examination of natural dentition and prosthetic restorations as well as the assessment of hygienic procedures referring to natural dentition and dentures accompanied the second gastroscopy. Results: No association was found between the efficacy of H. pylori eradication from the stomach and the number of natural teeth, decayed teeth, use of dentures, debris index, or periodontal index. However, an association between eradication success and some oral hygiene procedures were noted. Unexpectedly, in patients treated with omeprazole, amoxicillin and tinidazole, the removal of dental prosthesis for the night and brushing the natural teeth twice a day or more reduced the efficacy of H. pylori eradication from the stomach. Conclusions: Oral health and oral hygiene practices seem unlikely to increase the efficacy of H. pylori eradication from the stomach. (copyright) 2007 The Authors |
0 | Prevalence of bisphosphonate-related osteonecrosis of the jaw-like lesions is increased in a chemotherapeutic dose-dependent manner in mice | MSTS 2018 - Femur Mets and MM | Bisphosphonate-related osteonecrosis of the jaw (BRONJ) worsens oral health-related quality of life. Most BRONJ occurs in multiple myeloma or metastatic breast cancer patients treated with bisphosphonate/chemotherapeutic combination therapies. Cyclophosphamide (CY), an alkylating chemotherapeutic drug, is used to treat multiple myeloma, although its use has been recently reduced. The aim of this study was to clarify the effects of CY dose on tooth extraction socket healing when CY is used with or without bisphosphonate in mice. Low-dose CY (50mg/kg; CY-L), moderate-dose CY (100mg/kg; CY-M), high-dose CY (150mg/kg; CY-H), and bisphosphonate [Zometa (ZA): 0.05mg/kg] were administered for 7weeks. Each dose of CY and ZA in combination was also administered for 7weeks. Both maxillary first molars were extracted at 3weeks after the initiation of drug administration. Euthanasia was performed at 4weeks post-extraction. Gross wound healing, microcomputed tomography analysis, histomorphometry, and immunohistochemistry were used to quantitatively evaluate osseous and soft tissue wound healing of tooth extraction sockets. ZA monotherapy induced no BRONJ-like lesions in mice. CY monotherapy rarely induced open wounds, though delayed osseous wound healing occurred in a CY dose-dependent manner. In contrast, CY/ZA combination therapy prevalently induced BRONJ-like lesions with compromised osseous and soft tissue healing in a CY dose-dependent manner. Interestingly, anti-angiogenesis was noted regardless of CY dose and ZA administration, even though only CY-M/ZA and CY-H/ZA combination therapies induced BRONJ-like lesions. Our findings suggest that high-dose CY may be associated with the development of BRONJ following tooth extraction only when CY is used together with ZA. In addition to anti-angiogenesis, other factors may contribute to the pathoetiology of BRONJ. |
0 | The timed up and go test predicts fracture risk in older women independently of clinical risk factors and bone mineral density | Hip Fx in the Elderly 2019 | Summary: The timed up and go (TUG) test measures physical performance and predicts falls in the elderly. In older women, TUG time predicts the risk of major osteoporotic fracture and hip fracture independently of clinical risk factors and bone mineral density, and has a substantial impact on fracture probabilities. Introduction: The timed up and go (TUG) test measures physical performance and predicts falls in the elderly. A slow TUG has been associated with an increased fracture risk, but it is unclear whether the association is independent of clinical risk factors and bone mineral density (BMD). The aim of this study was to investigate if TUG time was associated with fracture risk independently of clinical risk factors and BMD and to determine its impact on fracture probabilities in older women. Methods: A standardized questionnaire was used to assess information regarding clinical risk factors in the large population-based SUPERB study of 3028 older women (75–80 years). At baseline, the TUG test was performed and BMD measured with DXA. The association between TUG time and the risk of hip fracture and major osteoporotic fracture (MOF) was examined using an extension of Poisson regression. Results: Fracture incidence increased steeply with increasing TUG time up to 12 s and subsequently started to level off. A slow TUG time was therefore defined as TUG > 12 s, a cutoff level then used in Cox models to study the association between slow TUG and fracture risk. A slow TUG time was associated with an increased risk of fracture (MOF 2.39 [1.80–3.18] and hip fracture 2.96 [1.62–5.40]). These associations were slightly attenuated but remained significant after adjustment for clinical risk factors and femoral neck BMD. Depending on BMD, the 4-year fracture probability of MOF increased by a factor of 1.5–1.9 in a 75-year-old woman with slow TUG (> 12 s). Conclusion: The TUG time predicts the risk of MOF and hip fracture independently of clinical risk factors and BMD and has a substantial impact on fracture probabilities, indicating that inclusion of the TUG test in patient evaluation should be considered in order to improve fracture prediction in older women. |
0 | Musculoskeletal symptoms and orthopaedic complications in pregnancy: pathophysiology, diagnostic approaches and modern management | DoD - ACS - Interrater Reliability | Low back pain is a common musculoskeletal symptom in pregnancy that can present as lumbar pain or pelvic girdle pain, with significant physical and psychosocial implications. Pelvic girdle pain is more prevalent and results in greater disability than lumbar pain. It is possible to distinguish between these two conditions from a detailed history based on the site of the pain, its intensity, disability and pain provocation tests. Management of low back pain in pregnancy is conservative, with physical exercise for lumbar pain and minimising activities that exacerbate pain, analgesics and bed rest for pelvic girdle pain, as well as avoiding abduction beyond the pain-free zone in labour. There is evidence that stabilising exercises in patients with pelvic girdle pain postpartum have a beneficial effect. Other treatment modalities that have been shown to be safe and effective include pelvic belts, transcutaneous electrical nerve stimulation, spinal manipulative therapy, acupuncture and complementary therapy with yoga. Other orthopaedic complications in pregnancy such as carpal tunnel syndrome, pubic symphysis rupture, transient osteoporosis and osteonecrosis are usually self-limiting with a satisfactory outcome. However, a lack of awareness and failure to recognise these complications can result in long-term morbidity. Knowledge of the preoperative diagnostic investigations, surgical approaches and intraoperative positioning of the mother to avoid gravid uterus compression is vital in orthopaedic emergencies such as lumbar disc herniation, cauda equina syndrome, fractures and acute compartment syndrome of the lower limb to ensure a safe maternal and fetal outcome and to prevent serious disability. Pregnancy is not contraindicated in women with pre-existing orthopaedic complications such as kyphoscoliosis and total hip arthroplasty as there is no evidence to suggest increased maternal or fetal risks.
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1 | Osteochondral Autologous Transplantation Compared to Microfracture for Treating Osteochondral Defect: An Updated Meta-analysis of Randomized Controlled Trials | OAK 3 - Non-arthroplasty tx of OAK | Various techniques have proven to be effective for treating articular cartilage defect of the knee joint, but knowledge regarding which method is best still remains uncertain. Osteochondral autologous transplantation (OAT) provides hyaline or hyaline-like repair for articular defects, whereas microfracture (MF) provides fibrocartilage repair tissue. To compare the OAT with MF procedure for the treatment of articular cartilage defect, we present an update of previous meta-analysis of randomized controlled trials.We searched for the published results of relevant trials. Then, we pooled the outcome measures of the included trials for analysis. The outcome measures assessed in this study included the number of patients who reached excellent or good results, the patients returning to the activity, the International Cartilage Repair Society (ICRS) scores, the failure rate, and the osteoarthritis rate. Six studies and 294 patients were identified as eligible for data extraction and meta-analysis. The pooled result showed that there was no significant difference in the excellent or good results (relative risks [RRs], 1.27; 95% confidence intervals [CIs], 0.95 to 1.70; p = 0.11) and the rate of osteoarthritis (RRs, 0.64; 95% CIs, 0.37 to 1.13; p = 0.12). There were significant differences between the two groups in the scores of ICRS (mean differences [MDs], 12.51; 95% CIs, 10.55 to 14.47; p = 0.00001), the patients returning to activity (RRs, 2.04; 95% CIs, 1.36 to 3.07; p = 0.0006), and in the failure rate (RRs, 0.23; 95% CIs, 0.11 to 0.49; p = 0.0001). OAT has more advantages compared with MF procedure in referring to the index of return to activity, the scores of ICRS, and the rate of failure. However, the limitations restrict the generalizability of this study, and larger, sufficiently powered studies are necessary to evaluate the efficiency of OAT compared with MF procedure in the future. |
0 | Minimal detectable change for mobility and patient-reported tools in people with osteoarthritis awaiting arthroplasty | Surgical Management of Osteoarthritis of the Knee CPG | BACKGROUND: Thoughtful use of assessment tools to monitor disease requires an understanding of clinimetric properties. These properties are often under-reported and, thus, potentially overlooked in the clinic. This study aimed to determine the minimal detectable change (MDC) and coefficient of variation per cent (CV%) for tools commonly used to assess the symptomatic and functional severity of knee and hip osteoarthritis. METHODS: We performed a test-retest study on 136 people awaiting knee or hip arthroplasty at one of two hospitals. The MDC95 (the range over which the difference [change] for 95% of patients is expected to lie) and the coefficient of variation per cent (CV%) for the visual analogue scale (VAS) for joint pain, the six-minute walk test (6MWT), the timed up-and-go (TUG) test, the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Hip Disability and Osteoarthritis Outcome Score (HOOS) subscales were calculated. RESULTS: Knee cohort (n = 75) - The MDC95 and CV% values were as follows: VAS 2.8 cm, 15%; 6MWT 79 m, 8%; TUG +/-36.7%, 13%; KOOS pain 20.2, 19%; KOOS symptoms 24.1, 22%; KOOS activities of daily living 20.8, 17%; KOOS quality of life 26.6, 44. Hip cohort (n = 61) - The MDC95 and CV% values were as follows: VAS 3.3 cm, 17%; 6MWT 81.5 m, 9%; TUG +/-44.6%, 16%; HOOS pain 21.6, 22%; HOOS symptoms 22.7, 19%; HOOS activities of daily living 17.7, 17%; HOOS quality of life 24.4, 43%. CONCLUSIONS: Distinguishing real change from error is difficult in people with severe osteoarthritis. The 6MWT demonstrates the smallest measurement error amongst a range of tools commonly used to assess disease severity, thus, has the capacity to detect the smallest real change above measurement error in everyday clinical practice |
0 | Mandibular Reconstruction with Lateral Tibial Bone Graft: An Excellent Option for Oral and Maxillofacial Surgery | DoD SSI (Surgical Site Infections) | Autogenous bone grafts are the gold standard for reconstruction of atrophic jaws, pseudoarthroses, alveolar clefts, orthognathic surgery, mandibular discontinuity, and augmentation of sinus maxillary. Bone graft can be harvested from iliac bone, calvarium, tibial bone, rib, and intraoral bone. Proximal tibia is a common donor site with few reported problems compared with other sites. The aim of this study was to evaluate the use of proximal tibia as a donor area for maxillofacial reconstructions, focusing on quantifying the volume of cancellous graft harvested by a lateral approach and to assess the complications of this technique. In a retrospective study, we collected data from 31 patients, 18 women and 13 men (mean age: 36 years, range: 19-64), who were referred to the Department of Oral and Maxillofacial Surgery at the Servidores do Estado Federal Hospital. Patients were treated for sequelae of orthognathic surgery, jaw fracture, nonunion, malunion, pathology, and augmentation of bone volume to oral implant. The technique of choice was lateral access of proximal tibia metaphysis for graft removal from Gerdy tubercle under general anesthesia. The mean volume of bone harvested was 13.0 ± 3.7 mL (ranged: 8-23 mL). Only five patients (16%) had minor complications, which included superficial infection, pain, suture dehiscence, and unwanted scar. However, none of these complications decreases the result and resolved completely. We conclude that proximal tibia metaphysis for harvesting cancellous bone graft provides sufficient volume for procedures in oral and maxillofacial surgery with minimal postoperative morbidity. |
0 | Public Interest in Cosmetic Surgical and Minimally Invasive Plastic Procedures During the COVID-19 Pandemic: Infodemiology Study of Twitter Data | Panniculectomy & Abdominoplasty CPG | BACKGROUND: The unprecedented COVID-19 pandemic has brought drastic changes to the field of plastic surgery. It is critical for stakeholders in this field to identify the changes in public interest in plastic procedures to be adequately prepared to meet the challenges of the pandemic. OBJECTIVE: The aim of this study is to examine tweets related to the public interest in plastic procedures during the COVID-19 pandemic and to help stakeholders in the field of plastic surgery adjust their practices and sustain their operations during the current difficult situation of the pandemic. METHODS: Using a web crawler, 73,963 publicly accessible tweets about the most common cosmetic surgical and minimally invasive plastic procedures were collected. The tweets were grouped into three phases, and the tweeting frequencies and Google Trends indices were examined. Tweeting frequency, sentiment, and word frequency analyses were performed with Python modules. RESULTS: Tweeting frequency increased by 24.0% in phase 2 and decreased by 9.1% in phase 3. Tweets about breast augmentation, liposuction, and abdominoplasty ("tummy tuck") procedures consecutively increased over the three phases of the pandemic. Interest in Botox and chemical peel procedures revived first when the lockdown was lifted. The COVID-19 pandemic was associated with a negative impact on public sentiment about plastic procedures. The word frequency pattern significantly changed after phase 1 and then remained relatively stable. CONCLUSIONS: According to Twitter data, the public maintained their interest in plastic procedures during the COVID-19 pandemic. Stakeholders should consider refocusing on breast augmentation, liposuction, and abdominoplasty procedures during the current phase of the pandemic. In the case of a second wave of COVID-19, stakeholders should prepare for a temporary surge of Botox and chemical peel procedures. |
0 | Is distal forearm fracture in men due to osteoporosis? | Distal Radius Fractures | Although widely regarded as a disease of women, osteoporosis does cause considerable morbidity and mortality in men. The lifetime risk of an osteoporortic fracture for a man is 1 in 12 and 30% of all hip fractures occur in men. In women, low-trauma distal forearm fracture is widely regarded as a typical early manifestation of postmenopausal osteoporosis. Traditionally, this has not been thought to be the case for men. We present a case-control study of 147 men with distal forearm fracture compared with 198 age-matched controls. The controls were selected from a pre-existing database of dual-energy X-ray absorptiometry scans of healthy volunteers. Both groups were sent questionnaires regarding basic demographics, fracture history and risk factors for osteoporosis, and the fracture group was asked to attend for bone densitometry. There were 103 responses from the fracture group (70%), of whom 67 (47%) underwent densitometry. There were 165 (83%) responses from the control group. Secondary causes of osteoporosis could be identified in 51% of the fracture group and 37% of the control group. The fracture group had significantly lower bone mineral density at all sites measured compared with the controls (0.75 g/cm(2) vs 0.85 g/cm(2) at the femoral neck, p<0.0001; 0.95 g/cm(2) vs 1.03 g/cm(2) at the total femur, p = 0.001; and 0.99 g/cm(2) vs 1.06 g/cm(2) at the lumbar spine, p = 0.001). These differences remained after adjusting for age and body mass index ( p<0.0005 at all sites). Overall, 41.8% of the fracture group were osteoporotic in at least one site ( T-score <-2.5 SD below the mean for young men) compared with only 10.3% of controls. This study is the first to demonstrate that men with distal forearm fractures have lower bone mineral density than their peers and a higher risk of osteoporosis. |
1 | Multimodal analgesia with gabapentin, ketamine and dexamethasone in combination with paracetamol and ketorolac after hip arthroplasty: a preliminary study | AAHKS (4) Acetaminophen | BACKGROUND AND OBJECTIVE: It has been hypothesized that combinations of analgesics with different mechanisms of action may reduce or even prevent postoperative pain. We, therefore, investigated the analgesic effect of gabapentin, dexamethasone and low-dose ketamine in combination with paracetamol and ketorolac as compared with paracetamol and ketorolac alone after hip arthroplasty.
METHODS: In this double-blind study, 42 patients were randomly assigned to either a combination group [gabapentin 1200 mg+dexamethasone 8 mg+ketamine (0.15 mg kg(-1))+paracetamol 1 g+ketorolac 15 mg] or a control group (placebo+paracetamol 1 g+ketorolac 15 mg). The medication was given preoperatively except for ketorolac, which was given at the end of surgery. Postoperative pain treatment was paracetamol 1 gx3; ketorolac 15 mgx3; and patient-controlled intravenous morphine. Morphine consumption, pain intensity at rest and during mobilization, nausea and vomiting, sedation, dizziness, hallucination and consumption of ondansetron were recorded 2, 4 and 24 h after operation. A P value of less than 0.05 was considered statistically significant.
RESULTS: Morphine consumption was not significantly different between groups (P=0.085). Overall pain scores were improved in the combination group as compared with the control group both at rest (P=0.042) and during mobilization (P=0.027). In the combination group, individual pain score above 30 mm on a 100 mm visual analogue scale was almost eliminated. The incidence of side effects did not differ between the groups.
CONCLUSION: Preoperative gabapentin, dexamethasone and ketamine combined with paracetamol and ketorolac reduced overall pain scores in patients after hip arthroplasty as compared with paracetamol and ketorolac alone. Morphine consumption was not reduced. |
0 | Expanded reverse abdominoplasty for reconstruction of burns in the epigastric region and the inframammary fold in female patients | Panniculectomy & Abdominoplasty CPG | We report the use of expanded reverse abdominoplasty in three female patients with postburn scars involving the entire epigastric region in which the inframammary folds were effaced, resulting in distortion of breast contour. In two of the patients, tissue expanders were used, and subsequently, reverse abdominoplasty was performed, thus re-creating the inframammary fold. The third patient reported to be pregnant after expanders were placed; therefore, smaller volumes of inflation for tissue expansion were necessary. We believe that this procedure is an optimal solution, both aesthetically and functionally, in respect to other reconstructive techniques in female patients with normal skin inferior to epigastric burns. The surgical technique and results are discussed. |
1 | Development of a surgical site infection prediction model in orthopaedic trauma: The Denver Health Model | DoD SSI (Surgical Site Infections) | BACKGROUND: The CDC's National Healthcare Safety Network's (NHSN) current risk adjustment model for surgical site infections (SSI) following open reduction internal fixation (ORIF) of long bone fractures is a suboptimal predictor of risk. We hypothesized that by including variables known to be associated with SSI following ORIF, we would develop a model that would increase the accuracy and predictability of SSI risk.
METHODS: Patients who underwent ORIF of a long bone between January 1, 2012 and December 31, 2014 were included in the study (n=1543). Patient risk factors, injury risk factors and perioperative risk factors were considered in the development of this model. We developed a risk prediction model for SSI following ORIF and then applied this to a new dataset of ORIF to determine the expected number of infections. This was compared to the expected number of infections calculated using the NHSN risk adjusted model.
RESULTS: The final multivariate model included age (odds ratio: 1.02, p-value<0.001, 95% confidence interval: 1.00-1.04), lower leg fracture (2.63, 0.004, 1.40-4.93), open fracture (1.87, 0.07, 0.93-3.76), American Society of Anesthesiologists (ASA) (2.09, 0.02, 1.07-4.08) and history of methicillin-resistant Staphylococcus aureus (MRSA), which was the most important predictor of infection (7.20, <0.001, 2.61-19.85). The c-index was 0.74 compared to 0.65 for the NHSN model, indicating that our model more accurate in estimating infection risk. When the developed model was used to predict the number of expected infections on a new dataset from 2015, 36.3 SSI were expected compared to 5.7 calculated by the NHSN model.
CONCLUSIONS: The model that was developed uses five easily identifiable risk factors that result in a more accurate prediction of infection at our facility than the currently used model.
LEVEL OF EVIDENCE: Prognostic and epidemiologic study, level III. |
0 | Medullary thyroid carcinoma: importance of serial serum calcitonin measurement | MSTS 2018 - Femur Mets and MM | Thirty-two patients with medullary carcinoma of the thyroid (MCT) were studied before and after therapy. Sixteen patients had familial and 16 had the sporadic type of disease. The groups differed in several features: Patients with sporadic disease were older at diagnosis and presented with enlargements in the thyroid or lymph nodes, and one patient had neuromata; in the familial group the disease was more often bilateral and was associated at times with the MEA syndrome (parathyroid adenoma or pheochromocytomas, or both). The immunoreactive serum calcitonin (CT) level was measured before and after some form of therapy in all 32 patients. Our investigations showed: 1) Delaying treatment was clearly detrimental in this progressive disease; 2) The most effective therapy was surgery, while radiotherapy and chemotherapy were less effective; 3) Postoperatively, the CT level usually fell sharply, when the disease was thought extirpated, but the lowest nadir might be reached at from 1 month to 6 years; 4) In all such patients the CT level eventually rose from the postoperative nadir; 5) Patients with no clinical or radiological evidence of disease, had high CT levels for a mean of 3 years of observation; 6) A marked rise of CT levels in three patients preceded metastases and death; 7) Patients with abdominal, particularly liver disease had the highest CT levels; and 8) Patients who died had relatively high CT levels, corresponding in general with the extent of disease. |
0 | A randomised single blind study comparing the molar ED50 of levobupivacaine and ropivacaine as a femoral perineural infusion for pain relief after total knee replacement | Surgical Management of Osteoarthritis of the Knee CPG | Background: Measure molar EC50 of levobupivacaine & ropivacaine using 4-point verbal pain score at 28-30 hours when administered via femoral perineural infusion after knee arthroplasty. Secondary objectives were pain measurement (visual score- 0-100mm), Motor block ( Bromage score 0-3); SLR (5-0) and EMG at 8/24 hours. Methods: Patients were randomised to levobupivacaine or ropivacaine. Single shot Obturator & sciatic blocks (dose) - 75KM or 150KM of study drug plus femoral perineural catheter sited. Spinal anaesthesia with 3ml hypebaric bupivacaine 0.5% , intrathecal morphine 0.1 mg performed. Measurements done at 8, 24h & 28-30h. Femoral bolus dosing at time zero used sequential allocation with starting dose of 150KM ( varying 10KM) by VRS (0 or (greater-than or equal to)1) response of previous patient at 8h. Femoral infusion dosing at 8h used sequential allocation with a starting dose of 1(mu)M.ml(-1),varying 0.1KM by VRS (0 or (greater-than or equal to)1) response of previous patient at 28-30h. Motor function assessed at 8/ 24h. ANOVA test gave group sample sizes of 12 (87% power to detect difference of 0.10 (mu)M.ml(-1)). Results: 14 patients were recruited. There was no difference in molar concentration of levobupivavacaine and ropivacaine for bolus, but a marked difference for the infusion. Maximum molar ropivacaine was 1.5(mu)M.m-1 and minimum levobupivacaine was 0.6(mu)M.ml(-1). Mixed model analysis of EMG showed less motor block with ropivacaine compared to levobupivacaine (p< 0.01) at 24h. Conclusions: Ropivacaine has higher molar EC50 but less motor block than levobupivacaine when administered as a femoral perineural infusion after knee arthroplasty |
0 | A sex-specific association between incident radiographic osteoarthritis of hip or knee and incident peripheral arterial calcifications: 8-year prospective data from Cohort Hip and Cohort Knee (CHECK) | OAK 3 - Non-arthroplasty tx of OAK | OBJECTIVES: There is sparse evidence for a relationship between cardiovascular disease (CVD) and osteoarthritis (OA). We investigated the association between incidence of arterial calcifications and incidence of radiographic knee and/or hip OA.
DESIGN: We used baseline and 8-year follow-up data of Cohort Hip and Cohort Knee (CHECK). Knees and hips were either Kellgren-Lawrence (KL) grade 0 or 1 at baseline. Arterial calcifications were scored on hip and knee radiographs using a four-grade scale. Scores were summed for patient-level analyses. To investigate incidence, participants with arterial calcifications at baseline or missing follow-up were excluded. Incident OA was defined per joint as KL >= 2 or prosthesis at year eight. The association between incidenct of arterial calcifications and incident OA was studied using mixed-effects logistic regression.
RESULTS: Of 763 participants included, 623 (82%) were women. Mean (sd) age was 56 (5.1) years, mean (sd) body mass index (BMI) 26.2 (4.1) kg/m<sup>2</sup>. Arterial calcifications developed in 174 participants (283 joints). OA developed in 456 participants (778 joints). Sex modified the association between arterial calcification and OA. In women, incident arterial calcification around a joint was positively associated with incident OA in that joint (adjusted OR 2.51 (95% CI 1.57-4.03)). In men, no association was observed on joint-level, but at patient-level the arterial calcification sum score was negatively associated with incident OA (adjusted OR per point increase 0.70 (95% CI 0.54-0.90)) indicating a systemic effect.
CONCLUSIONS: We observed sex-dependent associations between incident arterial calcification and incident radiographic knee and/or hip OA, which differs between joint- and patient-level. |
0 | Complications after spacer implantation in the treatment of hip joint infections | PJI DX Updated Search | The aim of this retrospective study was to identify and evaluate complications after hip spacer implantation other than reinfection and/or infection persistence. Between 1999 and 2008, 88 hip spacer implantations in 82 patients have been performed. There were 43 male and 39 female patients at a mean age of 70 [43-89] years. The mean spacer implantation time was 90 [14-1460] days. The mean follow-up was 54 [7-96] months. The most common identified organisms were S. aureus and S. epidermidis. In most cases, the spacers were impregnated with 1 g gentamicin and 4 g vancomycin/80 g bone cement. The overall complication rate was 58.5% (48/82 cases). A spacer dislocation occurred in 15 cases (17%). Spacer fractures could be noticed in 9 cases (10.2%). Femoral fractures occurred in 12 cases (13.6%). After prosthesis reimplantation, 16 patients suffered from a prosthesis dislocation (23%). 2 patients (2.4%) showed allergic reactions against the intravenous antibiotic therapy. An acute renal failure occurred in 5 cases (6%). No cases of hepatic failure or ototoxicity could be observed in our collective. General complications (consisting mostly of draining sinus, pneumonia, cardiopulmonary decompensation, lower urinary tract infections) occurred in 38 patients (46.3%). Despite the retrospective study design and the limited possibility of interpreting these findings and their causes, this rate indicates that patients suffering from late hip joint infections and being treated with a two-stage protocol are prone to having complications. Orthopaedic surgeons should be aware of these complications and their treatment options and focus on the early diagnosis for prevention of further complications. Between stages, an interdisciplinary cooperation with other facilities (internal medicine, microbiologists) should be aimed for patients with several comorbidities for optimizing their general medical condition |
0 | Multi-centre cluster randomised trial comparing a community group exercise programme with home based exercise with usual care for people aged 65 and over in primary care: protocol of the ProAct 65+ trial | HipFx Supplemental Cost Analysis | BACKGROUND: Regular physical activity reduces the risk of mortality from all causes, with a powerful beneficial effect on risk of falls and hip fractures. However, physical activity levels are low in the older population and previous studies have demonstrated only modest, short-term improvements in activity levels with intervention. DESIGN/METHODS: Pragmatic 3 arm parallel design cluster controlled trial of class-based exercise (FAME), home-based exercise (OEP) and usual care amongst older people (aged 65 years and over) in primary care. The primary outcome is the achievement of recommended physical activity targets 12 months after cessation of intervention. Secondary outcomes include functional assessments, predictors of exercise adherence, the incidence of falls, fear of falling, quality of life and continuation of physical activity after intervention, over a two-year follow up. An economic evaluation including participant and NHS costs will be embedded in the clinical trial. DISCUSSION: The ProAct65 trial will explore and evaluate the potential for increasing physical activity among older people recruited through general practice. The trial will be conducted in a relatively unselected population, and will address problems of selective recruitment, potentially low retention rates, variable quality of interventions and falls risk. TRIAL REGISTRATION: Trial Registration: ISRCTN43453770 |
0 | Utility of the UFOV test with mild traumatic brain injury | Upper Eyelid and Brow Surgery | Driving skills are socially important, easily disrupted by brain injury, and potentially risky and difficult to evaluate afterward. The Useful Field of View test has seen successful use with severe traumatic brain injury (TBI), but its use with mild TBI victims has not been examined. This study shows its ecological insensitivity among persons with mild TBI or no impairment and suggests its use be limited to more severely impaired persons. |
0 | Advanced age and comorbidity increase the risk for adverse events after revision total hip arthroplasty | PJI DX Updated Search | With the institution of quality-assurance parameters in health care, physicians must accurately measure and report the true baseline rates of adverse events (AEs) after complex surgical interventions. To better quantify the risk of AEs for revision total hip arthroplasty (THA), we divided a cohort of 306 patients (322 procedures) into age groups: group I (<65 years, n = 138), group II (65-79 years, n = 119), and group III (>/=80 years, n = 65). Ninety-day rates of major AE were 9%, 19%, and 34% in the groups, respectively. Group III had an increased chance of experiencing major AE compared with groups I and II. Age and Charlson Comorbidity Index independently predicted major complications, whereas body mass index, sex, and type of revision did not |
0 | The long-term effects of sysadoa treatment on knee osteoarthritis symptoms and progression of structural changes: Participants from the osteoarthritis initiative progression cohort | Surgical Management of Osteoarthritis of the Knee CPG | Purpose: This study aimed at exploring the effects of commonly used medication for the treatment of knee osteoarthritis (OA) on the progression of the disease over a period of 24 consecutive months. Methods: Participants were from the Osteoarthritis Initiative progression cohort (http://www.oai.ucsf.edu/) (n1,390) who met the following criteria: 24 consecutive months of follow-up with complete medical history, knee X-rays and MRI of the most symptomatic knee (greatest WOMAC pain) at 0, 12 and 24 months, and who had no total knee replacement during the follow-up. Using these criteria, 600 participants were found eligible. The knee radiograph data for joint space width (JSW) and narrowing (JSN) were analyzed (OAI database) and cartilage volume was assessed using fully-automated quantitative magnetic resonance imaging as published. Results: Of the 600 participants, 300 received continuous treatment for 24 months with commonly used pharmacological agents for OA (NSAIDs, analgesics, etc., starting at least 1 month before baseline) with or without (-) an OA slow acting drug (SYSADOA), namely glucosamine/ chondroitin sulfate (Glu/CS, starting at least 6 months before baseline). The other 300 had no OA treatment but could have received the Glu/CS. The groups were named as follows: treated (OA treatment - Glu/CS) and untreated (no OA treatment - Glu/CS). The two groups were balanced with the exception of a greater number of males (55% vs. 40%, p0.002) and higher body mass index (31-5 vs. 29-4, p0001) and |
0 | An orthopaedic enhanced recovery pathway | AAHKS (9/10) Regional Nerve Blocks | The use of enhanced recovery pathways within elective surgery has increased in recent years but uptake outside of specialist centres is still slow, despite the growing evidence base to support their introduction. This article will briefly outline what is meant by an enhanced recovery pathway (ERP) and outline the central characteristics and features which make up an ERP. The procedural details and results of an orthopaedic ERP which has been used in 2391 consecutive hip and knee joint replacement patients at a NHS district general hospital within the United Kingdom will then be outlined.The results of this unit illustrate that when a standardised, multi-disciplinary pathway is implemented and managed correctly, dramatic reductions to length of stay can be achieved. In combination, high levels of both staff and patient satisfaction are achieved along with good clinical outcomes. It is proposed that if such ways of working are implemented in other hospitals major economic and capacity savings could be realised at the same time as improving patient care. © 2010 Elsevier Ltd. |
0 | Skin cancer in solid organ transplant recipients: Advances in therapy and management: Part I. Epidemiology of skin cancer in solid organ transplant recipients | Reconstruction After Skin Cancer | Skin cancer is the most frequent malignancy in organ transplant recipients, 95% of which are nonmelanoma skin cancer, especially squamous cell and basal cell carcinomas. This paper also discusses the incidence of other tumors (eg, melanoma, Merkel cell carcinoma, and Kaposi sarcoma) that are also increased in organ transplant patients compared to the general population. Part I of this two-part series describes the latest data concerning the epidemiologic and pathogenic aspects of nonmelanoma skin cancer development in solid organ transplant recipients. This review also highlights the concept of "field cancerization," represented by extensive areas of actinic damage and epidermal dysplasia, which accounts for increased risk of aggressive skin cancer development in susceptible patients. © 2010 by the American Academy of Dermatology, Inc. |
1 | Antibiotic prophylaxis: a literature review | Dental Implant Infection | Antibiotic prophylaxis has been a matter of great interest and has been discussed by researchers and clinicians over the years. Changes and recommendations have been made in order to clarify protocol and make it safer for patients. Various organizations such as the American Heart Association, American Academy of Oral Surgeons, American Dental Association, and American Academy of Oral Medicine have played vital roles in formulating guidelines for antibiotic prophylaxis. These recommendations for prevention of infective endocarditis have been based on clinical experiences and research as well as expert opinion. This paper summarizes the most recent guidelines for general readers so that informed decisions may be made that are in the interest of patients and practitioners. |
0 | Below-knee amputations as a result of land-mine injuries: comparison of primary closure versus delayed primary closure | DoD LSA (Limb Salvage vs Amputation) | BACKGROUND: Antipersonnel land mines are designed to maim by mutilating the lower extremities, and these injuries are at higher risk for infection than injuries from other weapon systems. METHODS: The results of 474 unilateral traumatic below-knee amputations as a result of land-mine injuries were reviewed. If the delay in evacuation between the injury and arrival to the battle field hospital was less than 6 hours, 392 amputation stumps (group I) were closed primarily after meticulous debridement. Open amputation was performed after debridement in the remaining 82 amputation stumps (group II), because there was a suspicion of ineffective debridement, although they were evacuated in less than 6 hours or delay was more than 6 hours. RESULTS: Eleven patients in group I (2.8%) were reoperated because of wound sepsis of the stump. Wound sepsis was not encountered in group II. A total of 87.4% of stumps in group I and 81.2% of stumps in group II had healed without a problem. No gas gangrene or tetanus was encountered in any cases. CONCLUSION: Our results reveal that primary closure may be done in traumatic below-knee amputations caused by land-mine injuries with an acceptable infection rate, if the evacuation time is less than 6 hours, and if there is meticulous debridement. |
1 | Continuous femoral nerve blocks: decreasing local anesthetic concentration to minimize quadriceps femoris weakness | AAHKS (9/10) Regional Nerve Blocks | BACKGROUND: Whether decreasing the local anesthetic concentration during a continuous femoral nerve block results in less quadriceps weakness remains unknown.
METHODS: Preoperatively, bilateral femoral perineural catheters were inserted in subjects undergoing bilateral knee arthroplasty (n = 36) at a single clinical center. Postoperatively, right-sided catheters were randomly assigned to receive perineural ropivacaine of either 0.1% (basal 12 ml/h; bolus 4 ml) or 0.4% (basal 3 ml/h; bolus 1 ml), with the left catheter receiving the alternative concentration/rate in an observer- and subject-masked fashion. The primary endpoint was the maximum voluntary isometric contraction of the quadriceps femoris muscles the morning of postoperative day 2. Equivalence of treatments would be concluded if the 95% CI for the difference fell within the interval -20%-20%. Secondary endpoints included active knee extension, passive knee flexion, tolerance to cutaneous electrical current applied over the distal quadriceps tendon, dynamic pain scores, opioid requirements, and ropivacaine consumption.
RESULTS: Quadriceps maximum voluntary isometric contraction for limbs receiving 0.1% ropivacaine was a mean (SD) of 13 (8) N . m, versus 12 (8) N . m for limbs receiving 0.4% [intrasubject difference of 3 (40) percentage points; 95% CI -10-17; P = 0.63]. Because the 95% CI fell within prespecified tolerances, we conclude that the effect of the two concentrations were equivalent. Similarly, there were no statistically significant differences in secondary endpoints.
CONCLUSIONS: For continuous femoral nerve blocks, we found no evidence that local anesthetic concentration and volume influence block characteristics, suggesting that local anesthetic dose (mass) is the primary determinant of perineural infusion effects. |
1 | Implants for trochanteric fractures in Norway: the role of the trochanteric stabilizing plate-a study on 20,902 fractures from the Norwegian hip fracture register 2011-2017 | Hip Fx in the Elderly 2019 | BACKGROUND: The trochanteric stabilizing plate (TSP) is used as an adjunct to the sliding hip screw (SHS) in unstable trochanteric and subtrochanteric fractures. We wanted to describe the choice of implant for trochanteric fractures with a focus on the TSP in Norway.
METHODS: A total of 20,902 fractures from the Norwegian Hip Fracture Register treated surgically in 43 hospitals from 2011 to 2017 were included. Logistic regression analyses were performed to detect factors potentially influencing implant choice.
RESULTS: The mean age was 83 years, and 15,137 (72%) were women. An SHS was used in 13,273 (63%) fractures, of them 4407 (33%) with a TSP. Fracture classification was the most important determinant of TSP. In cases where an SHS was used, the odds ratio (OR) for using a TSP was 14 for AO/OTA 31A2 fractures and 71 for AO/OTA 31A3 and subtrochanteric fractures, compared to AO/OTA 31A1 fractures. The probability of receiving a TSP was higher in urban, academic, and high-volume hospitals (OR 1.2 to 1.3) and lower in Central and Northern Norway (OR 0.3 to 0.7). The use of an intramedullary nail (IMN) (n = 7629 (36%)) was also to a degree decided by fracture classification (OR 1.8 to 5.3). However, hospital factors, with OR 0.1 to 0.4 for IMN in academic, urban, and high-volume hospitals and OR 1.5 to 2.6 outside South-Eastern Norway (all p < 0.001), were also important.
CONCLUSIONS: Fracture classification was the main determinant for TSP use. Any additional benefit from a TSP on postoperative fracture stability or clinical outcome needs to be clarified. |
0 | Evaluation of Leber's hereditary optic neuropathy patients prior to a gene therapy clinical trial | Upper Eyelid and Brow Surgery | Gene therapy may be a promising approach for the treatment of Leber hereditary optic neuropathy. The aim of this study was to evaluate patients with this condition who were recruited into an upcoming gene therapy clinical trial and to assess any changes in the detection parameters to provide support for the clinical trial. Sixteen patients with Leber hereditary optic neuropathy were evaluated using visual function tests 12 months before the initiation of gene therapy. Then, the results of visual acuity (VA), visual field (VF), RNFL (retinal nerve fiber layer) thickness, and Pattern-reversal Visual evoked potential (PR-VEP) were compared and analyzed. A total of 32 eyes of 16 patients were evaluated. Based on the best-corrected visual acuity (BCVA), 24 eyes were relatively stable compared with the baseline evaluation, and 8 eyes had significant changes, including 5 eyes that showed improvement and 3 eyes that showed impairment. In all eyes, the changes in the best-corrected visual acuity were significantly correlated with the changes in the visual field index (VFI), mean defect (MD), and P100 of the visual evoked potential. In the eyes with relatively stable BCVA and those with an obvious improvement in the BCVA, only the visual mean defect showed a significant change; the other indicators were not significantly different. Aside from the patients showing a tendency of spontaneous improvement, the others were in accordance with the requirement. The effects of Leber hereditary optical neuropathy (LHON) gene therapy should be evaluated primarily based on visual acuity. Additionally, visual field, neural fiber thickness, and electrophysiology should be considered in the evaluation. |
0 | Histomorphometric analysis of subchondral bone of the femoral head in osteoarthritis and osteoporosis | Management of Hip Fractures in the Elderly | There have been reports both supporting and refuting an inverse relationship between hip fracture and hip osteoarthritis (OA). We have investigated this relationship using histomorphometric study of femoral head subchondral bone. We studied 74 subjects with hip fracture (74% females) and 24 subjects with osteoarthritis (45% females). By histomorphometric analysis of parafined sections, we analysed followed subhondral trabecular bone parameters bone volume (BV), bone volume/tissue volume (BV/TV), trabecular thickness (Tb.Th.), trabecular number (Tb.N.) and trabecular separation (Tb.S.). The subjects with osteoarthritis and subjects with hip fracture had BV/TV 31.3% and 19.6% respectively. BV/TV of osteoarthritis group was rather uniform whereas BV/TV of hip fracture group was greatly ranged and we divided it into three subgroups, 13.2%, 19.8% and 25.9% respectively. The OA group and hip fracture groups had Tb.Th. as followed 0.205 mm, 0.148 mm, 0.170 mm and 0.183 mm respectively. The OA group and hip fracture three subgroups had Tb.N. as followed 1.454/mm, 0.897/mm, 1.170/mm and 1.425/mm respectively. The OA group and hip fracture three subgroups had Tb.S. as followed 0.518 mm, 0.681 mm, 0.620 mm and 0.550 mm respectively. The results of our study support an inverse relationship between hip fracture and hip osteoarthritis |
0 | Fixation of subtrochanteric fracture of the femur: Our experience | Management of Hip Fractures in the Elderly | Introduction: Subtrochanteric fracture of the femur is a variant of the peritrochanteric fracture of the femur. It extends upto 5 cm below the lesser trochanter. The incidence is relatively much lower (3.9% of all the proximal femoral fractures). It is common in the older population with low energy trauma along with osteoporosis and in younger patients with high energy trauma. This is also the commonest site for a pathological fracture. Pathophysiological and biomechanical studies have shown that the subtrochanteric region is the most stressed area which concentrates stress on the implant and this is difficult to treat due to complications. With the improved knowledge and understanding of the fracture pattern, specific treatment options with successful results of improved quality may be obtained. Material and Methods: A total of 12 cases of subtrochanteric fracture of the femur which were admitted in the Orthopaedic Dept, Manipal Teaching Hospital, Pokhara, Nepal, from Jan, 2010 to July, 2011, were selected in our study. The classification of the fracture was done by using the Russell and Taylor's classification for simplicity and it is the one which is currently mostly used for clinical use. Various implants like locking plate, proximal femoral nail (PFN), dynamic hip screw (DHS) and K-nail were used for fracture fixation. Clinical and radiographic analyses were done at a follow up of 3 weeks, 6 weeks, 3 months, 6 months and 1 year. Results: Out of 12 cases, 9 were males and 3 were female.s K-nail fixation was done in one case of pathological fracture. Three locking plates, 4 DHS and 4 PFN were done. All the fractures united with good to excellent results, with few complications like mild restriction of the hip range of motion, mild varus deformity and a shortening of 2 cm. Conclusion: With the various choices of implants for the fixation of subtrochanteric fracture of the femur, PFN, in our opinion, gave the best fixation with excellent results. We recommend PFN as a reliable cephalomedullary implant for the fixation of subtrochanteric fracture of the femur |
0 | Does statin use have a disease modifying effect in symptomatic knee osteoarthritis? Study protocol for a randomised controlled trial | AMP (Acute Meniscal Pathology) | Background: Osteoarthritis (OA) is a major clinical and public health problem, with no current medications approved as having disease modifying effects. HMG-CoA reductase inhibitors, or "statins", a drug class widely used to prevent cardiovascular events, could potentially affect OA progression via a number of mechanisms including their effects on lipid metabolism and inflammation. The aim of this multicentre, randomised, double-blind, placebo-controlled trial is to determine whether atorvastatin reduces the progression of knee structural changes and symptoms over 2 years in patients with symptomatic knee OA. Methods/design: 350 patients with symptomatic knee OA will be recruited through the OA Clinical Trial Network (in Melbourne, Hobart and Adelaide). They will be randomly allocated to the two arms of the study, receiving either 40 mg of atorvastatin or identical placebo once daily for 2 years. Magnetic resonance imaging of the knee will be performed at baseline and 2 years later. Knee structure, symptoms and function will be assessed using validated methods. The primary outcome is annual percentage change in knee cartilage volume. Secondary outcomes include progression of cartilage defects, bone marrow lesions, knee pain and function. The primary analysis will be by intention to treat, but per protocol analyses will also be performed. Discussion: The study will provide high-quality evidence to address whether atorvastatin has a novel disease modifying effect in OA by delaying the structural and symptomatic progression of knee OA. Thus, the trial has major public health and clinical importance, as if found to be beneficial, atorvastatin could produce substantial cost savings by delaying and possibly reducing the need for joint replacement surgery, and provide marked improvements in quality of life for people with OA. Trial registration: Australian New Zealand Clinical Trials Registry: ACTRN12613000190707 , registered on 18 February 2013. |
1 | A comprehensive review of denosumab for bone metastasis in patients with solid tumors | MSTS 2018 - Femur Mets and MM | BACKGROUND: Denosumab is fully human monoclonal antibody that specifically binds and inactivates receptor activator of NF-kB ligand (RANKL), an important ligand that regulates bone remodeling. In this review, we aimed to show the clinical data about denosumab treatment and discuss its advantages for the management of patients with solid tumors and bone metastasis.
SCOPE: Denosumab showed positive results in clinical studies of solid tumors with bone metastasis. PubMed database and ASCO Symposium Meeting abstracts were searched until August 2015 by using the terms 'denosumab', 'RANKL inhibitor' and 'bone metastasis'. The last search was on 21 August 2015. All resulting studies were retrieved and were also checked for related publications. Clinical trials in this review fulfilled the following criterion: inclusion of sufficient data to allow estimation of the efficacy and safety of denosumab.
FINDINGS: The effects of denosumab on skeletal-related events (SREs) were investigated in three large randomized trials: one in patients with breast cancer, one in patients with prostate cancer, and one in patients with multiple myeloma or solid tumors other than breast or prostate cancer. In the breast cancer and prostate cancer studies denosumab was non-inferior and also superior to zoledronic acid in terms of the primary outcome time to first on-study SRE. In the third study denosumab was non-inferior to zoledronic acid but was not superior to zoledronic acid in solid tumors excluding breast and prostate cancer with bone metastases. In the three studies median overall survival and disease progression rates were similar between zoledronic acid and denosumab. Denosumab has also been studied in bone loss associated with hormonal therapy in both breast and prostate cancer. Adjuvant denosumab significantly reduced the risk of clinical fracture risk by 50% in breast cancer patients and by 62% in non-metastatic prostate cancer patients treated with adjuvant aromatase inhibitors or androgen deprivation therapy. In addition, biochemical markers of bone turnover and fractures were significantly reduced in patients under denosumab treatment.
CONCLUSION: The promising outcomes in the initial trials with denosumab have shown clinical activity and a favorable safety profile in patients with solid tumors and bone metastasis. Denosumab significantly reduced treatment-related osteoporosis associated with breast and prostate cancer and was superior to zoledronic acid in prevention or delaying of SRE. |
1 | The role of diet and exercise and of glucosamine sulfate in the prevention of knee osteoarthritis: Further results from the PRevention of knee Osteoarthritis in Overweight Females (PROOF) study | OAK 3 - Non-arthroplasty tx of OAK | BACKGROUND AND OBJECTIVES: The PRevention of knee Osteoarthritis in Overweight Females (PROOF) study (ISRCTN 42823086) described a trend for a decrease in the incidence of knee osteoarthritis (OA) by a tailored diet and exercise program (DEP) or by oral glucosamine sulfate in women at risk for the disease, using a composite clinical and/or radiological outcome. The aim of this updated post-hoc analysis was to re-assess the results according to more precise techniques and take advantage of the 2x2 factorial design.
METHODS: A total of 407 overweight (BMI >= 27kg/m(2)) women of 50-60 years of age with no diagnosis of knee OA were randomized to: (1) no DEP + placebo (Control, N = 102), (2) DEP + placebo (DEP, N = 101), (3) glucosamine sulfate + no DEP (GS, N = 102), and (4) DEP + glucosamine sulfate (DEP + GS, N =102) and followed for 2.5 years, with standardized postero-anterior, semiflexed (MTP) view knee radiographs at baseline and end of the study. DEP consisted of a tailored low fat and/or low caloric diet and easy to implement physical activities. Glucosamine was given as oral crystalline glucosamine sulfate 1500mg once daily, double-blinded vs. placebo. Incident knee OA was defined as radiographic progression of >=1mm minimum joint space narrowing (mJSN) in the medial tibiofemoral compartment, as previously assessed by the visual (manual) technique and by a new semi-automated method. Logistic regression analysis was used to calculate the odds ratio for the effect of the interventions.
RESULTS: After 2.5 years, 11.8% of control subjects developed knee OA. This incidence was decreased with glucosamine sulfate, either alone or in combination with the DEP, but not by the DEP alone. Since there was no statistical interaction between treatments, the 2x2 factorial design allowed analysis of patients receiving glucosamine sulfate (N = 204) vs. those not receiving it (N = 203), similarly for those on the DEP (N = 203) or not (N = 204). Glucosamine sulfate significantly decreased the risk of developing knee OA: odds ratio (OR) = 0.41 (95% CI: 0.20-0.85, P = 0.02) by the manual JSN assessment method and OR = 0.42 (95% CI: 0.20-0.92, P = 0.03) by the semi-automated technique. Conversely, there was no decrease in risk with the DEP.
CONCLUSIONS: Glucosamine sulfate decreased the risk of developing radiographic knee OA over 2.5 years in overweight, middle-aged women at risk, as determined by medial mJSN progression. Conversely a tailored diet and exercise program exerted no preventive effect, possibly because of the lower than expected effect on weight loss. |
0 | Age and weight effects on motor nerve conduction time measurements in an asymptomatic industrial population | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | Motor conduction delay has been demonstrated in patients with carpal tunnel syndrome (CTS), however, there is also evidence that conduction slowing can be effected by other factors, e.g., the aging process. Recent development of the digital electroneurometer, a hand-held, battery-powered device for measuring motor nerve conduction time, has made this test available for CTS screening in industry. A cross-sectional study of 77 industrial workers was performed to determine the relationship between median motor nerve conduction time at the carpal tunnel and select personal factors. Motor nerve conduction time increased with age, length of employment, and weight. However, these variables accounted for only 20.3% of the variance in conduction time. The study indicates users of this device should be aware of these effects, and that other sources of variation must be identified and controlled if motor nerve conduction tests are to be used for CTS screening in industry |
1 | Validation of the Injustice Experiences Questionnaire in a heterogeneous trauma sample | DoD PRF (Psychosocial RF) | PURPOSE/OBJECTIVE: A recent study by Trost et al. (2015) investigated the influence of perceived injustice-reflecting appraisals of the severity and irreparability of loss following injury, blame, and unfairness-on physical and psychological outcomes in a sample of patients 12 months after sustaining a traumatic injury. This brief report examines the psychometric properties of the Injustice Experiences Questionnaire (IEQ) using the previous sample from Trost et al. (2015) with added trauma patients (total N = 206).
RESEARCH METHOD/DESIGN: Primary analyses included confirmatory and exploratory factor analyses to validate the measurement model of the IEQ in patients 12 months after traumatic injury. Reliability analyses were conducted and construct validity was assessed by examining associations between the IEQ and other pain-related, psychological, and health-related outcome variables of interest.
RESULTS: Results replicated both one- and two-factor structures from past research, with a high factor correlation in confirmatory factor analyses and cross-loadings in exploratory factor analysis. Item characteristics analysis demonstrated overall strong internal consistency (alpha = .95). In addition, significant associations with psychosocial variables provide additional construct validity in regards to related outcomes.
CONCLUSION/IMPLICATIONS: The IEQ shows strong psychometric properties and is suitable for use in a sample of diverse traumatic injury. However, results suggest the use of a one-factor model for the IEQ in this sample. Future trauma and rehabilitation research can use the IEQ to explore how injustice perceptions related to traumatic injury can prospectively influence physical and psychological outcomes. (PsycINFO Database Record |
0 | Effect of inpatient quality of care on functional outcomes in patients with hip fracture | Management of Hip Fractures in the Elderly | OBJECTIVES: We sought to examine the relationship between functional outcome and process of care for patients with hip fracture. RESEARCH DESIGN AND PARTICIPANTS: We undertook a prospective cohort study in 4 hospitals of 554 patients treated with surgery for hip fracture. MEASUREMENTS: Information on patient characteristics and processes of hospital care collected from the medical record, interviews, and bedside observations. Follow-up information obtained at 6 months on function (using the Functional Independence Measure [FIM]), survival, and readmission. RESULTS: Individual processes of care were generally not associated with adjusted outcomes. A scale of 9 processes related to mobilization was associated with improved adjusted locomotion (P = 0.006), self care (P = 0.022), and transferring (P = 0.007) at 2 months, but the benefits were smaller and not significant by 6 months. These processes were not associated with mortality. The predicted value for the FIM locomotion measure (range, 2-14) at 2 months was 5.9 (95% confidence interval 5.4-6.4) for patients at the 10th percentile of performance on these processes compared with 7.1 (95% confidence interval 6.6, 7.6) at the 90th percentile. Patients who experienced no hospital complications and no readmissions retained the benefits in locomotion at 6 months. Anticoagulation processes were associated with improved transferring at 2 months (P = 0.046) but anticoagulation and other processes of care were not otherwise associated with improved function. DISCUSSION: Our findings indicate the need to attend to all steps in the care of patients with hip fracture. Additionally, functional outcomes were more sensitive markers of improved process of care, compared with 6-month mortality, in the case of hip fracture |
0 | MIB1 proliferation index in breast infiltrating carcinoma: comparison with other proliferative markers and association with new biological prognostic factors | MSTS 2018 - Femur Mets and MM | AIMS: In breast invasive carcinoma our objectives were I) to compare cellular proliferation determined by MIB1 index with S-phase fraction (SPF) assessed by flow cytometry and with mitotic index, and II) to examine the association of MIB1 index with classical and with new biological prognostic factors [bcl-2, p53, c-erbB-2 and cathepsin D (CD)].
METHODS AND RESULTS: From 102 cases of breast invasive carcinoma, 5-microm thick serial sections were cut from formalin-fixed, paraffin-embedded tissue blocks, and processed for detection of CD, c-erbB-2, p53, bcl-2, Ki-67 antigen MIB-1 and estrogen receptors (ER) and progesterone receptors (PR). SPF was measured by flow cytometry in fresh-frozen tissue samples taken from the carcinoma in each patient. MIB1 index was correlated with SPF (rho=0.45, p<0.0001) and with mitotic index (rho=0.42, p<0.0001). The MIB-1 index was positively associated with the histological grade (p=0.001), tumor size (p=0.04) and the presence of metastases in axillary lymph nodes (p=0.01). MIB1 was associated directly with p53 (p=0.045) and inversely with bcl-2 (p=0.0002). The MIB-1 index was not statistically associated with c-erbB-2. There was a weak association between MIBI index and stromal cell CD. The median MIB1 index was higher in tumors with moderate to strong CD staining of stromal cell, but the difference did not reach statistical significance (p=0.09).
CONCLUSIONS: MIB1 index correlates with well established methods for assessing tumor proliferation and with parameters of an aggressive phenotype of tumor. MIB1 index is an effective and readily accessible method for assessing tumor proliferation in breast carcinoma. |
0 | Biological Effects of Bone Marrow Concentrate in Knee Pathologies | BMAC (Bone Marrow Aspirate Concentrate) | With our aging population desiring to remain active, the incidence and costs associated with managing knee pain from both acute injury and symptomatic knee osteoarthritis continue to dramatically increase. Current treatment methods fall short with respect to their ability to improve the intra-articular environment and restore normal joint homeostasis. With increasing basic science and clinical evidence showing efficacy, cell-based therapies such as bone marrow concentrate (BMC) hold promise as a nonsurgical joint preserving treatment approach. BMC has inherent advantages over other treatments commonly used for various knee pathologies because it is a point-of-care orthobiologic product that uniquely and simultaneously delivers growth factors, anti-inflammatory proteins, and mesenchymal stem cells. There is increasing evidence for the use of BMC for repair of focal cartilage defects and for the treatment of generalized knee pain. However, continued high-quality studies are necessary for the clinical utility of BMC to be critically assessed with particular attention paid to appropriate patient selection, standardized aspiration, and processing and reporting of both functional and imaging-based outcomes. |
0 | Determinants of postsurgical discharge setting for male hip fracture patients | Hip Fx in the Elderly 2019 | Veterans hospitalized for hip fracture repair may be discharged to one of several rehabilitation settings, but it is not known what factors influence postsurgical discharge setting. The purpose of the study was to examine the patient, facility, and market factors that influence the choice of postsurgical discharge setting. Using a retrospective cohort design, we linked 11,083 veterans who had hip fracture surgeries in a Department of Veterans Affairs (VA) hospital from 1998 to 2005 as assessed by the VA National Surgical Quality Improvement Program dataset with administrative data. The factors associated with five postdischarge settings were analyzed using multinomial logistic regression. We found that few veterans (0.8%) hospitalized for hip fracture were discharged with home health. Higher proportions of veterans were discharged to a nursing home (15.4%), to outpatient rehabilitation (18.8%), to inpatient rehabilitation (16.9%), or to home (48.2%). Patients were more likely to be discharged to nonhome settings for VA-provided rehabilitation if they had total function dependence, had American Society of Anesthesiologists class 4 or 5, had surgical complications prior to discharge, or lived in counties with lower nursing home bed occupancy rates. Future research should compare postsurgical and longer-term morbidity, mortality, and healthcare utilization across these rehabilitation settings. |
0 | Functional outcome after major orthopedic surgery: the role of regional anesthesia redefined | AAHKS (9/10) Regional Nerve Blocks | PURPOSE OF REVIEW: Regional anesthesia can provide optimal pain management and stress reduction. This article aims to establish the impact of regional anesthesia in facilitating the recovery process, measured by significant clinical outcomes.
RECENT FINDINGS: The most common outcome assessing the effectiveness of regional anesthesia following major orthopedic procedures has been pain intensity. In recent literature, more precise outcome measures of disability and related to patient's quality of life and ability to return to daily activities have been introduced. Those found in the period of this review and discussed in this article are maximum voluntary isovolumetric contraction, range of motion, walking tests, time up and go, cumulated ambulation score, stair climb test, Short Musculoskeletal Function Assessment, Western Ontario McMaster Osteoarthritis Index, constant Murley score, Knee Society evaluation, Community Health Activities Model Program for Seniors, Short Form 12 and 16. Performance based outcomes have been found to correlate poorly with self-reported outcomes after knee arthroplasty.
SUMMARY: In order to establish the role of regional anesthesia in functional outcome after major orthopedic surgery, assessment of pain control is no longer sufficient. New clinically relevant outcomes must be introduced and used for procedure-specific studies. |
0 | Audit of deep wound infection following hip fracture surgery | DoD SSI (Surgical Site Infections) | An audit of 171 consecutive hip fractures treated surgically showed a deep wound infection rate of 3.6%. Several shortcomings in the implementation of the infection policy were identified and recommendations to eliminate them introduced. Review of the subsequent 186 patients gave a deep infection rate of 1.1%. Attention to detail and good practice are essential to maintain low wound infection rates. |
0 | Ultrasound-Guided Femoral Nerve Block to Facilitate the Closed Reduction of a Dislocated Hip Prosthesis | AAHKS (9/10) Regional Nerve Blocks | Prosthetic hip dislocation is a common but unfortunate complication in patients who have undergone total hip arthroplasty. Successful closed reduction in the emergency department leads to a reduced length of stay and rate of hospitalization.1,2 The use of regional anesthesia by femoral nerve block represents a novel approach for controlling pain in patients with hip pathologies.3 Ultrasound-guided approaches have been used with great success for controlling pain in patients with hip fractures.4,5 Here we report the case of a 90-year-old male who presented with a dislocated hip prosthesis, which was subsequently corrected with closed reduction following delivery of regional anesthesia to the femoral nerve under ultrasound guidance. To our knowledge, this represents the first reported use of an ultrasound-guided femoral nerve block to facilitate closed reduction of a dislocated prosthetic hip, and highlights a novel approach that avoids the use of procedural sedation in an elderly patient. |
0 | Treatment of failures related to articulation material in THA. A comprehensive algorithm of surgical options and open questions | Hip Fx in the Elderly 2019 | Total hip arthroplasty is considered one of the greatest advances in health care of the last century. More than one million THAs are estimated to be performed annually and an increasing number of revisions are expected in the future. Osteolysis and loosening are still the main reasons for failure, justifying the use of low-wear bearings. The aim of this paper is to describe the mode of failure of the different couplings (polyethylene, cross-linked PE, metal, ceramic) and the options of treatment considering the various scenarios that the surgeon has to face nowadays in the case of failure related to articulation material. A comprehensive algorithm of treatment strategies is proposed based on the best current evidence and on the authors' experience.Periodical follow-up, indications for early revision, selection of proper surgical techniques and tribology are suggested. Nowadays, few rules are strongly recommended: trying to avoid any metal in case of failure of metal-on-metal; to avoid metal in fracture of ceramic; never to mix metals or ceramics from different manufactures. We aim to address a great number of open questions. There is still need for further research and evidences in this essential field of orthopaedic surgery. |
0 | Dietary magnesium intake, serum high sensitivity C-reactive protein and the risk of incident knee osteoarthritis leading to hospitalizationâ??A cohort study of 4,953 Finns | OAK 3 - Non-arthroplasty tx of OAK | Objectives To study whether low dietary magnesium (Mg) intake and serum high sensitivity C-reactive protein (hs-CRP) predict the development of clinical knee osteoarthritis (OA). Methods The cohort consisted of 4,953 participants of a national health examination survey who were free of knee and hip OA at baseline. Information on the incidence of knee OA leading to hospitalization was drawn from the National Care Register for Health Care. During the follow-up of 10 years, 123 participants developed incident knee OA. Dietary magnesium intake was assessed on the basis of a food frequency questionnaire from the preceding year. We used Coxâ??s proportional hazards model to estimate the strength of the association between the tertiles of dietary Mg intake and incident knee OA, adjusted for baseline age, gender, energy intake, BMI, history of physical workload, leisure time physical activity, injuries, knee complaints, the use of Mg supplements, and serum hs-CRP levels. Results At baseline, dietary Mg intake was inversely associated with serum hs-CRP even after adjustment for all the potential confounding factors. During the follow-up, the adjusted hazard ratios (with their 95% confidence intervals) for incident knee OA in dietary Mg intake tertiles were 1.00, 1.28 (0.78â??2.10), and 1.38 (0.73â??2.62); the p value for trend was 0.31. Serum hs-CRP level at baseline did not predict incident knee OA. Conclusions The results do not support the hypothesis that low dietary Mg intake contributes to the development of clinical knee OA, although Mg intake is inversely associated with serum hs-CRP level. |
1 | Panniculectomy: improving lymph node yield in morbidly obese patients with endometrial neoplasms | Panniculectomy & Abdominoplasty CPG | OBJECTIVE: Panniculectomy has been used to facilitate pelvic surgery in obese women. The goal of this study was to determine the effect of panniculectomy on staging adequacy and lymph node yield in obese women with endometrial carcinoma undergoing staging laparotomy. METHODS: A retrospective review of patients with endometrial neoplasms who underwent panniculectomy at the time of hysterectomy was performed. For each subject, two control patients were matched by body mass index (BMI). RESULTS: Twenty-seven endometrial cancer patients who underwent panniculectomy at the time of staging were identified. Panniculectomy was successfully performed in all 27 patients. While the mean number of pelvic nodes was statistically similar between the two groups (16.2 vs. 13.7) (P = 0.199), the paraaortic node count was higher in patients who underwent panniculectomy (4.3 vs. 2.9) (P = 0.032). A paraaortic node dissection was not feasible in 3 (11.1%) of the panniculectomy patients and in 11 (20.4%) of the controls (P = 0.365). There were no differences in intraoperative or postoperative complications or in survival between the two groups. CONCLUSION: Among obese women with endometrial cancer, panniculectomy is well tolerated, feasible, and associated with acceptable morbidity. While the clinical significance of an increased paraaortic node count is uncertain, our findings suggest that panniculectomy may enhance operative exposure and facilitate endometrial cancer staging. |
0 | Cementless Revision Total Hip Arthroplasty with Ceramic Articulation | Hip Fx in the Elderly 2019 | PURPOSE: The results of ceramic-on-ceramic (CoC) bearing surfaces in primary total hip arthroplasty (THA) were well known. However, it was not known in revision THA. The purpose of this study is to report the results of revision THA with ceramic articulation.
MATERIALS AND METHODS: A total of 112 revision THAs were evaluated. The mean age at the time of surgery was 51.6 years (27.7 to 84.2 years). The mean duration of the follow-up periods was 6.3 years (2.3 to 11.4 years).
RESULTS: The Harris hip scores improved from an average of 56.2 at the index surgery to an average of 93.3 at the last follow-up (P<0.001). None of hips showed osteolysis or ceramic head fracture. One hip showed aseptic loosening in the acetabular component with squeaking that caused a re-revision. There were nine cases of dislocation. The survivorship at 5 years was 94.5% (95% confidence interval, 87.9% to 97.6%) with revision for any reason as the endpoint and 100% with femoral revision.
CONCLUSION: The ceramic articulation is one of good bearing options for revision THA in patients with a long life expectancy. |
0 | Short latency afferent inhibition and cognitive functions in multiple system atrophy | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | Objective: To study functional cortical cholinergic involvement in multiple system atrophy (MSA) by short latency afferent inhibition (SAI) and neuropsychological tests. Background: SAI is an in vivo technique to measure cortical cholinergic activity. It is impaired in Alzheimer's disease and Parkinson's disease (PD) dementia. MSA is a rapidly progressive synucleinopathy; and the pathology spreads to cortical areas in advanced disease. We expect involvement of cortical cholinergic activity in MSA as in advanced PD. Methods: Ten MSA cases (5 MSA-P and 5 MSA-C) and 8 agematched controls were studied. None of them had cognitive complaints. A detailed neuropsychological profile and SAI were evaluated. Severity of symptoms was assessed by Unified Multiple System Atrophy Rating Scale (UMSARS). In SAI study, a control motor-evoked potential (MEP) was elicited; then electrical stimulation of median nerve at wrist was followed by TMS to the contralateral M1. Obtained MEP amplitude in first dorsal interosseus muscle was expressed as the percentage of control value and called as SAI. A lower SAI value indicates a better response. Results: MMSE scores of MSA were lower than controls (26.1 (plus or minus) 1.0, 29.1 (plus or minus) 0.4; p:0.02). Memory scores were comparable; in tests that measure executive functions and visuospatial abilities, MSA cases performed worse (p < 0.05). SAI in MSA was higher but not statistically different than controls (50.2 (plus or minus) 6.5 vs 36.9 (plus or minus) 5.3; p > 0.05). There was no difference in SAI values between MSA-P and MSA-C. Interestingly, correlation analysis between the severity of symptoms (UMSARS I and IV) and SAI demonstrated that SAI is higher in cases with more severe functional impairment (r: 0.79, p:0.007 and r:0.83, p:0.003, respectively). Conclusions: This preliminary study shows general cognitive status, executive functions and visuospatial abilities are worse in nondemented MSA cases than controls. Likewise, SAI is higher in MSA cases with higher disability score. These findings imply that even in the absence of overt dementia, MSA cases may have cognitive alteration and the electrophysiological correlate of it in advanced stages. A follow-up study with increased number of cases with different stages of illness is planned |
0 | Postoperative Analgesia After Elective Hip Surgery - Effect of Obturator Nerve Blockade | AAHKS (9/10) Regional Nerve Blocks | The study investigates the effect of an obturator nerve block on the postoperative pain and opioid consumption after total hip replacement. |
0 | The role of electrodiagnostic testing in carpal tunnel syndrome | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | Electrodiagnostic testing in patients who have upper-extremity symptoms, which may include carpal tunnel syndrome (CTS), has been the gold standard for diagnosis for many years. Despite their value, these tests are underutilized. The authors examined the use patterns of electrodiagnostic testing at the University of Virginia by reviewing the records of the Electromyography Laboratory for the calendar year 1994. Studies in patients with CTS comprised 15% of the 1626 studies performed during that time. The mononeuropathy was mild in the majority of cases and most of the patients were referred for testing by specialists. There was a clear referral bias on the part of the primary care physicians, and the severity of mononeuropathy in the patients they referred for testing was significantly greater than in patients referred by specialists |
0 | The effect of marginal osteophytes on reduction of varus-valgus instability in osteoarthritic knees | Surgical Management of Osteoarthritis of the Knee CPG | The varus-valgus stability of 20 knees with unicompartmental osteoarthritis was studied in vivo at the time of total knee replacement. Intact osteoarthritic knees had an average of 11.0 degrees of varus-valgus motion. Removal of osteophytes from the osteoarthritic compartment significantly increased the motion to 13.1 degrees (P less than 0.05), while subsequent removal of osteophytes from the nonosteoarthritic compartment further increased motion to 14.7 degrees (P less than 0.025). In primarily unicompartmental osteoarthritis, marginal osteophytes appear to stabilize osteoarthritic knees, but can cause fixed deformity |
0 | Resection of an Occipital-Cervical Junction Schwannoma through a modified minimally invasive approach: Technical Note | Glenohumeral Joint OA | BACKGROUND: Minimally invasive spine (MIS) techniques have been available for many years, but their application has been largely limited to degenerative spine diseases. There are few reports in the literature of using MIS techniques for removal of neoplasms. We report our experience using a modified MIS technique for removal of an occipital-cervical junction (OCJ) schwannoma with attention to technical aspects of this approach.
CASE DESCRIPTION: A 64-year-old male presented with several months of neck pain radiating to the shoulder with bilateral hand numbness. The patient had evidence of early myelopathy on examination. Magnetic resonance imaging (MRI) demonstrated enhancing intradural lesion with significant mass effect on the spinal cord. The mass extended extradurally through the right C1 neural foramen. Imaging characteristics were suggestive of a schwannoma. The patient underwent a minimally invasive far lateral approach to the OCJ for resection of the lesion. A Depuy PipelineTM expandable retractor was used for visualization. Surgical resection was performed with microscopic visualization. Somatosensory evolved potentials (SSEP) monitoring was used. The patient tolerated the procedure well. Postoperative imaging demonstrated gross total resection. No intra- or postoperative complications were noted. The patient was discharged home on postoperative day 2. At 1-month follow-up, his preoperative symptoms were resolved and his wound healed excellently.
CONCLUSION: In properly selected patients, minimally invasive approaches to the OCJ for resection of mass lesions are feasible, provide adequate visualization of tumor and surrounding structures, and may even be preferable given the lower morbidity of a smaller incision and minimal soft tissue dissection. |
0 | Outcome of pubic rami fractures with or without concomitant involvement of the posterior ring in elderly patients | Hip Fx in the Elderly 2019 | INTRODUCTION: Pubic rami fractures are common fractures in a growing osteoporotic geriatric population. Concomitant posterior ring fractures (cPRF) are often found when properly looked for. The pain and consequent immobilization leaves this vulnerable patient group at risk for complications. Conservative therapy is usually sufficient, but with cPRF's surgery can be indicated. Although previous studies have pointed out that mortality rates are high, longer term morbidity outcomes are lacking. This study aims to further establish the longer term consequences of these fractures. Risk factors will be identified for complications, also addressing the possible differences between patients with or without a cPRF.
METHOD: Retrospective analysis of patients aged over 65 years sustaining a pubic rami fracture in the North-West Hospital Group Alkmaar combined with a survey to establish risk factors for morbidity and mortality after 6 months' post trauma. Multiple logistic regression analysis was used to identify risk factors.
RESULTS: 117 patients matched inclusion criteria with a median age of 83 and of which 86% was female. 23 cPRF's were identified. Significant deterioration in ambulation and independency was found. 34% was institutionalized at discharge. 49% lost their independent mobility status and 40% of the patients did not experience a full recovery. One-year mortality rate was 23%. Patients with a cPRF had a significant higher complication rate (44 vs 18% p = 0.02), but mortality and other morbidity outcomes did not statistically differ. The strongest predictor for 1-year mortality was complications during admission and a dependent ambulatory status (OR 5.2 and 4.1 respectively).
CONCLUSION: Pubic fractures with or without involvement of the posterior pelvic ring in patients aged over 65 have a significant impact on mobility and independency. Mortality rates are similar to hip fracture patients. Careful evaluation of every patient's mobility status is necessary to identify patients at risk for complications and determine their future health care needs. Future studies are needed to achieve consensus on diagnostic and treatment protocols and identify ways to decrease the significant impact of this injury. |
0 | Maslinic acid improves quality of life by alleviating joint knee pain in the elderly: Results from a community-based pilot study | OAK 3 - Non-arthroplasty tx of OAK | Chronic kneejoint pain is common in theelderly and associated with poor quality of life. This study, an open-label clinical trial, aimed to examine how the intake on a daily basis of maslinic acid-containing product (30 mg maslinic acid) on 29 elderly residents (mean 70.7 ± 10.1 years) of Nakajima Island, Ehime, Japan. Study participants consumed 10 g jelly containing maslinic acid daily for 16 weeks and at 0 (baseline), 4, 8, 12 and 16 weeks, assessed for health-related quality of life (Short Form-8) and knee pain score (Japanese Knee Osteoarthritis Measure). After 16 weeks, the physical quality of life, more specifically, the level of Bodily Pain and Physical Component Summary, but not mental quality of life, was significantly improved by maslinic acid intake. Furthermore, maslinic acid intake significantly decreased the Japanese Knee Osteoarthritis Measure at week 8 and tended to decrease Visual Analogue Scale score at weeks 4 and 16. These results suggest that consumption of maslinic acid has a protective effect against chronic knee pain in elderly residents in a community where knee pain causes high quality of life burden. |
0 | Treatment of Pseudomonas aeruginosa-infected orthopedic prostheses with ceftazidime-ciprofloxacin antibiotic combination | HipFx Supplemental Cost Analysis | Indwelling device infections are associated with considerable morbidity and extremely high cost. Pseudomonas aeruginosa is the most frequent gram- negative etiologic agent associated with infections of indwelling catheters and foreign body implants. It is generally agreed that eradication of infection in the presence of a foreign body requires removal of the foreign body. Using a combination of ceftazidime and ciprofloxacin, we cured nine of nine patients with P. aeruginosa-infected osteosynthetic material and four of five patients with hip and knee prostheses without removing the foreign material. Follow-up was for a mean of 21 months (range, 6 to 60 months). Some patients experienced minor side effects (arthralgia in one patient and rash in another patient). We conclude that this combination is effective and safe and should he useful in the treatment of P. aeruginosa-infected orthopedic implants |
0 | Illustrative review of knee meniscal tear patterns, repair and replacement options, and imaging evaluation | AMP (Acute Meniscal Pathology) | This review article aims to reinforce anatomical concepts about meniscal tears while linking associated treatment options. The main teaching points start with the basic meniscal anatomy and key differences between the medial and lateral menisci. Subsequently, various meniscal tear patterns along with their associated history and physical exam findings will be discussed with corresponding illustrations and MR images. Additional discussion will involve the different surgical repair techniques (with arthroscopic correlates), their indications with pertinent imaging findings, imaging related to previous meniscal tear repairs, and novel surgical techniques. Lastly, keys to evaluating for retear with an emphasis on MRI arthrogram findings will be reviewed. While each of these topics is not discussed in totality, the key points of the review article will enforce key concepts and help radiologists evaluate the menisci on imaging. |
0 | Nonagenarians on a Rehabilitation Unit: Characteristics, Progress, and Outcomes | Management of Hip Fractures in the Elderly | Objective: To determine the diagnostic, functional, and demographic characteristics and to review the progress of nonagenarians admitted to a general rehabilitation unit. In addition, to compare their outcomes with a selected group of younger patients. Design: A 4-yr retrospective chart review of the 40 admitted nonagenarians. Functional status was assessed by means of the FIM(trademark) instrument. Results: The most common diagnostic category was hip or femur fracture. Only two of the 40 patients required a transfer back to an acute medical unit. Mean FIM gain was 14.42 points. Nineteen of the 40 patients were discharged directly to their homes. Discharge home was related to younger age, living situation before hospitalization, and whether the patient lived alone or with others prehospitalization. No admission FIM score was related to discharge disposition. Compared with younger hip or femur fracture patients, nonagenarians were more likely to be women, be unmarried, not lived at home before admission, and less likely to be discharged home. Conclusion: The majority of this select group of nonagenarians was able to complete a structured program on a rehabilitation unit. Their demographic and functional characteristics and long-term outcomes merit further study |
0 | Anatomical quadrilateral plate for acetabulum fractures involving quadrilateral surface: A review | Hip Fx in the Elderly 2019 | Introduction: The management of acetabulum fractures in osteoporotic elderly, as well as comminuted fractures in younger patients is likely to be difficult. These fractures need specific fixation techniques especially when the quadrilateral plate is involved. Standard implants may not be able to adequately support the fixation, so newer pre-shaped fixation plates have been proposed with some of these already in use. The concept of anatomic plates has come up for many fracture locations for providing a better buttress effect to the comminuted fragments. There has been a need to look for an anatomic buttress plates being developed for acetabulum fractures involving the quadrilateral surface.
Materials and methods: The literature has been reviewed to find the various newer designs that have been used for buttressing the quadrilateral surface in comminuted acetabular fractures. An attempt has been made to study their design characteristics and clinical outcomes. The review also includes the analysis of Anatomic Quadrilateral plate (AQP) used in fixation of acetabulum fracture involving quadrilateral surface in a series of 33 patients.
Results: There has been few anatomical plates developed for the stabilization of acetabular quadrilateral surface fractures. Some of these plates have been successfully used in management of acetabular fractures primarily in young patients. Issues however remain in their application and outcomes in osteoporotic fractures of the acetabulum, as these plates support the pelvic brim fragments either from superior or medial surface. The newer development i.e. 'Anatomical Quadrilateral Plate' is optimized to counter the displacement forces due to its positioning on the pelvic brim rather than its superior or medial surface. Other special features include the possibility of longer screws across bone due to oblique position of holes, the typical location of a locking hole on the plate beam which permits dual cortical compression fixation either by using a bigger screw or a specially designed screw in screw construct across the supra-acetabular corridor. The option of using hybrid fixation of both locking and unlocked screws in AQP allows proper stress distribution on the underlying bone, aiding both primary as well as secondary stability. The minimum of one year post surgery outcome of patients having acetabular fixation using this Anatomic quadrilateral plate has been analyzed in 33 patients. Twenty three of these were aged more than 50 years and 28 out of total 33 were males. Associated injuries included Ipsilateral lower limb injury in 2 patients and distal radius fracture in 5 patients. The fracture pattern included 'Anterior column posterior hemi-transverse' in 10 patients,' Associated Both Column' injury in 9 and 'T type' acetabular fractures in 8 patients. Isolated 'Anterior column' was fractured in 6 patients. The surgical approach was 'Anterior Intra-pelvic' (AIP) in 23 patients and 'Modified Ileo-femoral' in other 10 patients. One patient had additional K L approach. Among the implants, the AQP plate was used without its pubic arm in 6 patients. The post-operative x rays showed anatomical reduction in 28 patients, while other 5 had gaps and/or steps up to 2 mm size. In subsequent car, one of these patients needed hip arthroplasty for problem arising due to collapse in fixation within six months. EQ 5D 5L telephonic score was used to know the outcome at minimum of one year follow up in 33 patients. As per this score, only 3 patients had an issue with mobility, with only one having problem in self-care activity. Six patients complained of minor limitations in carrying out their usual activities and only one patient had anxiety affecting him. In their self-assessment of overall health status, 22 patients marked it 100, 7 made it 90, 3 as 80 and 1 had marked it as 70 in a score range of 0-100. Considering the predominant elderly profile in this series of patients, the acetabular reconstruction using 'Anatomic quadrilateral plate' has shown encouraging results.
Conclusion: For stabilization of acetabular fractures involving quadrilateral surface area and pelvic brim, various new implants have been used. The Anatomic quadrilateral plate due to its anatomical shape, the various options in fracture fixation is best optimized for management of comminuted acetabulum fractures especially in poor quality bones. It has been successful in achieving good outcome in elderly group of patients having these complex injuries. |
0 | Transscleral resection without hypotensive anaesthesia vs iodine-125 plaque brachytherapy in the treatment of choroidal melanoma | Reconstruction After Skin Cancer | Aims: The aim of this study was to compare transscleral resection technique performed without hypotensive anaesthesia (TSRWH) with iodine-125 brachytherapy (IBT) in the treatment of choroidal melanoma. Patients and methods: This was a retrospective surgical cohort study. Nineteen eyes treated with TSRWH were matched with 53 eyes treated with IBT according to: tumour size, distance to fovea, distance to optic nerve, and follow-up time. Best-corrected visual acuity (BCVA), local recurrence, secondary enucleation, metastasis, overall and specific survival, and complications were evaluated. Results: Patients treated with TSRWH had significantly better BCVA than those treated with IBT. The local recurrence risk was significantly higher when ciliary body was involved (HR=11.4, 95% CI 2.24-49.7, P=0.04). Metastatic disease was observed in 14 of 53 patients (26.4%) in the IBT group vs 3 patients (15.8%) in the TSRWH group (P=0.531). Multivariate analysis showed that iris involvement (HR=16.0, 95% CI 4.2-170.2, P=0.033) and large tumour (HR=2.3, 95% CI 1.2-4.8, P=0.04) increased the probability of metastasis. During follow-up, six patients (11.3%) in IBT group died vs two (10.5%) in the TSRWH group (P>0.999). Nine patients required secondary enucleation: 5 (9.4%) in the IBT group vs 4 (21.1%) in the TSRWH group (P=0.231). The most common complications in IBT group were radiation-induced retinopathy (45.3%), neovascular glaucoma (28.3%), and macular oedema (24.5%), whereas rhegmatogenous retinal detachment (21.1%), ocular hypertension (21.1%), and submacular haemorrhage (15.8%) were the most frequent complications after TSRWH. Conclusion: TSRWH is a technically challenging procedure. However, when performed successfully, this technique achieves better preservation of visual acuity than IBT and without the limitations inherent in hypotensive anaesthesia. |
1 | Musculoskeletal system disorders in computer users: Effectiveness of training and exercise programs | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | Various musculoskeletal system disorders occur as a result of the use of computers, which have become an integral part of modern life. The most important among such disorders is known as cumulative trauma disorder (CTD). In this study, we attempt to investigate CTD's effects on daily life and the effectiveness of training and exercise programs in the management of this disorder at a state department where computers are widely used. Fifty patients with CTD between the ages 25 and 50 were recruited for the study and were randomized into two groups. The complaints of patients with CTD had appeared after they had started working in this job and they reported that their complaints were related to their occupation. The patients complained of head, neck, shoulder, back and wrist pains and most of them were diagnosed as Myofascial Pain Syndrome (MPS) and Carpal Tunnel Syndrome (CTS). The first group was given mobilization, stretching, strengthening and relaxation exercises five days a week for a period of two months following a training course. The second group was given a training course only. Both groups were assessed in terms of the following outcome criteria before and after the treatment: Numeric Rating Scale (NRS) and Pain Disability Index for pain; Tiredness Scale for tiredness; and Beck Depression Scale for depression. At 2 months, the treatment group was observed to have experienced statistically significant improvements in NRS (p < 0.001), pain disability index (p < 0.05) and Beck depression scale (p < 0.05) values as compared to the control group. Mobilization, stretching, strengthening and relaxation exercises reduce pain and depression levels of CTD patients in the short term. We propose that studies with long-term follow-up are needed to confirm the above results. (copyright) 2003/2004 - IOS Press and the authors. All rights reserved |
0 | Application of Platelet-Rich Plasma to Disorders of the Knee Joint | PRP (Platelet-Rich Plasma) | Importance. The promising therapeutic potential and regenerative properties of platelet-rich plasma (PRP) have rapidly led to its widespread clinical use in musculoskeletal injury and disease. Although the basic scientific rationale surrounding PRP products is compelling, the clinical application has outpaced the research. Objective. The purpose of this article is to examine the current concepts around the basic science of PRP application, different preparation systems, and clinical application of PRP in disorders in the knee. Evidence Acquisition. A systematic search of PubMed for studies that evaluated the basic science, preparation and clinical application of platelet concentrates was performed. The search used terms, including platelet-rich plasma or PRP preparation, activation, use in the knee, cartilage, ligament, and meniscus. Studies found in the initial search and related studies were reviewed. Results. A comprehensive review of the literature supports the potential use of PRP both nonoperatively and intraoperatively, but highlights the absence of large clinical studies and the lack of standardization between method, product, and clinical efficacy. Conclusions and Relevance. In addition to the call for more randomized, controlled clinical studies to assess the clinical effect of PRP, at this point, it is necessary to investigate PRP product composition and eventually have the ability to tailor the therapeutic product for specific indications. © The Author(s) 2013. |
0 | Transcutaneous blepharoptosis surgery - advancement of levator aponeurosis | Upper Eyelid and Brow Surgery | Ptosis surgery has seen many advances in the last few decades, the most important of which have emerged as a result of better understanding of the anatomy and physiology of the eyelid and orbit. Anterior approaches such as a levator aponeurosis advancement, tarsoaponeurectomy and posterior repair involving resection of Muller's muscle have proven to be effective in most cases. The focus of this article is a discussion of the indications, operative techniques, success rates and complications of transcutaneous levator advancement in detail. |
0 | Placental hCG immunohistochemistry and serum free-Beta-hCG at 11-13 weeks' gestation in intrauterine fetal demise | DoD PRF (Psychosocial RF) | Intrauterine fetal demise (IUFD) is a continuing problem that can result in severe psychosocial trauma for expecting parents. Our aim was to analyze placental human chorionic gonadotropin (hCG) expression at the third trimester and free-Beta-hCG levels measured at 11-13 weeks in cases of IUFD that occurred after 34 weeks' gestation, alongside a parallel analysis of a set of controls. In this retrospective study we present immunohistochemical data of a tissue microarray that included the following: 12 placentas where IUFD occurred (24 samples); 28 control placentas from first and early second trimester (56 samples); and 30 control placentas at term of pregnancy (60 samples). We used immunohistochemistry to analyze the expression of hCG. Data are also presented from 3,240 first trimester trisomies screening tests, of which 21 pregnancies resulted in IUFD (15 after 22 weeks' gestation and 6 after 34 weeks). All pregnancies took place between 2001 and 2010. For each case, our analysis took account of pregnancy-related data that we gathered from the relevant clinical files. Small for gestational age (SGA) was defined as neonatal weight <10th centile. Our results show that full-term placentas displayed a decreased immunohistochemical expression of hCG in comparison with those at the first trimester (p < 0.05). Moreover, low hCG expression in placentas at the third trimester was shown to be an independent risk factor for IUFD after 34 weeks' gestation (under multivariate analysis with p < 0.05). When we reviewed first trimester screening results, free-Beta-HCG was found to be lower for the group of IUFD after 34 weeks' gestation than in the group of live births (p < 0.05). This difference was heavily weighted by non small for gestational age (non-SGA) associated cases of IUFD: these presented a free-Beta-hCG MoM log of -0.27 (+/- 0.09) in contrast to just -0.01 (+/- 0.03) in SGA-associated IUFD (p < 0.05). Our results show that low hCG is an independent risk factor for IUFD after 34 weeks' gestation, and that levels of the hormone are significantly lower in non-SGA associated cases of IUFD. |
1 | Reducing heterogeneity in OA clinical trials: Data from a phase 2 study of SM04690, a novel, intra-articular, WNT pathway inhibitor in knee osteoarthritis | TO: WNT2 Pathway Modulator | Background/Purpose: Kellgren-Lawrence [KL] radiographic grading is used to classify knee osteoarthritis (OA), but may not accurately reflect disease progression. Classifying subjects by baseline medial joint space width (mJSW) may be a more specific measure. This hypothesis was assessed in a post-hoc analysis of data from a phase 2, multicenter, 52-week, randomized controlled trial of SM04690, a small molecule Wnt pathway inhibitor in development as a potential disease modifying drug in knee OA. Methods: In the trial, subjects with KL grade 2-3 knee OA were randomized to a single, 2 mL, intra-articular injection of 0.03 mg, 0.07 mg, 0.23 mg SM04690 or placebo (PBO) into their target (most painful) knee at Day 0. WOMAC Pain and Function were assessed at 0, 4, 13, 26, 39 and 52 weeks, with fixed location radiographic assessment of mJSW at Weeks 0, 26 and 52. Exploratory analysis of clinical outcomes in the intention to treat (ITT) population was conducted by analysis of covariance adjusted for baseline mJSW with multiple imputation. This post-hoc analysis examined a group with baseline mJSW of 2-4 mm in comparison to the full ITT population. Results: 455 subjects (mean age 60.3 [±8.7] years, BMI 29.9 [±4.6] kg/m2, 268 [58.9%] female, 293 [64.4%] KL Grade 3) were enrolled. Contralateral knee KL grade was equal or worse than target knee in 91% of ITT population. 258 subjects had baseline mJSWs of 2-4 mm. At week 52, in the placebo group, imputed mean mJSW change from baseline was -0.14 [SE 0.06] mm. In the ITT population, compared to placebo, imputed mean mJSW changes from baseline were positive for 0.03 mg and 0.07 mg SM04690 doses (Table, figure). In the post-hoc analysis of the smaller 2-4mm mJSW subgroup, heterogeneity was similar to ITT for all doses compared to PBO and for the 0.03 mg and 0.07 mg doses changes beyond measurement error (>0.13 mm)1 were observed. In addition, improvement in WOMAC Function compared to placebo was seen in the 0.07 mg SM04690 group at Week 52 within the mJSW subgroup (change compared to placebo -13.6, 95% CI (-25.5, -1.7), P=0.025). Conclusion: Stricter inclusion criteria for mJSW provided a less heterogenous baseline group, reducing sample size by 42% without increasing standard error. When applied to this dataset, meaningful radiographic changes were demonstrated with 0.03 mg and 0.07 mg SM04690 groups compared to placebo. Future trials of structure modification in knee OA should consider specific mJSW inclusion criteria. (Figure presented). |
0 | Prevalence of intra-articular mineralization on knee computed tomography: the multicenter osteoarthritis study | AMP (Acute Meniscal Pathology) | OBJECTIVE: The aim of this work was to report the prevalence of computed tomography (CT)-detected intra-articular mineralization.
DESIGN: We included participants from the Multicenter Osteoarthritis (MOST) Study. At the 12th year visit of the MOST study, bilateral knee CTs were first obtained. All participants also had posteroanterior and lateral radiographs of bilateral knees and completed standard questionnaires. Knee radiographs were assessed for Kellgren & Lawrence grade (KLG) and radiographic evidence of intra-articular mineralization. CT images were scored using the Boston University Calcium Knee Score (BUCKS) for cartilage, menisci, ligaments, capsule, and vasculature. Prevalence of intra-articular mineralization was computed for the total sample, and stratified by age, sex, race, Body Mass Index (BMI), presence of frequent knee pain, and KLG. We also determined distribution of mineralization in the cartilage and meniscus, and co-localization.
RESULTS: 4140 bilateral knees from 2070 participants were included (56.7% female, mean age 61.1 years, mean BMI: 28.8 kg/m<sup>2</sup>). On radiographs 240 knees (5.8%) had intraarticular mineralization, while CT-detected mineralization was present in 9.8% of knees. Prevalence of hyaline articular and meniscus mineralization increased with age and KL grade, and was similar by sex, BMI categories, and comparable in subjects with and without frequent knee pain. Mineralization tended to be ubiquitous in the joint, most commonly involving all three (medial/lateral tibiofemoral and patellofemoral) compartments (3.1%), while the patellofemoral compartment was the most involved compartment in isolation (1.4%).
CONCLUSIONS: CT of the knee provides greater visualization of intra-articular mineralization than radiographs and allows better localization of the crystal deposition within the joint. Further studies should focus on the co-localization of intra-articular crystal deposition and corresponding magnetic resonance imaging (MRI)-features of knee osteoarthritis (OA). |
0 | The medial shelf of the knee. A follow-up study | AMP (Acute Meniscal Pathology) | After a publication in 1979 on Plica Synovialis Mediopatellaris a review of 1328 arthroscopies from 1978 onwards has been done at the Orthopedic Department of the University Clinic Duesseldorf. One hundred and eighty knees with medial shelf of the knee were found. Forty-three patients were treated by arthroscopic surgery. Plica excision alone was carried out in 17 knees. Twenty-six times multiple intraarticular surgery like patella-shave, lateral release, meniscectomy or local synovectomy have been performed in addition to plica excision. A shelf alone was present in 21.1%. Additional lesion like chondromalacia of the patella occurred in 38.8%. Control of biopsy material and tissue specimen from arthroscopic surgery revealed shelf fibrosis in 15.5% of the 180 knees with Plica Synovialis Mediopatellaris. The best results were obtained in those patients with a medial shelf as the only abnormality in the knee joint. The reason for the relatively high amount of unsatisfactory results in knees with multiple lesion and medial shelf excision is caused by overlap of other lesions accompanied by the Plica Synovialis Mediopatellaris. Under the impression of the results of the follow-up study a detailed proposal as indication for Plica excision is discussed. |
0 | Role of thallium-201 total-body scintigraphy in follow-up of thyroid carcinoma | MSTS 2018 - Femur Mets and MM | To evaluate the reliability of total-body scintigraphy using [201Tl]chloride in postoperative follow-up of thyroid carcinoma, this procedure was performed in 326 patients after total thyroidectomy for thyroid carcinoma. The results were compared with those of 131I scintigraphy and thyroglobulin assays. 201Tl total-body scintigraphy was found to have the greatest sensitivity (94%), whereas 131I scintigraphy had the highest specificity (99%). It is shown that 201Tl total-body scintigraphy is a useful procedure in follow-up of thyroid cancer, however, the combination of parameters provides the greatest reliability. In medullary thyroid carcinoma, which is usually 131I negative, 201Tl total-body scintigraphy can be of great value for the localization of metastases which are indicated by elevated serum levels of calcitonin and carcinoembryonic antigen. |
0 | Observation of vestibular asymmetry in a majority of patients over 50 years with fall-related wrist fractures | Management of Hip Fractures in the Elderly | Previously [The abstract has been shortened somewhat, and the headings removed, in order to conform to journal style], we have observed vestibular asymmetry in about one-third of healthy senior citizens and in about two-thirds of subjects with previous hip fractures and no other significant ailments. Wrist fractures are considered a harbinger of hip fractures. If vestibular asymmetry is correlated with falls and fractures among the elderly then it should also be reflected among subjects with wrist fractures. Sixty-six consecutive patients (mean age 67.8 years) who had sustained a fall-related wrist fracture during a 10-month period were included in the study. The frequency of head shake nystagmus among the patients was compared to that found among 49 healthy senior citizens (mean age 74.9 years). Nystagmus after head shaking, indicating asymmetric vestibular function, was found in 50 participants (76%) (p <0.001). Thirty-eight of these were graded with distinct or prominent nystagmus responses. Sixty percent of the subjects with horizontal nystagmus had a wrist fracture coinciding with the slow phase of nystagmus. Twenty-three subjects reported 30 previous fall-related fractures during the previous 10 years. Subjects with nystagmus after head shaking sustained 26 of these fractures. The frequency of signs of vestibular asymmetry was significantly higher (p < 0.001) among the subjects than among healthy senior citizens. These findings suggest that an asymmetric vestibular function could be an epidemiologically important contributory factor to falls and wrist fractures among the elderly population |
0 | Diagnostic difficulty identifying Apophysomyces trapeziformis septic arthritis in a patient with multiple myeloma | DoD LSA (Limb Salvage vs Amputation) | INTRODUCTION: Mucormycosis is a rare fungal infection, but can cause substantial morbidity and mortality in both immunocompromised and immunocompetent patients. Apophysomyces is a mucormycetes species ubiquitous in nature, particularly in soil, decaying wood and other organic matter. Apophysomyces is known to cause cutaneous fungal infections, particularly after penetrating trauma. Septic arthritis is a rare clinical manifestation. CASE PRESENTATION: We describe a case of Apophysomyces trapeziformis causing septic arthritis of the knee of a patient with multiple myeloma. He was treated multiple times for bacterial septic arthritis with minimal improvement. Surgical tissue specimens finally grew mucoraceous mould, and DNA sequencing and morphological assessment of spores identified the mould as A. trapeziformis. The patient was treated with amphotericin B and posaconazole, but ultimately required an above-the-knee amputation for definitive treatment. CONCLUSION: This case illustrates the need to evaluate for fungal infection in a persistent septic arthritis that is culture negative and refractory to empiric antibiotics, particularly in an immunocompromised individual. It also shows the importance of a thorough social history and adequate tissue specimens for culture. |
1 | Open fractures of the distal radius: the effects of delayed debridement and immediate internal fixation on infection rates and the need for secondary procedures | DoD SSI (Surgical Site Infections) | PURPOSE: There are few clinical data evaluating the outcome of surgery for open distal radius fractures based on treatment method. Specifically, the major contributing factors to infection are largely unknown. The purpose of this study is to determine the effect of early versus delayed debridement and the choice of initial external versus internal fixation on infection rates and the need for secondary procedures.
METHODS: Thirty-two patients with open distal radius fractures were identified from a database. Ten debridements were early (<6 h after hospital admission), and 22 debridements were delayed (>6 h after hospital admission). There were 10 treating surgeons for the 32 patients in this study. Based on the attending surgeon's preference and experience, 20 fractures were treated with external fixation, 7 with plating, and 5 with planned staged conversion from external fixation to plating. The cohort included 19 grade I, 11 grade II, and 3 grade IIIA open injuries.
RESULTS: There were no infections, regardless of the time to debridement or the use of immediate plating. Other complications requiring secondary procedures occurred more frequently in patients treated with a planned staged conversion from external fixation to plating than in the patients treated with either external fixation or plating.
CONCLUSIONS: We did not encounter infections for grade I and grade II open distal radius fractures, and infections do not appear to be related to either the time to debridement or the initial type of fracture fixation. Plating might be safe at the initial debridement, but temporary external fixation with a staged conversion to plating increases the risk of complications, which necessitates corrective secondary procedures.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III. |
0 | Prune belly syndrome: early management outcome of nine consecutive cases | Panniculectomy & Abdominoplasty CPG | BACKGROUND: Prune belly syndrome (PBS) is a rare congenital malformation of unclear etiology. The disease progress and outcome in developing countries are not clear as most reports are isolated case reports. MATERIALS AND METHODS: A review of 9 patients managed for PBS in 5 years. RESULTS: There were 7 males and 2 females, aged 30 min-11 days (median = 5 days) at the time of presentation (a child presented as neonate, defaulted from follow-up and represented at 10 years of life). Their weights on admission were 2.5-4.2 kg (median = 3 kg). Maternal age range was 26-37 years (median = 32 years), with five mothers being above 30 years. Seven mothers had febrile illness in the first trimester and took antimalarial drugs or antibiotics. Intestinal malrotation was the most common associated anomaly. The degree of the anterior abdominal wall and the urinary tract morphology varies from patient to patient. Urinary tract anomalies were initially managed conservatively. Two infants however later had cutaneous ureterostomy due to worsening renal function and recalcitrant urinary tract infection (UTI). Four infants had abdominoplasty at the 2 nd week, 6 th week, 3 rd year and 10 th year of life. Seven orchiopexies were done. Four were done by Fowler-Stephen's method while the rest were via the inguinal route. Of the former, 3 testicles have normal volume 6 months after, whereas one atrophied. Post abdominoplasty, there was a significant reduction in the frequency of respiratory tract infection (RTI), UTI and post void urine volume in three infants. In addition, there was improved peer interaction and academic performance in the 10-year-old child. One infant died of pulmonary hypoplasia and two others from worsening urosepsis and progressive renal failure. CONCLUSION: PBS presents with a spectrum of features. Initial conservative management of the urinary tract was beneficial. Abdominoplasty and orchiopexy have both physiological and improved quality of life benefits. Early Parental education helped in reducing defaults from follow-up. |
0 | The use of a large pharmacoepidemiological database to study exposure to oral corticosteroids and risk of fractures: Validation of study population and results | Management of Hip Fractures in the Elderly | Purpose - The objective of this study was an evaluation of the sensitivity of findings of the relationship between oral corticosteroid use and the risk of fracture. We found in earlier work that the risk of fracture was significantly higher during oral corticosteroid treatment, with increases of 61% in hip and 160% in vertebral fractures. Methods - Information was obtained from the General Practice Research Database which contains medical records of general practitioners in the UK. The study included 244,235 oral corticosteroid users and 244,235 controls. Results - The validation of fracture cases showed that the hip fractures, as recorded in the GPRD, were confirmed by the GP on the questionnaire in 90.7% of the cases and by discharge summary in 86.5%. The relative rate of non-vertebral fracture during oral corticosteroid use did not vary substantially between patients with different diseases, age, or gender. The sensitivity analysis, modifying the type of analysis or inclusion of patients, did not materially change the findings. Conclusions - We found a high level of validity of the |
1 | Effect of weight change on progression of knee OA structural features assessed by MRI in overweight and obese women | AMP (Acute Meniscal Pathology) | OBJECTIVE: To evaluate the effects of weight change on progression of knee osteoarthritis (OA) structural features by magnetic resonance imaging (MRI) in overweight and obese women without clinical knee OA.
DESIGN: 347 participants from the Prevention of Knee Osteoarthritis in Overweight Females (PROOF) study were classified with latent class growth analysis into a subgroup with steady weight (n = 260; +0.1 +/- 4.0 kg, +0.2 +/- 4.4%), weight gain (n = 43; +8.6 +/- 4.0 kg, +9.8 +/- 4.1%) or weight loss (n = 44; -9.0 +/- 7.2 kg, -9.8 +/- 7.5%) over 2.5 years. Baseline and follow-up 1.5T MRIs were scored with MRI Osteoarthritis Knee Score (MOAKS) for progression of bone marrow lesions (BMLs), cartilage defects, osteophytes, meniscal abnormalities, meniscal extrusion and synovitis. Associations between subgroups and change in MRI features at knee-level were assessed using adjusted Generalized Estimating Equations.
RESULTS: 687 knees from 347 women (median age 55.2 years, interquartile range (IQR) 5.5, median body mass index (BMI) 31.2 kg/m<sup>2</sup>, IQR 5.3) were analyzed. Progression of synovitis was 18% in the weight gain vs 7% in the stable weight subgroup (OR 2.88; 95%CI 1.39-5.94). The odds for progression of patellofemoral (PF) BMLs and cartilage defects increased with 62% (OR 1.62; 95%CI 0.92-2.84) and 53% (OR 1.53; 95%CI 0.92-2.56) in the weight gain vs the stable weight subgroup.
CONCLUSIONS: In overweight and obese women, progression of synovitis increased more than 2.5 times in a weight gain compared to a stable weight subgroup over 2.5 years. Large effect sizes were also found for the difference in progression of PF BMLs and PF cartilage defects between the weight gain and stable weight subgroup. |
0 | Population preferences of undergoing brachioplasty for arm laxity | Panniculectomy & Abdominoplasty CPG | BACKGROUND: The number of patients requesting surgical procedures performed for brachioplasty and massive weight loss is increasing. The authors set out to quantify the health state utility outcome assessment of living with arm deformity requiring brachioplasty. METHODS: Utility assessments using the visual analog scale (VAS), time trade-off (TTO), and standard gamble (SG) were used to obtain utilities scores for arm deformity, monocular blindness, and binocular blindness from a sample of the general population and medical students. Linear regression and Student t test were used for statistical analysis. A P value less than 0.05 was deemed statistically significant. RESULTS: All the measures for arm deformity of the 107 volunteers (VAS, 0.80 +/- 0.14; TTO, 0.91 +/- 0.12; SG, 0.94 +/- 0.10) were significantly different (P < 0.001) from the corresponding measures for monocular blindness and binocular blindness. When compared to the sample of the general population, having a medical education demonstrated a statistical significance of being less likely to trade years of life and less likely to gamble risk of death for a procedure such as a brachioplasty. Race and sex were not statistically significant independent predictors of risk acceptance. CONCLUSIONS: We have objectified the health state of living with upper arm deformity requiring brachioplasty. Utility outcome scores (VAS, 0.80 +/- 0.14; TTO, 0.91 +/- 0.12; SG, 0.94 +/- 0.10) were comparable to living with health states such as aging neck needing rejuvenation, excess skin in the thighs necessitating thigh lift, and massive weight loss requiring panniculectomy based on previously reported studies. |
0 | Combination of lumbar erector spinae plane block and transmuscular quadratus lumborum block for surgical anaesthesia in hemiarthroplasty for femoral neck fracture | Hip Fx in the Elderly 2019 | Femur neck fractures may occur in elderly patients with multiple co-morbidities. Spinal or general anaesthesia may not be safe in such patients, leading to a search for other safer alternatives. Herein, we report a case in which a never previously reported combination of quadratus lumborum block (QLB) and erector spinae plane block (ESPB) was successfully used as the main anaesthetic method for hemiarthroplasty. An 86-year-old female patient with severe aortic stenosis was scheduled for internal fixation or hemiarthroplasty due to right femoral neck fracture. Following sedoanalgesia, the patient was placed in lateral decubitis position and ESPB and transmuscular QLB were performed from the fourth lumbar vertebra level. Adequate and effective surgical anaesthesia was achieved and hemiarthroplasty was performed. The combination of lumbar ESPB and QLB can be used for the anaesthesia management in high-risk patients undergoing hemiarthroplasty. |
0 | Adipokines in arthritis: New kids on the block | SR for PM on OA of All Extremities | Along with its capacity to store energy, the white adipose tissue is a source of cytokines, called "adipocytokines" or "adipokines" , acting by paracrine, autocrine and systemic pathways. However, it is noteworthy that the source of these adipokines in physiological and/or pathological conditions is not restricted to the adipose tissue. The modulation of immunological and inflammatory pathways by adipokines has been extensively studied in the last ten years. This systematic literature review focuses on the role of leptin, adiponectin, resistin and visfatin in arthritis. Although their roles need to be clarified, these adipokines will soon be pivotal to the diagnosis, the prognosis and the pharmacological approaches of rheumatoid arthritis and osteoarthritis. (copyright) 2009 Bentham Science Publishers Ltd |
0 | Medical problems affecting the management of children in dentistry | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | Medical problems can affect the type and timing of dental treatment in children and also the methods of pain control used. In this paper, conditions which influence the choice of anaesthesia and the performance of nonsurgical and surgical dentistry are discussed, as are conditions which affect dental development |
0 | Epidemiology of work-related musculoskeletal disorders | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | Musculoskeletal disorders are common in the United States. Although precise estimates are not available, most researchers agree that exposure to a combination of work place risk factors is a major contributor to these disorders. Along with personal factors (age, gender, etc.). Epidemiologic studies of workers have associated these disorders with many work-place physical and psychosocial factors. Specific physical factors associated with these disorders include intense, repeated, or sustained exertions, awkward, sustained, or extreme postures of the body, insufficient recovery time, vibration, and cold temperatures. Specific examples of work-place psychosocial factors include monotonous work, time pressure, high work load, lack of peer support, and a poor supervisor-employee relationship |
0 | A fluid-immersed multi-body contact finite element formulation for median nerve stress in the carpal tunnel | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | Carpal tunnel syndrome (CTS) is among the most important of the family of musculoskeletal disorders caused by chronic peripheral nerve compression. Despite the large body of research in many disciplinary areas aimed at reducing CTS incidence and/or severity, means for objective characterization of the biomechanical insult directly responsible for the disorder have received little attention. In this research, anatomical image-based human carpal tunnel finite element (FE) models were constructed to enable study of median nerve mechanical insult. The formulation included large-deformation multi-body contact between the nerve, the nine digital flexor tendons, and the carpal tunnel boundary. These contact engagements were addressed simultaneously with nerve and tendon fluid-structural interaction (FSI) with the synovial fluid within the carpal tunnel. The effects of pertinent physical parameters on median nerve stress were explored. The results suggest that median nerve stresses due to direct structural contact are typically far higher than those from fluid pressure |
0 | Medical exercise therapy, and not arthroscopic surgery, resulted in decreased depression and anxiety in patients with degenerative meniscus injury | AMP (Acute Meniscal Pathology) | The purpose of this pilot study was to compare the effectiveness of conservative therapy involving medical exercise therapy (MET) versus arthroscopic surgery in patients with knee pain, with MRI-verified degenerative meniscus. The patients were randomly assigned either to MET (n = 9) or to arthroscopic surgery (n = 8). Patients receiving MET had 3 treatments a week for 3 months, a total of 36 treatments. The arthroscopy consisted of meniscectomy with no structured conservative therapy after surgery. Assessment of pain, function, anxiety and depression were performed at inclusion and after 3 months. At the end of treatment, which was 3 months after inclusion, there were no statistical differences between the two groups regarding pain and function. However, anxiety and depression were significantly reduced in the MET group compared with the patients receiving arthroscopic surgery. Bearing in mind the low number of included patients in this pilot study, arthroscopy was found to be no better than MET regarding knee pain and overall daily function. The results from this pilot study are similar to other clinical studies, thereby demonstrating that conservative therapy is just as effective as surgery. |
0 | Dermoid cysts: a report of 75 pediatric patients | Reconstruction After Skin Cancer | Dermoid cysts (DCs) are benign cutaneous tumors that tend to persist and grow. The aim of this study was to examine the clinicopathologic features of congenital DCs. We present a case series of 75 children with a clinicopathologic diagnosis of DC. Seventy-two cysts were located on the head, one on the neck, and two on the trunk. Six cysts were located along the midline. Eight patients had symptoms other than changes in cyst size. Imaging studies were performed on 15 patients. Surgical excision was the primary treatment in all 75 cases. Neurosurgery and ophthalmology services were involved in the care of some patients. Histopathologic studies reported a foreign body giant cell reaction in 17 of the cysts. No recurrence was documented. DCs can remain stable for years, but they can become symptomatic as a result of enlargement and rupture or, more rarely, as a result of extension into surrounding tissues. Physicians should be aware that certain locations have a higher risk of DC extension, and adequate diagnostic investigations should be performed before their complete resection. |
0 | Oophorectomy vs ovarian conservation with hysterectomy: cardiovascular disease, hip fracture, and cancer in the Women's Health Initiative Observational Study | Management of Hip Fractures in the Elderly | BACKGROUND: Elective bilateral salpingo-oophorectomy (BSO) is routinely performed with hysterectomy for benign conditions despite conflicting data on long-term outcomes. METHODS: This is a prospective cohort of 25 448 postmenopausal women aged 50 to 79 years enrolled in the Women's Health Initiative Observational Study who had a history of hysterectomy and BSO (n = 14 254 [56.0%]) or hysterectomy with ovarian conservation (n = 11 194 [44.0%]) and no family history of ovarian cancer. Multivariable Cox proportional hazards regression models were used to examine the effect of BSO on incident cardiovascular disease, hip fracture, cancer, and death. RESULTS: Current or past use of estrogen and/or progestin was common irrespective of BSO status (78.6% of cohort). In multivariable analyses, BSO was not associated with an increased risk of fatal and nonfatal coronary heart disease (hazard ratio, 1.00 [95% confidence interval, 0.85-1.18]), coronary artery bypass graft/percutaneous transluminal coronary angioplasty (0.95 [0.82-1.10]), stroke (1.04 [0.87-1.24]), total cardiovascular disease (0.99 [0.91-1.09]), hip fracture (0.83 [0.63-1.10]), or death (0.98 [0.87-1.10]). Bilateral salpingo-oophorectomy decreased incident ovarian cancer (0.02% in the BSO group; 0.33% in the ovarian conservation group; number needed to treat, 323) during a mean (SD) follow-up of 7.6 (1.6) years, but there were no significant associations for breast, colorectal, or lung cancer. CONCLUSIONS: In this large prospective cohort study, BSO decreased the risk of ovarian cancer compared with hysterectomy and ovarian conservation, but incident ovarian cancer was rare in both groups. Our findings suggest that BSO may not have an adverse effect on cardiovascular health, hip fracture, cancer, or total mortality compared with hysterectomy and ovarian conservation |
0 | Bone metastases from squamous cell carcinoma of the head and neck | MSTS 2022 - Metastatic Disease of the Humerus | BACKGROUND AND OBJECTIVES: Carcinoma of the head and neck is an uncommon primary source of bone metastases. The increasing duration of survival of these patients, however, increases the probability of late bone involvement. The objective was to identify the frequency, clinical presentation, and clinical course of metastatic disease to bone from head and neck primaries.
METHODS: A retrospective review was accomplished of the radiographs and nuclear medicine studies for 363 cases of squamous cell carcinoma of the head and neck for whom radiologic studies had been performed. For those with identified bone involvement, a chart review was performed to identify clinical presentation, disease course, and outcome.
RESULTS: Only approximately 1% of these patients had clinically demonstrable bone metastases. Eight sites of bone involvement were identified in five patients, including three pelvic, two femoral, and one each humeral, rib, and thoracic spine lesions. All lesions were purely lytic with moth-eaten or permeative borders. Time from primary tumor diagnosis to identification of metastatic disease ranged from being present at diagnosis to a maximum 3.5 years later. Time from identification of metastatic disease to patient death was no greater than 8 months.
CONCLUSIONS: Despite the increasing overall survival of patients with these carcinomas, distant bone metastases are infrequent, but should be considered a possibility in any patient with a concurrent or past diagnosis of head and neck carcinoma. The very short time from discovery of bone dissemination to death in most of these patients should be taken into consideration when contemplating operative intervention. |
0 | Different classifications concerning fractures of the lateral humeral condyle in children | Pediatric Supracondylar Humerus Fracture 2020 Review | PURPOSE: Fractures of the lateral condyle are the second most frequent elbow fractures in children. Although the pathobiomechanism is well known and different fracture classifications exist, there are still adverse clinical results. This raises the questions how precise classifications predict fracture stability, especially in the context of choosing the best therapy. It also remains unclear how these classifications can be applied in practice. METHODS: Seventy-five patients with a fracture of the lateral condyle were analyzed in this retrospective study. We included all patients with an age?=?14 years admitted at a German Level I Trauma Center between 2005 and 2017. Different classifications according to Jakob, Finnbogason, Song and Hasler/v. Laer have been applied. RESULTS: Seventy-five patients with fractures of the lateral condyle were analyzed thereof 53 treated operatively and 22 conservatively. In sum, 6 out of 75 fractures showed no lateralization (Jakob: stable) in the first X-ray, but the same wide of the fracture gap medial as lateral (Finnbogason and Song: unstable). In 2 out of 75 patients, fracture instability occurred although it was not detected by the classification of Jakob, Finnbogason, Song and Hasler/v. Laer. CONCLUSION: Classifying fractures according to the Jakob-Classification has limitations if notable rotation without lateral displacement occurs. Hasler/v. Laer's classification appears most adequate but can sometimes not be applied due to missing X-ray 4 days after trauma. The Finnbogason- and Song-Classification performs best in prediction of instability based on the X-ray at the time of accident because of considering the fracture pathobiomechanism. All in all, we recommend the classification of Hasler and v. Laer, because it is the best predictive classification. |
0 | Incidence and treatment patterns of complicated bone metastases in a population-based radiotherapy program | MSTS 2022 - Metastatic Disease of the Humerus | Introduction There is abundant evidence in support of single fraction (SF) radiation therapy (RT) for uncomplicated bone metastases (BoM). We sought to determine the proportion of BoM that is complicated in a population-based RT program in order to act as a potential guide for assessing SFRT utilization rates. Materials and methods A total of 3200 RT courses were prescribed to 1880 consecutive patients diagnosed with BoM in 2013. Associations between choice of RT fractionation and BoM characterization, whether complicated or not, were assessed with logistic regression. Results The incidence of complicated BoM was 34.4%, resulting most often from adverse features of actual pathological fracture (42.1%), and neurological compromise (36.3%). Complicated BoM were most common in lung cancers (24.2%) and in the spine (68.5%), followed by extremity (15.2%) and pelvis (14.4%). SFRT was prescribed less commonly in complicated versus un-complicated BoM (39.4% vs. 70.4%; p < 0.001), which was confirmed on multivariable analysis (OR 0.32; 95% CI 0.28-0.61; p < 0.001). Conclusions This study found that 34.4% of BoM are complicated by fracture, or neurological compromise (i.e. 65.6% were un-complicated), and that they were less likely to receive SFRT. A reasonable benchmark for SFRT utilization should be at least 60%. |
0 | Inequality in 30-day mortality and the wait for surgery after hip fracture: the impact of the regional health care evaluation program in Lazio (Italy) | Management of Hip Fractures in the Elderly | OBJECTIVE: INTERVENTIONS: that address inequalities in health care are a priority for public health research. We evaluated the impact of the Regional Health Care Evaluation Program in the Lazio region, which systematically calculates and publicly releases hospital performance data, on socioeconomic differences in the quality of healthcare for hip fracture. DESIGN: /st>Retrospective cohort study. SETTING: and participantsWe identified, in the hospital information system, elderly patients hospitalized for hip fracture between 01 January 2006 and 31 December 2007 (period 1) and between 01 January 2009 and 30 November 2010 (period 2). MAIN OUTCOME MEASURES: /st>We used multivariate regression models to test the association between socioeconomic position index (SEP, level I well-off to level III disadvantaged) and outcomes: mortality within 30 days of hospital arrival, median waiting time for surgery and proportion of interventions within 48 h. RESULTS: /st>We studied 11 581 admissions. Lower SEP was associated with a higher risk of 30-day mortality in period 1 (relative risk (RR) = 1.42, P = 0.027), but not in period 2. Disadvantaged people were less likely to undergo intervention within 48 h than well-off persons in period 1 (level II: RR = 0.72, P < 0.001; level III: RR = 0.46, P < 0.001) and period 2 (level II: RR = 0.88, P = 0.037; level III: RR = 0.63, P < 0.001). We observed a higher probability of undergoing intervention within 48 h in period 2 compared with the period 1 for each socioeconomic level. CONCLUSION: /st>This study suggests that a systematic evaluation of health outcome approach, including public disclosure of results, could reduce socioeconomic differences in healthcare through a general improvement in the quality of care |
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