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1 | Tranexamic acid in hip fracture patients: A protocol for a randomised, placebo controlled trial on the efficacy of tranexamic acid in reducing blood loss in hip fracture patients | Hip Fx in the Elderly 2019 | Introduction: There is a high incidence of blood transfusion following hip fractures in elderly patients. Tranexamic acid (TXA) has proven efficacy in decreasing blood loss in general trauma patients as well as patients undergoing elective orthopaedic surgery. A randomised controlled trial will measure the effect of TXA in a population of patients undergoing hip fracture surgery. Methods: This is a double-blinded, randomised placebo-controlled trial. Patients admitted through the emergency room that are diagnosed with an intertrochanteric or femoral neck fracture will be eligible for enrolment and randomised to either treatment with 1 g of intravenous TXA or intravenous saline at the time of skin incision. Patients undergoing percutaneous intervention for non-displaced or minimally displaced femoral neck fractures will not be eligible for enrolment. Postoperative transfusion rates will be recorded and blood loss will be calculated from serial haematocrits. Ethics and dissemination: This protocol was approved by the Institutional Review Board (IRB) and is registered with clinicaltrials.gov. The findings of the trial will be disseminated through peer-reviewed journals and conference presentations. |
1 | Psychosocial consequences of traffic accidents: a two year follow-up | DoD PRF (Psychosocial RF) | The aim of the study was to assess long term outcome of injuries from traffic accidents with focus on psychosocial aspects. Eighty-four persons injured in traffic accidents and with moderate to severe injuries (ISS > or = 9) were interviewed approximately two years after the accident. We examined psychosocial consequences within eight different domains; sequelae of the injury, psychological consequences, sickness compensation received, living conditions, need of assistance, working capacity, economic situation and leisure time activity. Sixty-eight percent of the persons reported that they still suffered from physical seqelae and 57% had been or were still suffering from psychological distress after the accident. Sixty-three percent were on the sick-list for at least three months because of the accident. Fifty-eight percent needed some type of handicap aid during some time after the accident. For 29% of the professionally employed the traffic accident led to changed working conditions. The study indicates a need not only for adequate medical treatment, but also psychological and social counseling in the rehabilitation of victims of traffic accidents. Resources for crisis intervention should also be available at an early stage. |
0 | Genomic Predictors of Recurrence Patterns in Localized Soft Tissue Sarcoma Treated With Radiation Therapy | MSTS 2022 - Metastatic Disease of the Humerus | PURPOSE/OBJECTIVE(S): Soft tissue sarcomas (STSs) are diverse mesenchymal tumors that are primarily managed with surgery. Radiation therapy (RT) is frequently added pre- or post-operatively for localized disease but uncommonly used as definitive treatment because the majority of unresected tumors progress with RT alone. Advances in next-generation sequencing have led to the widespread use of clinical genomic profiling, but the genetic determinants of radiation response in STSs are unknown. We hypothesized that integrating patient outcome data and clinical tumor mutation profiling could identify genomic predictors of recurrence patterns after RT for localized STS. MATERIALS/METHODS: We retrospectively identified 31 patients treated at our institution with definitive RT with or without surgery for localized STS who underwent tumor genomic profiling using a sequencing platform. For genes altered in at least 10% of patients, the associations between genetic alterations and local failure or distant metastasis were analyzed with univariable and multivariable competing risk regression adjusted for the competing risk of death. Age, maximum tumor diameter, tumor grade, and extent of resection were included as co-variables, and P values were adjusted for multiple hypothesis testing. RESULTS: Median follow up was 24 months, and the median RT dose was 50.4 Gy in 28 fractions. The most common histologies were leiomyosarcoma (n?=?4) and myxofibrosarcoma (n?=?4). The majority of tumors were located in the trunk and extremities (68%) with the remaining tumors originating in the head and neck (16%) or abdomen and pelvis (16%). 48% of patients underwent margin-negative resection, 36% had microscopically positive margins, and 16% were unresected or had gross residual disease following surgery. Median age was 58, median tumor size was 7.5 cm, and 65% of tumors were high grade. On univariable analysis, younger age (P?=?0.02) and extent of resection (P?=?0.0002) were significantly associated with local recurrence, and there was a trend towards association between higher grade and distant metastasis (P?=?0.09). On univariable analysis, amplification of FRS2 in isolation or in combination with MDM2 and CDK4 was associated with a significantly increased risk of local recurrence (n?=?4, HR 4.3), and genetic alterations in FBXO11 were associated with a significantly increased risk of distant metastasis (n?=?4, HR 3.9). On multivariable analysis, FBXO11 alterations continued to predict for distant metastasis (HR 5.7, P?=?0.0002), but there were no significant predictors of local recurrence. CONCLUSION: Our results suggest that somatic tumor mutations may contribute to the risk of local recurrence and distant metastasis in patients treated with RT for localized STS. Additional analysis and validation in larger multi-institutional cohorts will be critical to identify molecular predictors of prognosis and patterns of recurrence. |
0 | Patella bone density is lower in knee osteoarthritis patients experiencing moderate-to-severe pain at rest | PJI DX Updated Search | Objective: To determine differences in patellar subchondral bone mineral density (BMD) between knee osteoarthritis (OA) patients with differing levels of pain at rest. Methods: The preoperative knee of 41 total knee replacement (TKR) patients was scanned using QCT and scored for pain using Western Ontario McMasters Osteoarthritis Index (WOMAC). âPain at restâ was defined as average pain while lying/sitting and nocturnal pain. Participants were divided into groups: âmild-to-no pain at restâ and âmoderate-tosevere pain at restâ. We used a depth-specific CT-based mapping technique to measure patellar subchondral BMD at depths of 0-2.5 mm, 2.5-5 mm, and 5-7.5 mm from the subchondral surface. Mean lateral and medial facet BMD were compared between groups using MANCOVA. Results: Mean adjusted BMD was lower in participants with âmoderate-to-severe pain at restâ over the total lateral facet at depths of 0-2.5 mm (10% lower, p=0.041), 2.5-5 mm (20% lower, p=0.017), and 5-7.5 mm (25% lower, p=0.004), and over the total medial facet at 2.5-5 mm (22% lower, p=0.033) and 5-7.5 mm (28% lower, p=0.016). Conclusions: In OA patients with âmoderate-to-severe pain at restâ, depth-specific density measures demonstrated up to 28% lower lateral and medial subchondral BMD. Patients with high levels of pain at rest may have reduced amounts of native bone prior to TKR |
0 | Differences in health at age 100 according to sex: Population-based cohort study of centenarians using electronic health records | DoD PRF (Psychosocial RF) | Objectives: To use primary care electronic health records (EHRs) to evaluate the health of men and women at age 100. Design: Populationâ?based cohort study. Setting: Primary care database in the United Kingdom, 1990â??2013. Participants: Individuals reaching the age of 100 between 1990 and 2013 (N = 11,084, n = 8,982 women, n = 2,102 men). Measurements: Main categories of morbidity and an index of multiple morbidities, geriatric syndromes and an index of multiple impairments, cardiovascular risk factors. Results: The number of new female centenarians per year increased from 16 per 100,000 in 1990â??94 to 25 per 100,000 in 2010â??13 (P P = .06). The most prevalent morbidities at the age of 100 were musculoskeletal diseases, disorders of the senses, and digestive diseases. Women had greater multiple morbidity than men (odds ratio (OR) = 1.64, 95% confidence interval (CI) = 1.42â??1.89, P P < .001). Conclusion: Fewer men than women reach the age of 100, but male centenarians have lower morbidity and fewer geriatric syndromes than women. Research using EHRs offers opportunities to understand the epidemiology of aging and improve care of the oldest old. (PsycINFO Database Record (c) 2016 APA, all rights reserved) |
0 | The effect of skin expansion on acellular dermis in an experimental model | Acellular Dermal Matrix | OBJECTIVE: Although acellular dermis is widely used in prosthesis-based breast reconstruction, there is no study evaluating its expandability and histological, ultra-structural related changes. The purpose of this study is to determine whether acellular dermis could be expanded and whether the histological changes occurring in the skin with tissue expansion is different from normal when acellular dermis is used. METHODS: Twenty-two male Wistar rats were used in this study. In group 1 (n?=?6), a rectangular-shaped tissue expander with final volume of 35?ml was placed subcutaneously. In group 2 (n?=?6) tissue expander was placed submuscularly. In group 3 (n?=?6), a 4?×?5?cm, acellular dermis was inserted and sutured in place, tissue expander was placed underneath acellular dermis. Group 4 (n?=?4) was control, no procedure was done after creation of a pocket. After day 30, tissue expanders were inflated with 2?ml every 2 days with saline solution. On day 66, midvertical, midhorizontal surface expansion measurements were recorded. Samples were examined macroscopically. Biopsies were taken from mid-point of the expanded full-thickness flap. Histological evaluation, total skin thickness, epidermal thickness, and the amount of vascularisation were measured. RESULTS: There was no expansion noted on the acellular dermis; however, acellular dermis increased vascularity and decreased the thinning of the overlying skin and thickening of the epidermis when compared to other groups. CONCLUSION: Acellular dermis use can be beneficial in implant-based breast reconstruction in terms of morbidity and its tissue support. |
1 | Which comes first: Crystals or osteoarthritis? | AMP (Acute Meniscal Pathology) | Crystal deposition could be a primary factor leading to joint damage in osteoarthritis or a secondary phenomenon resulting from it. Circumstantial evidence supports both. In 5 patients with hypermobility (laxity) of only 1 or 2 joints, calcium pyrophosphate dihydrate or hydroxyapatite crystals were found in the lax joints but not elsewhere. In a study of 100 meniscectomy patients, a higher incidence of clinical problems and radiological OA was found in the operated knees of the chondrocalcinosis group than in operated knees with no evidence of crystal deposition. |
0 | Removal of intramedullary rods after femoral shaft fracture | Management of Hip Fractures in the Elderly | We are reporting a retrospective review of the removal of 60 intramedullary rods in 58 patients. All fractures had healed at the time of rod extraction. The implant was removed from 34 asymptomatic patients (36 femurs). Twenty-four patients (24 femurs) had preoperative symptoms attributed to the femoral rod. Fourteen patients had symptoms about the greater trochanter preoperatively, five patients had symptoms referable to the knee, and five had infections about the femoral implant. Problems encountered included broken rods in five femurs, one of which was not apparent on preoperative radiographs. There were six patients (six femurs) who required further hospital care for postoperative hematomas. The development of a significant hematoma was not related to the location of the fracture, the presence of interlocking devices requiring removal, the length of time since injury, the performance of this procedure as an inpatient or outpatient, or the presence or absence of a functional drain. Of the 10 patients (10 femurs) who had proximal heterotopic ossification Brooker stage 2 or greater, wound hematomas developed in four patients (40%). There were no refractures. Although there may be an indication for rod removal, we do not recommend the procedure in asymptomatic patients |
1 | Impact of reduction mammaplasty on sexuality in patients with macromastia and their partners | Reduction Mammoplasty for Female Breast Hypertrophy | AIM OF STUDY: Women with breast hypertrophy often experience a number of physical symptoms and psychological difficulties. The breasts are very important for the psychological well-being of women, which might be affected negatively because of breast size and shape distortions. Self-body dissatisfaction and, in this background, the breasts can lead to low levels of self-confidence and self-esteem, which might affect sexuality.
MATERIALS AND METHODS: Thirty-five women with macromastia and their partners were evaluated for their sexual function and surgery satisfaction before and 6 months following reduction mammaplasty. Physical status and sexual satisfaction were assessed using a questionnaire. In addition, the sexual function of the women and their partners was evaluated using the Index of Female Sexual Function (IFSF) and the International Index of Erectile Function (IIEF).
RESULT: There was a significant improvement in the mean IFSF and IIEF scores after surgery in both patients and their partners. In addition, patients expressed high levels of satisfaction with the results of surgery in terms of physical and psychological scores.
CONCLUSION: Reduction breast surgery has a positive impact on the health status and psychological function as well as on the sexual activity of patients and their partners. |
0 | Coping with the Asian tsunami: perspectives from Tamil Nadu, India on the determinants of resilience in the face of adversity | DoD PRF (Psychosocial RF) | The Asian tsunami of December 26, 2004 wreaked havoc along the southeastern coast of India and resulted in devastating losses. The high rates of long-term mental health consequences in adult survivors predicted immediately after the disaster have not been borne out by recent surveys. This qualitative study explored the psychological impact of the tsunami on survivors with a view to gaining insights into the ethno-cultural coping mechanisms of affected communities and evaluating resilience in the face of incomprehensible adversity. We conducted focus group discussions 9 months after the tsunami with two groups of fishermen, two groups of housewives, a group of village leaders and a group of young men in four affected villages of Nagapattinam district in Tamil Nadu, India. In spite of incomplete reconstruction of their lives, participants reconstructed meaning for the causes and the aftermath of the disaster in their cultural idiom. Qualitative changes in their social structure, processes and attitudes towards different aspects of life were revealed. Survivors valued their unique individual, social and spiritual coping strategies more than formal mental health services. Their stories confirm the assertion that the collective response to massive trauma need not necessarily result in social collapse but also includes positive effects. The results of this study suggest that interventions after disaster should be grounded in ethno-cultural beliefs and practices and should be aimed at strengthening prevailing community coping strategies. |
1 | Costs of osteoporosis related fractures in hospital admitted patients, Tigrai, Northern Ethiopia: a retrospective study | HipFx Supplemental Cost Analysis | BACKGROUND: Osteoporotic fractures are among the non-communicable diseases imposing a growing morbidity and economic burden upon developing countries which have limited resources. Despite several studies from other countries, in Ethiopia sufficient information regarding the cost of illness related to osteoporotic fractures is not available. OBJECTIVE: The aim of the study was to estimate the direct and indirect costs attributable to osteoporotic fractures from a patient perspective. METHODS: A retrospective review of 1,169 medical records of cases of osteoporosis related fracture that had been diagnosed and treated over a two year period were selected systematically and included in the analysis. Cost of illness was estimated after developing a checklist to extract the direct patient side medical costs from individual based data and indirect costs were estimated using a human capital approach. RESULT: Analysis of the patient side direct medical costs of osteoporotic fracture according to the site of the fracture resulted in hip fractures identified as the most expensive fractures accounting for about 25% of the total (Median cost, was ETB 237.50 (US$14.09), and Mean = ETB 367.80 (US$ 21.83 per individual patient), while wrist fractures were the least expensive accounting for 6.2% (Median ETB 59.00 (US$3.50) and Mean ETB 59.40 (US$ 3.53 per individual patient). The average length of hospitalization was 22 days. The maximum number of days of hospitalization took place in cases with proximal femoral fracture and fractures of the hip and vertebrae, with a median of 25 days. For every single day increment in inpatient hospital stay there was an equivalent increment of ETB 23.27 (US$1.38). The hospital bed occupancy rate for the two years due to osteoporotic fractures was 6.8%. The total direct medical and indirect cost attributable to osteoporotic fractures during the two year period was ETB 1,314,979.00 (US$78,045.08). Of this total, direct medical cost and indirect costs incurred by the patients accounted for 49.2% and 50.9%, respectively. CONCLUSION: The total patient side cost attributable to osteoporotic fractures incurred over a two year time period was over ETB 1.3 million ($US 78,000). Over 50% of the cost was related to absenteeism from work due to hospitalization. From the patients' perspective the costs pose substantial burden on patients and their families. Hence, interventions to prevent osteoporosis should be implemented |
0 | Role of cytokines in gonarthrosis and knee prosthesis aseptic loosening | Surgical Management of Osteoarthritis of the Knee CPG | Cytokines, which have been demonstrated in synovial fluids during various joint diseases, play an important role in mediating synovial inflammation and in regulating the immune response of many inflammatory processes. We studied synovial fluid, serum, and synovial fragments obtained from 33 patients--10 affected by serious gonarthrosis re-quiring a prosthetic implant, 8 with knee prosthesis aseptic loosening, and (as controls) 15 affected by degenerative meniscopathies--to evaluate the degree of inflammation and level of interleukins (IL-2, IL-4, IL-6, IL-10) and interferon gamma secretion. Histological analysis revealed slightly more infiltration by inflammatory cells in the synovial tissue of patients with gonarthrosis and knee prosthesis aseptic loosening than in that of the control group, with a high prevalence of macrophages. Moreover, we observed enhanced production of the studied cytokines, especially in synovial fluid as compared to serum, indicating that in the pathological conditions examined the inflammatory events are mainly localized. Because the role of these cytokines is to modulate inflammation, better knowledge of the involvement of cells and their soluble mediators in articular damage could guide immunomodulating treatment |
1 | Acetabular development after closed reduction of congenital dislocation of the hip | Developmental Dysplasia of the Hip CPG | We reviewed the serial radiographs of 54 hips in 47 children treated by closed reduction for congenital dislocation of the hip and followed to at least 14 years of age, to determine the causes of acetabular dysplasia. We excluded hips with femoral head deformity or residual subluxation and compared the results with those from a control series of unaffected hips of patients with unilateral CDH. Acetabular development after the age of 11 or 12 years was significantly worse in Severin group III than in Severin group I hips on the affected side or Severin group III in unaffected control hips. One of the causes of acetabular dysplasia at maturity was found to be impairment of acetabular development after 11 or 12 years of age. This may be attributable to impaired secondary ossification in the acetabular rim. Our findings emphasise the importance of continuing the follow-up of patients treated for congenital dislocation of the hip until full skeletal maturity |
1 | Cost-Effectiveness of Tramadol and Oxycodone in the Treatment of Knee Osteoarthritis | OAK 3 - Non-arthroplasty tx of OAK | OBJECTIVE: To evaluate the cost-effectiveness of incorporating tramadol or oxycodone into knee osteoarthritis (OA) treatment.
METHODS: We used the Osteoarthritis Policy Model to evaluate long-term clinical and economic outcomes of knee OA patients with a mean age of 60 years with persistent pain despite conservative treatment. We evaluated 3 strategies: opioid-sparing (OS), tramadol (T), and tramadol followed by oxycodone (T+O). We obtained estimates of pain reduction and toxicity from published literature and annual costs for tramadol ($600) and oxycodone ($2,300) from Red Book Online. Based on published data, in the base case, we assumed a 10% reduction in total knee arthroplasty (TKA) effectiveness in opioid-based strategies. Outcomes included quality-adjusted life years (QALYs), lifetime cost, and incremental cost-effectiveness ratios (ICERs) and were discounted at 3% per year.
RESULTS: In the base case, T and T+O strategies delayed TKA by 7 and 9 years, respectively, and led to reduction in TKA utilization by 4% and 10%, respectively. Both opioid-based strategies increased cost and decreased QALYs compared to the OS strategy. Tramadol's ICER was highly sensitive to its effect on TKA outcomes. Reduction in TKA effectiveness by 5% (compared to base case 10%) resulted in an ICER for the T strategy of $110,600 per QALY; with no reduction in TKA effectiveness, the ICER was $26,900 per QALY. When TKA was not considered a treatment option, the ICER for T was $39,600 per QALY.
CONCLUSION: Opioids do not appear to be cost-effective in OA patients without comorbidities, principally because of their negative impact on pain relief after TKA. The influence of opioids on TKA outcomes should be a research priority. |
0 | Epinephrine 4 μg/mL added to a low-dose mixture of ropivacaine and fentanyl for lumbar epidural analgesia after total knee arthroplasty | AAHKS (8) Anesthetic Infiltration | BACKGROUND: Epinephrine 2 μg/mL added to a local anesthetic-opioid mixture has been found to improve postoperative continuous epidural analgesia at the thoracic (TEA) but not at lumbar (LEA) level. Therefore, we studied whether a higher dose of epinephrine could improve LEA. METHODS: Patients received LEA comprising of ropivacaine 1.8 mg/mL and fentanyl 3 μg/mL either without (group RF, n = 32) or with epinephrine 4 μg/mL (group RFE, n = 31) for 2 days after total knee arthroplasty. Rescue pain medication consisted of epidural top-ups (study mixture) and parenteral oxycodone. RESULTS: Total amounts of epidurally administered drugs were significantly higher in group RFE. Otherwise, the groups did not differ significantly regarding pain relief and side effects. CONCLUSIONS: As part of the multimodal pain treatment used, the epidural adjuvant epinephrine 4 μg/mL (12-32 μg/h) did not improve LEA after total knee arthroplasty. © 2008 by International Anesthesia Research Society. |
0 | The uses of tendon transfers to correct paralytic deformity of the foot and ankle | DOD - Acute Comp Syndrome CPG | Tendon transfers for paralytic foot and ankle deformities can be rewarding in well-selected patients. The goal should be to achieve a stable plantigrade foot which will not require a brace. This is possible if there is adequate preoperative tendon strength, adherence to the basic principles of tendon transfer during surgery, and intensive retraining of the muscle in the recovery phase. The optimal method of tendon fixation remains unclear. |
0 | Fear responses in patients with epilepsy | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | Ictal fear was found equally with left- and right-sided temporal lobe foci, suggesting that basic components of fear may be bilaterally represented. With regard to interictal fear, patients with left-sided foci reported more fear of social and sexual situations, but not of animals and physical injury, compared with other groups. Men with foci in the right temporal lobe reported less fear than men with left-sided foci. It is conceivable that the two hemisphere contribute differently in the cognitive elaboration of fear responses. Alternatively, differential patterns of self-report of fearfulness may be secondary responses to cognitive or sensorimotor loss. Finally, the present study not only demonstrates differences between right and left temporal lobe epileptics, but also between these groups and those with and without other CNS dysfunction |
0 | Tranexamic acid reduces haematomas but not pain after total knee arthroplasty | AAHKS (4) Acetaminophen | Aim: Tranexamic acid (TxA) reduces total blood losses (TBL) and allogenic transfusion (TH) after total knee arthroplasty (TKA). TBL can be external (surgical field, drains), or hidden (haematomas). Haematomas induce pain and limit postoperative rehabilitation. The aim of the study was to evaluate if TxA reduces haematomas and pain after TKA. Study design: Prospective nonâ?randomized study. Method: After ethical committee approvement and written informed consent, the patients planned for a primary TKA were included (control group followed by a TxA group, 15. mg/kg before incision and at skin closure). General anaesthesia and analgesia were standardized (sciatic block, continuous femoral block, ketamine, ketoprofene, paracetamol, PCA with morphine). Volume of haematomas = TBL (calculated based on haemograms performed the day before surgery, and at postoperative day 5, and on transfusions). â?measured external bleeding. Patients were followed up for 8. days, and at postoperative day 180 (by phone). Fifty patients per group allowed the detection of a 50% morphine sparing at day 8 (alpha = 0.05 and beta = 0.2), and a 25% reduction of haematoma volumes at day 5. Results. â? Perioperative data, pain scores and functional parameters (until day 180) were not different between control group patients (n = 52) and TxA group patients (n = 55): morphine consumption at day 8 was respectively 35 + 32 and 42 + 38 mg (P = 0.29). Yet, TxA reduced hematoma volumes (526 + 202 versus 337 + 165 mL of red blood cells, P < 0.0001) and clinically apparent hematomas. Morphine consumptions at day 8 and haematoma volumes were not correlated. Conclusion. â? After TKA, TxA reduces the volume of hematomas, without any improvement in analgesia and rehabilitation until the sixth postoperative month. 2010 Elsevier Masson SAS. |
0 | Beneficial effects on intraoperative and postoperative blood loss in total hip replacement when performed under lumbar epidural anesthesia. An explanatory study | AAHKS (8) Anesthetic Infiltration | The effects of continuous lumbar epidural anesthesia and two types of general anesthesia on blood loss and hemodynamics during and after total hip replacement were compared in three groups of patients. Fourteen patients received local anesthetics via continuous lumbar epidural administration; 10 patients received inhalational anesthetics and breathed spontaneously after endotracheal intubation; and 14 received artificial ventilation after intubation and intermittent intravenous (i.v.) injections of pancuronium and fentanyl. The results documented that both intraoperative and postoperative blood losses were significantly reduced in patients subjected to total hip replacement under lumbar epidural anesthesia as compared with the patients receiving the two general anesthetic techniques. Hemodynamic differences explained the differences in blood loss. The epidural anesthesia induced hypotension on the arterial and venous sides as compared with the two general anesthetic techniques. Inhalational anesthesia also induced hypotension on the arterial and venous sides intraoperatively as compared with general anesthesia with artificial ventilation. Postoperatively, the hemodynamics of the general anesthesia groups were similar, and no differences in blood loss occurred. Continuous' epidural anesthesia can be viewed as a tool to achieve hypotensive anesthesia--notably on the venous side--for the purpose of minimizing blood loss. The reduction in blood loss associated with lumbar epidural anesthesia is beneficial in decreasing the hazard and cost of blood transfusion. |
0 | Indications, techniques and complications in surgical treatment of the acetabulum | DoD SSI (Surgical Site Infections) | Almost 50 % of acetabular fractures occur in polytraumatized patients; in over 80 % additional injuries are found. The surgical goal is anatomical restoration of the acetabulum and stable fixation, in order to avoid postoperative external fixation.Careful clinical and radiological evaluation is essential to successful surgery. Standard radiological investigations include an anteroposterior view of the pelvis, a "spot" radiograph of the affected hip as well as obturator and iliac oblique views. The latter arc is especially helpful in assessing the central segment of the acetabulum ("dome fragment"). The documentation of any primarily traumatic sciatic nerve lesion is very important, and the quality of reduction depends greatly on the timing of surgery. The operation should be performed as early as possible after the surgical procedure has been carefully planned. A 3-D CT scan provides good information in choosing the surgical approach for complex fractures. In most cases, adequate reduction cannot be accomplished without appropriate aids. For internal fixation, both curved ASIF plates and straight plates are used. The operation demands a high degree of experience.Postoperative complications include iatrogenic nerve palsy, insufficient reduction, incorrectly placed implants, unstable fixation, redislocation, etc. With scrupulous aseptic conditions, the postoperative wound infection rate is low. Ectopic bone formation can occur after extensive surgical approaches and may, depending on size (Brooker III and IV), impair the range of motion of the hip. Indometacin given perioperatively is always indicated. Postoperative radiation treatment should as a rule be viewed critically. |
0 | Anterior knee pain in the young athlete: diagnosis and treatment | Diagnosis and Treatment of Osteochondritis Dissecans AUC | The underlying etiology of anterior knee pain has been extensively studied. Despite many possible causes, often times the diagnosis is elusive. The most common causes in the young athlete are osteosynchondroses, patellar peritendinitis and tendinosis, synovial impingement, malalignment, and patellar instability. Less common causes are osteochondritis dissecans and tumors. It is always important to rule out underlying hip pathology and infections. When a diagnosis cannot be established, the patient is usually labeled as having idiopathic anterior knee pain. A careful history and physical examination can point to the correct diagnosis in the majority of cases. For most of these conditions, treatment is typically nonoperative with surgery reserved for refractory pain for an established diagnosis |
0 | The mental health and psychosocial impact of the Bougainville Crisis: a synthesis of available information | DoD PRF (Psychosocial RF) | BACKGROUND: The Bougainville Crisis (1988-1997) was the largest armed conflict in the Pacific since WW-II. Despite this, there has been no assessment of the Mental Health and Psychosocial (MHPS) impact of the war. The aim of this paper is to summarize the available data regarding the longer-term MHPS impact of the Bougainville Crisis.
METHODS: A literature review and a sequence of consultations in Bougainville were conducted to identify the MHPS impact of the Bougainville Crisis and the capacity within Bougainville to address these issues.
RESULTS: The Bougainville Crisis resulted in violence-related deaths; the displacement of more than half of the population; widespread human rights abuses; far-reaching societal impacts including undermining of the traditional authority of elders and women and damage to cultural values and relationships; property damage; and significant impacts on education and the economy. Conflict-related experiences continue to impact on mental health in the form of trauma-related symptoms, anger, complicated grief, alcohol and substance abuse, domestic violence including sexual assault, excessive alcohol use and a lack of engagement in purposeful activities. Other impacts include an increase in other forms of gender-based violence (including sexual assault), population displacement, and adverse trans-generational effects on children exposed to disturbed parental behaviours attributable to conflict exposure. In spite of the evident needs, there is limited capacity within Bougainville to address these pressing MHPS issues.
CONCLUSIONS: The Bougainville Crisis has had a significant MHPS impact at multiple levels in the society. There is a strong interest within Bougainville to draw on external expertise to build local capacity to address MHPS issues. Preliminary recommendations are made to assist the process of building the capacity in Bougainville to address MHPS needs. |
0 | Incremental cost of medical care after hip fracture and first vertebral fracture: the Rotterdam study | HipFx Supplemental Cost Analysis | The aim of this study was to estimate the additional cost of medical care (the incremental cost) caused by incident hip and vertebral fractures, using a matched case cohort design within a longitudinal follow-up study. Incident hip fractures were recorded using the regular follow-up system of the Rotterdam Study. Incident vertebral fractures were recorded by morphometric comparison of spinal radiographs taken at intervals of 2.2 years on average. The matched control group was randomly selected from other participants of the Rotterdam Study in whom no fracture occurred during follow-up, but who were otherwise comparable at baseline. Cases were matched for age, gender, self-perceived health, ability to perform activities of daily life, living situation and general practitioner. Medical expenditure was assessed by retrieval of the general practice medical records and by recording all hospital and nursing home admissions, and all general practice and outpatient visits. Pharmaceutical consumption was recorded through the computerized records of the central pharmacy. Valid results were obtained for 44 pairs (91%) in the hip fracture and for 42 pairs (93%) in the vertebral fracture group. Cost of medical consumption in the year before the hip fracture was similar in patients and control subjects, but the incremental cost in the first year after the hip fracture was almost US$10 000. In the second year after hip fracture the incremental cost was still about $1000. Accounting for the excess mortality in hip fracture patients had little effect on cost in the first year, but cost in the second year was doubled to almost $2000. For vertebral fractures, we did not detect important acute care costs, but these fractures were associated with a yearly recurrent incremental cost of over $1000. However, almost half this difference was already present before the occurrence of the fracture, and was attributable to hospital admissions. The remainder of the incremental cost was mainly due to pharmaceutical consumption and to a lesser extent to admissions to orthopedic surgery wards. We conclude that hip fractures cause excess mortality and an important incremental cost especially during the first year, and that these could probably be avoided by prevention of hip fractures. For vertebral fractures we found no evidence of important acute care costs but we observed a yearly returning incremental cost. Part of this incremental cost, however, was pre-existing and might therefore by caused by co-morbidity |
0 | Use of prescription analgesic medication and pain catastrophizing after total joint replacement surgery | OAK 3 - Non-arthroplasty tx of OAK | Objective: To survey the use of analgesic medication 4.8 years after total joint replacement (TJR) surgery and assess the determinants of medication usage. Patients and methods: Of 852 patients who had undergone TJR for osteoarthritis were recruited from secondary care. Participants (mean age, 73.7 years) responded to a questionnaire on medication use, physical function and pain (WOMAC, VAS and body pain), pain catastrophizing and illness behaviour (somatization). Results: Only 37% of study participants were not on any pain relief medication, 25.1% were taking opioids, 6.9% were taking prescription NSAIDs and 25.9% were taking only non-prescription analgesics. Use of NSAIDs correlated with presence of back pain, body pain and high illness behaviour. The strongest associations with use of opioids were severe joint pain, high pain catastrophizing, body and back pain. After adjustment for covariates plus presence of pain, catastrophizing remained significantly associated with higher risk of opioid use (OR = 1.66, 95% CI: 1.13-2.43, p < 0.009) and of other prescription medication that can be used to treat pain (anti-depressants, anti-epileptics and hypnotics) (OR = 2.52, 95% CI: 1.61-3.95, p < 0.0005). Conclusions: Use of opioid medication 4 years post-TJR is very high in our study population. In addition to joint, back and body pain, a major contributor to opioid use is pain catastrophizing. Our data suggest that current opioid and other analgesic prescribing patterns may benefit from considering the catastrophizing characteristics of patients. |
1 | Retrograde Stainless Steel Flexible Nails Have Superior Resistance to Bending in Distal Third Femoral Shaft Fractures | Pediatric Diaphyseal Femur Fractures 2020 Review | BACKGROUND: It has been shown that retrograde titanium flexible intramedullary nails (Ti FIN) provide superior resistance to bending compared to antegrade Ti FIN in distal femur fractures. The purpose of this study was to compare resistance to torsional and bending forces of stainless steel (SS) FIN, with or without a locking screw, and Ti FIN in distal third femoral shaft fractures. We hypothesize that locked retrograde SS FIN will demonstrate greater resistance to both bending and torsional forces. METHODS: Thirty adolescent synthetic femur models were used to simulate transverse distal femoral fractures at either 60â??mm or 90â??mm proximal to the distal femoral physis. The femurs were instrumented with antegrade Ti FIN, antegrade SS FIN, retrograde Ti FIN, retrograde SS FIN, or retrograde locked SS FIN. Three models for each construct at both osteotomy levels were tested. Models were analyzed to determine maximum resistance to bending and torsion. RESULTS: In fractures 60â??mm from the physis, retrograde SS FIN demonstrated statistically superior resistance to bending when compared with both antegrade and retrograde Ti FIN (P=0.001 and 0.008, respectively) and antegrade SS FIN (P=0.0001). Locked SS constructs showed a trend towards greater resistance to bending forces when compared with unlocked constructs (P>0.05). No significant difference was seen in resistance to bending when fractures were 90â??mm proximal to the distal femoral physis between the five groups. No significant differences were observed in resistance to torsion in either the proximal or distal fracture models, regardless of construct type. CONCLUSIONS: Retrograde SS FIN confer significantly greater resistance to bending forces for fractures 60â??mm proximal to the distal femoral physis compared with Ti FIN or antegrade entry SS FIN. In fractures 90â??mm from the physis, no differences were noted in our model. Our results support the use of retrograde SS nails in the pediatric patient with distal femoral shaft fractures. LEVEL OF EVIDENCE: Level II-comparative biomechanical study. |
0 | The negative influence of multiple symptomatic joint involvement on patient-reported outcomes following TJR for OA can last up to 5 years | Surgical Management of Osteoarthritis of the Knee CPG | Purpose: Patient-reported pain and physical function are the most common outcomes examined in total joint replacement (TJR) for hip and knee osteoarthritis (OA). While TJR is an effective treatment for relieving pain and improving function, previous work has shown that the reporting of multiple symptomatic joints at the time of surgery negatively impacts 1-yr outcome scores. However, whether these negative effects persist beyond the recovery period is unknown. This work evaluated whether the presence of symptomatic joints predicted worse pain and physical function scores over a five year period following TJR. Methods: Participants completed a health questionnaire including the hip/knee-specific WOMAC pain and physical function measures presurgery and at 3, 6, 12 and 60 months post-surgery. Higher scores reflected worse status. Symptomatic joints were indicated on a homunculus pre-surgery based on pain or discomfort on most days of the previous month. Not including the surgical joint, symptomatic joint count was categorized as 0-1, 2-4, and 5+ (each group representing about one-third of the sample). Individuals reporting other hip or knee TJR during the 5 years of follow-up were not included in this analysis. Linear GEE regression modeling (accounting for the within-person correlated scores over time) was used to examine the relationship between symptomatic joint count and hip/knee-specific pain and physical function scores over the five years. Model covariates included age, sex, body mass index, comorbidity, hip/knee, and time since surgery. Results: 433 participants provided data up to and including the 5th year post-surgery. Age at surgery ranged from 35-88 years (mean = 65) with 61% female. At baseline 36% reported 0-1 symptomatic joints, 34% reported 2-4, and 30% reported 5+ symptomatic joints. No baseline differences in age, sex, surgical joint, BMI, or symptomatic joint counts were found between those who did and did not complete the 5th year survey. While there were statistical differences for baseline pain and physical function, the magnitude of these differences were small: 0.7 and 3 units on scales ranging from 0-20 and 0-68, respectively. Significant time trends for improvement in pain and physical function scores were found. Adjusting for covariates, increasing joint count was associated with worse pain and function scores throughout the 5 year follow-up (all p-values < 0.006), and more so for physical function. Accounting for baseline covariate effects, the least square mean differences at 5 years between those in the highest and lowest symptomatic joint count categorieswere nearly 2 for pain and 7.4 for physical function. Conclusions: While TJR is an effective intervention, these study results suggest that joint-specific patient-reported outcomes are negatively influenced by more than the symptoms of the surgical joint alone. Further, it appears that these negative effects are not limited to the early recovery period, and rather persist for many years following surgery. This knowledge should inform rehabilitation strategies post-TJR and the need for ongoing follow-up. The findings also potentially speak to a need for a more holistic approach to OA management |
0 | Experimental validation of a pinless femoral reference array for computer-assisted hip arthroplasty | PJI DX Updated Search | The use of computer navigation systems during total hip arthroplasty requires the femoral fixation of a reflective dynamic reference base (DRB), which theoretically involves the risk of bony fracture, infection, and pin loosening. The first objective of this study was to evaluate the relative movements between a novel, noninvasive external femoral DRB system and the femur. Secondly, the maximum effects of these 3D movements on intraoperative, computer-assisted leg length and offset measures were evaluated. An imageless navigation system was used to track the positions of the soft tissue attached, pinless DRB relative to an invasive reference marker on the femur during a less-invasive, anterior surgical hip approach. Relative translatory movements up to 8.2 mm mediolaterally and up to 8.8 degrees in rotation were measured. Using a measurement technique in which the calculation of leg length and offset changes is primarily based on a specific realignment of the leg, maximum differences of 1.3 mm for leg length and 1.2 mm for offset were found when comparing the pin-based and pinless methods. Thus, invasive fixation techniques with screws or pins are still the method of choice when standard measurement algorithms for intraoperative leg length and offset measures are used. Though direct translatory and rotational variations between the pinless array and the femoral bone were detected, the pinless array can be used to assess leg length and offset when used with a specific measurement technique that compensates for such variations |
0 | Can we prevent BRCA1-associated breast cancer by RANKL inhibition? | MSTS 2018 - Femur Mets and MM | BRCA1 mutation carriers face a high lifetime risk of breast cancer, estimated at 60 % compared to 10 % in the general population. BRCA1 breast cancers typically have an aggressive course (i.e., high-grade, triple-negative) and are associated with a poor prognosis. At present, primary prevention is limited to prophylactic removal of the unaffected breasts. Effective chemopreventive strategies are not yet available. Emerging evidence suggests that BRCA1 mutation carriers have high circulating levels of progesterone which may play a role in their susceptibility to breast cancer. Recently, the RANK/RANKL system was found to be dysregulated in women with a BRCA1 mutation. Mutation carriers had significantly lower endogenous levels of osteoprotegerin (OPG) than women without a BRCA1 mutation. OPG is an endogenous decoy receptor for RANKL and inhibits RANKL-mediated signaling. RANKL binds to RANK on mammary epithelial cells and stimulates their proliferation and maturation. Low OPG levels may contribute to mammary tumorigenesis through increased proliferation and may explain in part the increased breast cancer risk in BRCA1 mutation carriers. Denosumab is an anti-RANKL monoclonal antibody which is approved to treat osteoporosis and to prevent skeletal damage caused by bone metastases. The emerging role of aberrant RANK-signaling in BRCA1 tumorigenesis suggests that targeting of RANKL may prevent breast cancer among women with germline BRCA1 mutations. Clinical investigations of denosumab are warranted and may lead to a novel chemopreventive approach for breast cancer for high-risk women. |
0 | Infrapatellar fat pad area is associated with reduced knee symptomatic and structural abnormalities in older adults: A cross-sectional study | Surgical Management of Osteoarthritis of the Knee CPG | Background Recent studies consider infrapatellar fat pad (IPFP) as an active joint tissue in the initiation and progression of knee OA, as inflammatory cells from IPFP can produce inflammatory mediators [1]. As a result, partial resection or total excision of IPFP is usually occurred in the process of knee surgery (e.g., knee replacement, arthroscopy) without consideration of any side effects. However, as an intraarticular tissue, |
0 | Cytokine levels after transfusion of washed wound drainage in total knee arthroplasty: a randomized trial comparing autologous blood and washed wound drainage | Surgical Management of Osteoarthritis of the Knee CPG | Forty patients undergoing total knee arthroplasty (TKA) were prospectively randomized to autologous blood transfusion or retransfusion of washed wound drainage. The wound drainage was washed using a dynamic disk separation chamber. Interleukin (IL)-1 beta, IL-6, IL-8, and tumor necrosis factor (TNF) alpha blood levels were measured prior to epidural anesthesia and at 0, 30, 60, and 120 minutes after initiation of the transfusion. Washed wound drainage contained significantly higher amounts of IL-6 (P < .05) and IL-8 (P < .05) than predonated autologous blood. No significant difference was found for IL-1 beta (P = .28) and TNF-alpha (P = .14). The patients' IL-6 and IL-8 blood levels increased in both groups within 2 hours after the transfusion. This increase was correlated to the time interval between surgery and transfusion (P < .05) and was not significantly different between both groups. No correlation was found between the increase in patients' cytokine levels and the amount of washed wound drainage transfused. According to these results, the increase in IL-6 and IL-8 after transfusion is related to the surgical trauma response and not the transfusion protocol |
0 | Femoral-shaft fractures and nonunions treated with intramedullary nails: the role of dynamisation | DoD SSI (Surgical Site Infections) | Dynamisation of a previously interlocked intramedullary nail is believed to stimulate an osteogenic response due to increased load across the fracture site. The purpose of this study was to retrospectively investigate fracture patterns that could tolerate dynamisation without the risk of major complications. Thirty patients (24 males) with an average age of 33 years (17-90) were studied. As many as 21 suffered from a fresh femoral fracture, whereas the remaining nine patients suffered from femoral nonunions. Four patterns of osseous lesion were recognised in terms of mechanical stability under a dynamic nail and biological activity at the fracture/nonunion site: stable/hypertrophic, stable/atrophic, unstable/hypertrophic and unstable/atrophic osseous lesions. Complete union (within 6 months) occurred in 21 patients. Six fractures united within the 7th-11th post-dynamisation month and, in the remaining three cases, a nonunion developed. Significant femur shortening (>20 mm) was noticed in four patients and rotational malalignment in one patient. Logistic regression analysis revealed high odds ratio (OR=70, 95% confidence interval (CI) 2.5-1998) for the unstable/atrophic pattern of osseous lesion to develop major complications. In the unstable/atrophic pattern of osseous lesion, dynamisation should never be done, as it could lead to significant complications. |
1 | Negative Pressure Wound Therapy Prevents Hernia Recurrence in Simultaneous Ventral Hernia Repair and Panniculectomy | Panniculectomy & Abdominoplasty CPG | Simultaneous ventral hernia repair with panniculectomy (VHR-PAN) is associated with a high rate of wound complications. Closed incision negative pressure wound therapy (ciNPWT) has been shown to lower complications in high-risk wounds. There is a debate in the literature as to whether ciNPWT is effective at preventing complications in VHR-PAN. The aim of our study was to evaluate if ciNPWT improves outcomes of VHR-PAN. METHODS: A retrospective review of patients who underwent VHR-PAN between 2009 and 2021 was conducted. Patients were divided into two groups: (1) those who received standard sterile dressings (SSD), or (2) ciNPWT. Primary outcomes were postoperative complications, including surgical site occurrences (SSO) and hernia recurrence. RESULTS: A total of 114 patients were identified: 57 patients each in the SSD group and ciNPWT group. The groups were similar in demographics and comorbidities. There were more smokers in the SSD group (22.8% versus 5.3%, P = 0.013). Hernia defect size was significantly larger in patients who received ciNPWT (202.0 versus 143.4?cm(2), P = 0.010). Overall SSO was similar between the two groups (23.2% versus 26.3%, P = 0.663). At a mean follow-up of 6.6 months, hernia recurrence rate was significantly higher in the SSD group compared with that in the ciNPWT group. (10.5% versus 0%, P = 0.027). Smoking, diabetes, component separation, mesh type, and location were not significantly associated with hernia recurrence. CONCLUSIONS: Application of incisional NPWT is beneficial in decreasing hernia recurrence in VHR-PAN, compared with standard dressings. Larger prospective studies are warranted to further elucidate the utility of ciNPWT in abdominal wall reconstruction. |
0 | Predictors of Intraoperative Fractures during Hemiarthroplasty for the Treatment of Fragility Hip Fractures | Hip Fx in the Elderly 2019 | Background: The aim of our study was to determine the rate and preoperative predictors of intraoperative fracture (IOF) during hip hemiarthroplasty (HA) in patients who have sustained a fragility hip fracture injury.
Methods: We reviewed 626 patients who underwent HA at our institution using the National Hip Fracture Database. Various patient- and surgery-related data including demographic information, cement usage, surgeon grade, time to surgery, and operative duration were collected. The metaphyseal diaphyseal index and modified canal bone ratio were measured on preoperative radiographs. We compared patients with and without IOF with respect to all variables collected. Multivariate regression modeling was used to identify significant preoperative risk factors for IOF.
Results: There was a 7% incidence of IOF in our cohort exclusively comprising of Vancouver A fractures. The majority of these complications were treated nonoperatively (52%). There was no statistically significant difference with respect to cement usage, surgeon grade, operative duration, time to surgery, and radiographic parameters collected. Increasing age was found to be the most significant preoperative risk factor for predicting IOF (p = 0.024, overall relative risk = 1.06).
Conclusions: Our identified predictor of increasing age is nonmodifiable and illustrates the importance of meticulous surgical technique in older patients. Furthermore, its independence from fixation methods or prosthesis design as a predictor of IOF may support using an uncemented prosthesis in patients at risk from cement implantation. |
0 | The initiative on hip fractures of the Veneto Region | Management of Hip Fractures in the Elderly | Objective: to assess the prevalence of the most relevant environmental and individual risk factors in subjects with a recent hip fracture was the aim of this observational study promoted by the Health Authorities of the Regione Veneto (Italy). Methods: patients aged > 60 years of both genders with a recent hip fracture not associated with malignancies, were administered questionnaires on dietary habits, sun exposure, disability score. A complete family, pharmacological and pathology history was collected together with previous falls, details of the fracture index, anthropometric data. In a subgroup of patients blood was taken for the measurements of serum 25 hydroxy-vitamin D (25OHD). Results: the study includes 704 patients (573 women and 131 men). Mean age was 81(plus or minus)8 years (range 60-102). Severe prefracture disability was a common feature (58%) associated with multiple co-morbidities (84%), more frequently cardiovascular and neurological diseases, and specific medications. In a large proportion (86%) of the patients environmental or individual risk factors for falling were found. Vitamin D insufficiency was quite common, particularly in the regional Health Districts were strategies for preventing vitamin D deficiency were not implemented. Only a small proportion (17%) of the study population had been evaluate and treated for osteoporosis. Conclusions: in senile patients with a recent hip fracture pre-existing disability, multiple co-morbidities, high risk of falling and inadequate intake of calcium and vitamin D was quite common. Community and case-finding interventions are highly warranted |
0 | Preoperative adjuvant epidural tramadol: the effect of different doses on postoperative analgesia and pain processing | Surgical Management of Osteoarthritis of the Knee CPG | BACKGROUND: Tramadol is an analgesic with combined opioid agonist and monoamine reuptake blocker properties, which may be useful as a perioperative analgesic and antinociceptive adjuvant. METHODS: The dose-dependent effects of adjuvant preoperative epidural tramadol on postoperative analgesia (pain scores and patient-controlled analgesia (PCA) use) and pain processing (heat pain thresholds) were prospectively studied in a double-blind, randomised, placebo-controlled 5-day trial. Forty patients undergoing knee or hip surgery received anaesthesia with epidural lidocaine and epidural tramadol 20, 50 or 100 mg or placebo as a preoperative adjuvant. Postoperative analgesia was by intravenous PCA tramadol in all patients. RESULTS: Postoperative pain scores were similar in all groups. The time to first PCA use was shorter, the total dose and duration of PCA use greater, and side-effects more common with 20 mg tramadol than with 100 mg or placebo (P < 0.05). There were no differences in PCA doses required or side-effects between the tramadol 100 mg and placebo treatment groups. Heat pain tolerance thresholds were increased with 100 mg tramadol at 48 h postoperatively compared to baseline and placebo (P = 0.01). CONCLUSIONS: Preoperative adjuvant epidural tramadol does not improve postoperative analgesia after lidocaine epidural anaesthesia compared to placebo. Tramadol 20 mg results in anti-analgesia and increased side-effects. While tramadol 100 mg depresses postoperative pain-processing, as measured by heat pain tolerance thresholds, this is not reflected in improved clinical pain measures |
0 | Gender and disease severity determine proximal femoral morphology in developmental dysplasia of the hip | Developmental Dysplasia of the Hip 2020 Review | In this computed tomography (CT) morphological study we describe the way the proximal femoral morphology differs with worsening degrees of developmental dysplasia of the hip (DDH) and describe gender differences in patients with DDH. Forty-nine male patients with DDH were matched with 49 females with DDH, using age and the Crowe classification of DDH severity. The femoral length, anteversion, neck-shaft angle, offset, neck length, canal-calcar ratio, canal flare index, lateral center-edge angle, alpha angle, pelvic tilt, and pelvic incidence were measured for each patient on their pre-operative CT scans, prior to total hip arthroplasty surgery. Femoral anteversion and neck length were 16° and 47â??mm, 25°and 36â??mm, 26° and 43â??mm, and 44° and 36â??mm, for Crowe I and III males and Crowe I and III females, respectively. The mean male anteversion was 22° (±14), compared to 30° (±15.5) in females (pâ??=â??0.02, Confidence Interval: 1.6-14.9). Gender differences in femoral length, neck length and offset lost significance when height-normalized and no other significant gender differences were found. In conclusion, femoral neck length reduces with increasing DDH severity, whilst anteversion tends to increase. Male patients with DDH have significantly less femoral anteversion, which has important implications for osteotomy and arthroplasty surgery in DDH. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res. |
0 | Cementless Oxford medial unicompartimental knee replacement: an independent series with a 5-year-follow-up | OAK 3 - Non-arthroplasty tx of OAK | Purpose: Cemented unicompartmental knee replacement (UKR) has proven excellent long-term survival rates and functional scores in Price et al. (Clin Orthop Relat Res 435:171â??180, 2005), Price and Svard (Clin Orthop Relat Res 469(1):174â??179, 2011) and Murray et al. (Bone Joint Surg Br 80(6):983â??989, 1998). The main causes for revision, aseptic loosening and pain of unknown origin might be addressed by cementless UKR in Liddle et al. (Bone Joint J 95-B(2):181â??187, 2013), Pandit et al. (J Bone Joint Surg Am 95(15):1365â??1372, 2013), National Joint Registry for England, Wales and Northern Ireland: 10th Annual Report 2013 (http://www.njrcentre.org.uk/njrcentre/Portals/0/Documents/England/Reports/10th_annual_report/NJR%2010th%20Annual%20Report%202013%20B.pdf, 2013), Swedish Knee Arthroplasty Register: Annual Report 2013 (http://www.myknee.se/pdf/SKAR2013_Eng.pdf, 2013). Methods: This single-centre retrospective cohort study reports the 5-year follow-up results of our first 30 consecutively implanted cementless Oxford UKR (OUKR). Clinical outcome was measured using the OKS, AKSS, range of movement and level of pain (visual analogue scale). The results were compared to cemented OUKR in a matched-pair analysis. Results: Implant survival was 89.7%. One revision each was performed due to tibial fracture, progression of osteoarthritis (OA) and inlay dislocation. The 5-year survival rate of the cementless group was 89.7% and of the cemented group 94.1%. Both groups showed excellent postoperative clinical scores. Conclusions: Cementless fixation shows good survival rates and clinical outcome compared to cemented fixation. |
0 | Results of buccal mucosal grafting for patients with medically controlled ocular cicatricial pemphigoid | Upper Eyelid and Brow Surgery | Eyelid surgery for patients with ocular cicatricial pemphigoid is risky when there is unchecked perioperative inflammation. The authors performed buccal mucosal grafts on 42 eyelids (23 eyes) of 17 patients with ocular cicatricial pemphigoid whose disease was controlled by systemic immunosuppression. Results were graded as: improved (12 cases, 16 eyes); satisfactory (2 cases, 2 eyes); or poor (5 patients, 5 eyes). Complications included breakthrough trichiasis, surface keratinization of the graft, blepharoptosis, phimosis, depressed eyelid blink, incomplete eyelid closure, submucosal abscess formation, and persistent nonhealing epithelial defects of the cornea. Technical errors at surgery accounted for two complications. Secondary corneal ulceration developed in two patients. The immunologic aspect of the disease flared or progressed in five patients in the postoperative period and necessitated an increase or change in systemic medication for immunosuppression. Buccal mucosal grafting shows promise in temporarily rehabilitating eyelids of some ocular cicatricial pemphigoid patients whose disease is controlled by immunosuppressive therapy. |
1 | Arthroscopic meniscal repair using the BioStinger | AMP (Acute Meniscal Pathology) | PURPOSE: Biodegradable devices are available for all-inside meniscal repairs. One device, the BioStinger (Linvatec, Largo, FL), is made of molded poly-L-lactic acid. The purpose of this study was to evaluate the effectiveness of and any adverse events associated with meniscus repair using this device.
TYPE OF STUDY: Nonrandomized prospective cohort study.
METHODS: A prospective, consecutive, 3-center meniscal repair series using BioStingers (group 1), vertical inside-out sutures (group 2), or hybrid repairs combining BioStingers and sutures (group 3) was studied. Lysholm, Tegner, Cincinnati, and IKDC activity scores were obtained and clinical outcomes and adverse events documented.
RESULTS: There were 85 patients who underwent 89 meniscus repairs with an average 26.5 months of follow-up. There were 47 BioStinger repairs (group 1), 29 suture repairs (group 2), and 13 hybrid repairs (group 3). The tear length was statistically greater for the hybrid repair group (P < .5). There were 73 repairs associated with anterior cruciate ligament reconstructions and 12 repeat arthroscopies were performed. Meniscal healing failed in 6 knees (4 in group 1, 0 in group 2, and 2 in group 3). The meniscal healing failed in 7% of those associated with anterior cruciate ligament reconstructions. Mean Tegner scores improved from 2.8 to 6.3, the final IKDC activity score was 3.2 out of 4, the mean Lysholm score improved from 51 to 88, and the mean Cincinnati score improved from 44 to 84. Two BioStinger repair cases had joint-line tenderness from device migration confirmed by magnetic resonance imaging. No tenting of the skin or articular cartilage scuffing was observed.
CONCLUSIONS: The success rate for the 29 suture repairs was 100% and for the 47 BioStinger repairs was 91%. These preliminary results are consistent with other repair techniques.
LEVEL OF EVIDENCE: Level II, Therapeutic Prospective Cohort Study. |
1 | Brace treatment for osteoarthritis of the knee: a prospective randomized multi-centre trial | OAK 3 - Non-arthroplasty tx of OAK | OBJECTIVE: To evaluate the effect of a brace intended to reduce load in patients with medial or lateral compartmental osteoarthritis (OA) and concurrent varus or valgus alignment, respectively. DESIGN: This multi-centre randomized controlled trial (performed 2001-2003) studies the additive effect of a brace intended to reduce load in conservative treatment of unicompartmental OA of the knee. SETTING: Orthopedic department of a university medical centre and of one general hospital. The follow-up was 12 months. PATIENTS: 117 patients with unicompartmental OA of the knee. Intervention group (n=60) comprising conservative treatment with additional brace treatment and a control group (n=57) comprising conservative treatment alone. PRIMARY OUTCOME MEASURES: Pain severity and knee function score. SECONDARY OUTCOME MEASURES: Walking distance and quality of life. ANALYSIS: Multiple linear regression models according to the intention-to-treat-principle were used to assess outcome differences for the entire group of patients. In addition, we performed explorative subgroup analyses on primary overall outcomes stratified for alignment, degree of OA, origin of OA, and age. RESULTS: Although the primary outcome measures were improved in the intervention group in comparison with the controls at each assessment point, the differences reached only borderline significance. The reported walking distances at 3 months, 12 months and overall were significantly longer in the brace group (P=0.03, P=0.04 and P=0.02, respectively). Subgroup analysis showed a better effect in the varus group, in patients with severe OA, in patients with secondary OA and in patients younger then 60 years. In total 25 patients in the brace group and 14 in the control group changed their initial treatment, mostly (74%) because of a lack of beneficial effect. CONCLUSIONS: The results indicate that a brace intended to reduce load shows small effects in patients with unicompartmental OA. However, many patients do not adhere in the long run to this kind of conservative treatment. |
0 | Peliosis hepatis. Report of nine cases | Management of Hip Fractures in the Elderly | Nine cases of peliosis hepatis are reported: five of these were associated with the administration of androgen or anabolic androgenic steroids and a sixth with large doses of medroxy-progesterone acetate. In five instances, neoplasm was present as an underlying disease. Antemortem evidence of liver disease was detected in six of seven cases but was not severe and had not contributed to death. The pathogenesis of blood-filled cystic cavities is discussed and the literature reviewed. Angiopathy of hepatic sinusoids in patients with wasting diseases or in those receiving androgens in coexistence with passive congestion of the liver appear to be factors in the pathogenesis of pleiosis hepatis |
0 | Articular cartilage regeneration using acellular bioactive affinity-binding alginate hydrogel: A 6-month study in a mini-pig model of osteochondral defects | Osteochondritis Dissecans 2020 Review | BACKGROUND: Despite intensive research, regeneration of articular cartilage largely remains an unresolved medical concern as the clinically available modalities still suffer from long-term inconsistent data, relatively high failure rates and high prices of more promising approaches, such as cell therapy. In the present study, we aimed to evaluate the feasibility and long-term efficacy of a bilayered injectable acellular affinity-binding alginate hydrogel in a large animal model of osteochondral defects. METHODS: The affinity-binding alginate hydrogel is designed for presentation and slow release of chondrogenic and osteogenic inducers (transforming growth factor-β1 and bone morphogenic protein 4, respectively) in two distinct and separate hydrogel layers. The hydrogel was injected into the osteochondral defects created in the femoral medial condyle in mini-pigs, and various outcomes were evaluated after 6 months. RESULTS: Macroscopical and histological assessment of the defects treated with growth factor affinity-bound hydrogel showed effective reconstruction of articular cartilage layer, with major features of hyaline tissue, such as a glossy surface and cellular organisation, associated with marked deposition of proteoglycans and type II collagen. Microcomputed tomography showed incomplete bone formation in both treatment groups, which was nevertheless augmented by the presence of affinity-bound growth factors. Importantly, the physical nature of the applied hydrogel ensured its shear resistance, seamless integration and topographical matching to the surroundings and opposing articulating surface. CONCLUSIONS: The treatment with acellular injectable growth factor-loaded affinity-binding alginate hydrogel resulted in effective tissue restoration with major hallmarks of hyaline cartilage, shown in large animal model after 6-month follow-up. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE: This proof-of-concept study in a clinically relevant large animal model showed promising potential of an injectable acellular growth factor-loaded affinity-binding alginate hydrogel for effective repair and regeneration of articular hyaline cartilage, representing a strong candidate for future clinical development. |
0 | Low intensity laser therapy: Still not an established clinical tool | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | The surgical, ophthalmological, and dermatological applications of high power lasers are well known and easily understood. What is neither as well known nor as easily understood is that lasers at powers that are orders of magnitude smaller have also been used in the laboratory and clinic for nearly 30 years to modulate cell function, lessen pain, and accelerate healing of soft tissue injuries. This article analyzes the rationale of this approach, examines the utility of laser therapy in its most common clinical applications, reviews and synthesizes the findings, and concludes that although laboratory findings seem authentic, clinical utility remains unestablished |
0 | Psychosocial characteristics of young Norwegian women interested in liposuction, breast augmentation, rhinoplasty, and abdominoplasty: a population-based study | Panniculectomy & Abdominoplasty CPG | BACKGROUND: The present study investigated various psychosocial factors expected to predict an interest in liposuction, breast augmentation, rhinoplasty, and abdominoplasty. METHODS: Questionnaire data were obtained from 1862 participants who responded to a survey distributed to a representative sample of 3500 women from northern Norway aged 18 to 35 years. RESULTS: Liposuction was the most popular procedure (25 percent), followed by breast augmentation (15 percent), rhinoplasty (7.0 percent), and abdominoplasty (5.6 percent). Most of the women interested in rhinoplasty and breast augmentation reported interest in more than one procedure, whereas the vast majority of women interested in abdominoplasty were not interested in any other procedure. Multiple regression analyses showed that a low level of education, indicators of social acceptance of cosmetic surgery, and negative appearance evaluation were predictors of an interest in all procedures. Body dysmorphic disorder-like symptoms, appearance orientation, and teasing history were predictors of an interest in all procedures except for abdominoplasty, whereas having children was a predictor of all procedures except for rhinoplasty. Divorce rate and eating disorder were predictors of an interest in liposuction only. Univariate regression analyses showed that the Big-Five personality traits were associated with all procedures except abdominoplasty. CONCLUSIONS: It appears that women interested in abdominoplasty may be motivated by a desire to repair the bodily changes occurring after childbirth, whereas women interested in liposuction, breast augmentation, and rhinoplasty may have more complex psychological factors associated with their interest in cosmetic surgery. The findings of this study provide increased knowledge about psychosocial factors characterizing women interested in liposuction, breast augmentation, rhinoplasty, and abdominoplasty. |
0 | Alendronate in the treatment of postmenopausal osteoporosis | Management of Hip Fractures in the Elderly | The following article reviews the results of 2 investigational Phase III trials of alendronate. Alendronate has been found to induce clinically significant increases in bone mineral density at the spine, hip and other cortical and trabecular sites while maintaining bone quality thereby reducing the rate of vertebral fracture. Alendronate was revealed to be well tolerated, with a good safety profile; a dose of 10 mg daily offers the best risk:benefit ratio and appears to be the optimal dosage for the treatment of established postmenopausal osteoporosis. The persistence of bone gain with extended treatment offers a considerable advantage over currently available forms of therapy |
1 | 3T MRI of the knee with optimised isotropic 3D sequences: Accurate delineation of intra-articular pathology without prolonged acquisition times | AMP (Acute Meniscal Pathology) | OBJECTIVES: To investigate optimised isotropic 3D turbo spin echo (TSE) and gradient echo (GRE)-based pulse sequences for visualisation of articular cartilage lesions within the knee joint.
METHODS: Optimisation of experimental imaging sequences was completed using healthy volunteers (n=16) with a 3-Tesla (3T) MRI scanner. Imaging of patients with knee cartilage abnormalities (n=57) was then performed. Acquired sequences included 3D proton density-weighted (PDW) TSE (SPACE) with and without fat-suppression (FS), and T2*W GRE (TrueFISP) sequences, with acquisition times of 6:51, 6:32 and 5:35 min, respectively.
RESULTS: One hundred sixty-one confirmed cartilage lesions were detected and categorised (Grade II n=90, Grade III n=71). The highest sensitivity and specificity for detecting cartilage lesions were obtained with TrueFISP with values of 84.7% and 92%, respectively. Cartilage SNR mean for PDW SPACE-FS was the highest at 72.2. TrueFISP attained the highest CNR means for joint fluid/cartilage (101.5) and joint fluid/ligament (156.5), and the lowest CNR for cartilage/meniscus (48.5). Significant differences were identified across the three sequences for all anatomical structures with respect to SNR and CNR findings (p-value <0.05).
CONCLUSION: Isotropic TrueFISP at 3T, optimised for acquisition time, accurately detects cartilage defects, although it demonstrated the lowest contrast between cartilage and meniscus.
KEY POINTS: * Cartilage is better visualised with 3D TrueFISP than 3D SPACE sequences. * 3D TrueFISP is a reliable sequence for detecting low- and high-grade cartilage defects. * 3D TrueFISP at 3T provides excellent contrast between cartilage and joint fluid. |
0 | Comparison of Hallux Interphalangeal Joint Arthrodesis Fixation Techniques: A Retrospective Multicenter Study | DoD SSI (Surgical Site Infections) | Few studies have investigated the complications that occur after hallux interphalangeal joint arthrodesis. The present study evaluated complications in 152 patients aged 18 to 80 years from 2005 to 2012 from 4 different academic institutions after hallux interphalangeal joint arthrodesis. Overall, 65.8% of the patients had =1 complication. Infections occurred in 16.5%, dehiscence in 12.5%, and reoperations in 27.0%. The clinical nonunion rate was =17.8%, and the radiographic nonunion rate was =13.8%. After logistic regression analysis, only the study site and peripheral neuropathy were associated with having =1 complication (p < .01 and p < .05, respectively). Single screw fixation compared with other fixation did not have a statistically significant influence on the postoperative complications. However, when fixation was expanded to 4 categories, single screw fixation had lower infection and reoperation rates than either crossed Kirschner wires or other fixation category but not compared with crossed screws on multivariate logistic regression analysis. Although additional studies are warranted, the findings from the present study might aid in both the prognosis of complications and the support of the use of a single screw over crossed Kirchner wire fixation in hallux interphalangeal joint arthrodesis. |
0 | Cosmetic surgery prior to diagnosis of breast cancer | Reduction Mammoplasty for Female Breast Hypertrophy | BACKGROUND: Cosmetic breast surgery is amongst the top five most commonly performed cosmetic surgical procedures. With breast cancer being the most common non-skin malignancy in women, the likelihood that a woman undergoing cosmetic breast surgery may have an occult breast cancer needs to be considered. Most of the available data pertaining to breast cancer diagnosis in the setting of cosmetic surgery are from studies of cosmetic breast surgery populations. We report on the prevalence of breast cancer as an incidental finding during cosmetic breast surgery in the context of women subsequently diagnosed with invasive breast cancer.
METHODS: The Bupa Health Foundation Health and Wellbeing after Breast Cancer Study is a prospective cohort study of 1684 women recruited within 12 months of their first diagnosis with invasive breast cancer. Participants completed an enrolment questionnaire and annual follow-up questionnaires for 5 years.
RESULTS: At the second follow-up, 1.5% of women reported having undergone cosmetic breast surgery prior to being diagnosed with breast cancer, 16 had undergone breast reduction and seven had augmentations. Invasive breast cancer was diagnosed at the time of a cosmetic breast procedure in two women, in both an augmentation and a reduction procedure, which is 8.7% (95% confidence interval 23.5% to +20.9%) of the women in our study reporting a cosmetic breast procedure prior to diagnosis.
CONCLUSIONS: Although prior cosmetic breast surgery was reported by few women, breast cancer was diagnosed in two women during the procedure. Surgeons performing elective breast surgery need to understand and apply consistent, reliable breast cancer screening practices. |
0 | Laser evoked potentials in carpal tunnel syndrome | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | OBJECTIVES: The aim of this study was to evaluate the function of Adelta fibers at the hand level in patients with clinical symptoms of Carpal Tunnel Syndrome (CTS) using CO(2) laser evoked potentials (LEPs), in light of the intensity and distribution of sensory symptoms and pain. METHODS: Thirty-four CTS outpatients (62 hands) were compared to 23 sex- and age-matched control subjects (46 hands). The periungueal skin of the first, second, third and fifth fingers, and the dorsum of the hands were stimulated in random order. The latency and amplitude of the N2, P2 and N1 components were evaluated with respect to the Nerve Conduction Study (NCS) data, clinical scales, pain intensity and glove-like symptoms distribution. RESULTS: The amplitude of the N2-P2 complex was significantly reduced in CTS hands compared to normal hands after stimulation of the second and third fingers, even in patients with mild nerve conduction impairment. No significant fifth finger LEP abnormalities were found in patients with glove-like distribution symptoms. The N2-P2 amplitude at the second and third fingers was positively correlated with the severity of sensory symptoms. CONCLUSIONS: The involvement of median nerve Adelta fibers in CTS seems to be an early phenomenon, which concurs with the impairment of large motor and sensory afferents and is linked to the severity of the disease. SIGNIFICANCE: The finding of reduced sensory symptoms in patients with severe thin afferents damage, may suggest a slight expression of central sensitisation phenomena in the advanced stage of CTS syndrome |
0 | Trends in trabecular and cortical bone in the radius compared with whole body calcium balance in osteoporosis | Distal Radius Fractures | Mean linear attenuation coefficients for trabecular bone (T) in the distal radius and total absorption coefficients (TA) in the radial mid-shafts of 22 patients with crush fracture osteoporosis were measured serially for a year by using computed tomography. After approximately 6 months, each patient was admitted to a metabolic ward for an 18-day calcium balance study. The rate of change (trend) in trabecular bone (T) in the distal radius was a better predictor of calcium balance than the trend in mid-shaft cortical bone (TA). The scatter in the regressions of the trends of T and TA on calcium balance could be accounted for by known methodological uncertainties. |
0 | Comparison of the modified subvastus and medial parapatellar approaches in total knee arthroplasty | Surgical Management of Osteoarthritis of the Knee CPG | In this paper, we evaluated the difference between the modified subvastus approach and the medial parapatellar approach in total knee arthroplasty(TKA). We assessed the time of active straight-leg raise (SLR) post-operatively and the range of flexion of the operated knee at the tenth post-operative day, 6 weeks and 6 months, 12 months and 3 years. We investigated the degree of the patellar tilt and subluxation 24 months post-operatively. The patients who underwent the modified subvastus approach performed active SLR earlier (mean 0.5 days) than the medial parapatellar approach patients (mean 2.2 days). Knee flexion was better at the tenth post-operative day in the modified subvastus approach group compared to the medial parapatellar approach group. There was no statistical difference between the two groups with regard to the patellar tilt and subluxation. We conclude that the modified subvastus approach is recommendable in primary TKA |
0 | Etiology of supracondylar humerus fractures | The Treatment of Pediatric Supracondylar Humerus Fractures AUC | The specific etiology of supracondylar humerus fractures in children is not well known. All supracondylar humerus fractures treated at Children's Hospital and Health Center, San Diego (CHSD) over an 8-year period (n = 391) were reviewed to determine specific information about the manner in which the injury occurred. Girls tended to sustain these fractures more often, and the nondominant arm was more often injured. Falls from a height accounted for 70% of the fractures. Children < or = 3 years old tended to fall off of household objects (beds, couches, other objects 3-6 feet high), and children 4 years and older tended to fall from playground equipment such as monkey bars, slides, and swings. Safety precautions should be implemented in homes of young children and at playgrounds to avoid these fractures |
0 | Effects of vacuum sealing drainage combined with ilizarov bone transport technique in the treatment of tibial traumatic osteomyelitis | DoD SSI (Surgical Site Infections) | Background: The aim of this study was to analyze the efficacy of vacuum sealing drainage combined with Ilizarov bone transport technique in the treatment of tibial traumatic osteomyelitis and risk factors for postoperative pin infection. Material/Methods: We enrolled 78 patients with tibial traumatic osteomyelitis admitted at the First People's Hospital of Kashgar from January 2015 to September 2017 and treated with vacuum sealing drainage combined with Ilizarov bone transport technique. Results: After combined treatment, SAS and SDS scores decreased significantly, while SF-36 scores increased significantly. Comparisons showed that there were significant differences in the scores of patients after treatment (P<0.05). Univariate analysis showed that there were no significant differences in gender, BMI, hypertension, diabetes mellitus, COPD, smoking index, alcohol abuse history, or residence (P>;0.05). There were significant differences in age, fracture type, flxation type, pin loosening, and indwelling time between the 2 groups (P<0.05). Multivariate logistic analysis showed that age, fracture type, fixation type, pin loosening, and indwelling time were independent risk factors for pin infection. Age, fracture type, fixation type, pin loosening, and indwelling time are independent risk factors for pin infection in patients with tibial traumatic osteomyelitis. Conclusions: Combination of vacuum sealing drainage with Ilizarov bone transport technique can effectively improve the condition of tibial traumatic osteomyelitis, improve the quality of life of patients, and reduce the occurrence of adverse emotions of patients. Age, fracture type, fixation type, pin loosening, and indwelling time are independent risk factors for pin infection in patients with tibial traumatic osteomyelitis. |
1 | The MeTeOR trial (Meniscal Tear in Osteoarthritis Research): rationale and design features | AMP (Acute Meniscal Pathology) | This paper presents the rationale and design features of the MeTeOR Trial (Meniscal Tear in Osteoarthritis Research; Clinical Trials.gov NCT00597012). MeTeOR is an NIH-funded seven-center prospective randomized controlled trial (RCT) designed to establish the efficacy of arthroscopic partial meniscectomy combined with a standardized physical therapy program as compared with a standardized physical therapy program alone in patients with a symptomatic meniscal tear in the setting of mild to moderate knee osteoarthritic change (OA). The design and execution of a trial that compares surgery with a nonoperative treatment strategy presents distinctive challenges. The goal of this paper is to provide the clinical rationale for MeTeOR and to highlight salient design features, with particular attention to those that present clinical and methodologic challenges. |
1 | Treatment of distal radius fractures with locking plates: an update | Distal Radius Fractures | Internal fixation with volar locking plates has revolutionized the treatment of distal radius fractures. Manufacturers have introduced plate designs that closely follow the anatomy of the distal radius. However, use of volar plates has also led to the emergence of new types of complications. While the use of monoaxial or polyaxial locking screws and of minimally invasive techniques (arthroscopy, preservation of pronator quadratus) increases the cost of the surgical procedure, it results in a tangible benefit for patients, allowing them to move their wrist almost immediately after surgery and to quickly regain their autonomy. We reviewed the literature to analyze the level of proof. |
0 | Safe approach for fixation of first metacarpal fractures: an anatomical study | Distal Radius Fractures | This anatomical study defines a safe zone for percutaneous or minimally invasive fixation of first metacarpal fractures in order to avoid injury of the superficial branch of the radial nerve and the dorsal branch of the radial artery. The courses of the nerve and artery branches were marked in 20 embalmed cadaver specimens. With computer-assisted surgical anatomy mapping, a large diversity in the anatomical patterns for the nerve and a consistent pattern for the artery were found. Based on these findings, we conclude that transfixation of the first and the second metacarpals with K-wires placed in the distal 75% of both the first and second metacarpals is the safest way to avoid damages to the nerve and artery branches during fracture fixation. |
0 | Characterization of patients undergoing total knee arthroplasty in a real-world setting and pain-related medication prescriptions for management of postoperative pain | OAK 3 - Non-arthroplasty tx of OAK | Presently, no "gold-standard" exists for the management of pain after total knee arthroplasty (TKA) surgery. Understanding pain management methods used in clinical practice and the associated patient outcomes are necessary to fill gaps in pain management strategies. This study characterizes medication use in the immediate postoperative period among patients undergoing TKA at an academic medical center. Additionally, pre- and postoperative measures of pain (numeric pain rating scale), physical function (Knee Society Scale and Lower Extremity Function [LEFS]), and quality of life (Medical Outcomes Study Short-Form [SF]-36) were evaluated. The patient data were extracted from a clinical database at the University of Utah Orthopedic Clinic between September 1, 2008, and November 30, 2010. A total of 168 patients (mean age 64.0 +/- 10.1 years, 63.1% were female, mean body mass index [BMI] 31.7 +/- 7.1 kg/m(2)) were included. The most common comorbidities in these patients were osteoarthritis, hypertension, and major depressive disorders. Bupivacaine and fentanyl were commonly given on the day of surgery with oxycodone, hydrocodone/acetaminophen, and celecoxib prescribed at hospital discharge. Preoperative pain levels were reduced by half at 6 weeks. Physical function and quality of life were similar to established benchmarks and previously reported levels, respectively. Confirmation of results over a longer follow-up period is warranted. |
0 | Options for managing severe acetabular bone loss in revision hip arthroplasty. A systematic review | PJI DX Updated Search | Revision hip arthroplasty in the presence of severe acetabular bone loss is challenging and requires a solid understanding of current techniques. A literature search of multiple databases applying specific criteria revealed a total of 50 articles of level IV scientific evidence comprising 2415 patients (2480 hips) managed with reinforcement devices (roof-reinforcement rings and anti-protrusio cages), custom-made triflanged acetabular components (CTACs), jumbo cups and tantalum metal (TM) systems. Overall, patients had improved postoperative hip scores for each technique. The use of reinforcement devices resulted in a mean revision rate of 8.2% and a mean complication rate of 29.21%. CTACs were associated with a revision rate of 15.9% and had a complication rate of 24.5%. Jumbo cups were revised in 8.8% of patients and had a complication rate of 18.4%. TM systems had an overall revision rate of 8.5% with complications seen in 18.5% of patients. CTACs had considerably higher revision rates compared to the other techniques. Jumbo cups and TM systems had lower complication rates compared to the use of reinforcement devices and CTACs. The most frequently occurring complications seen throughout the series were aseptic loosening, dislocation and infection |
1 | Patella retention versus replacement in total knee arthroplasty; functional and clinimetric aspects | Surgical Management of Osteoarthritis of the Knee CPG | INTRODUCTION: Whether to resurface the patella or not in total knee arthroplasty still remains undecided. Classical scores and questionnaires might not be responsive or demanding enough. This study used two accelerometer based systems to study the hypothesis whether performance based tests are able to detect a difference in patients with or without a resurfaced patella. METHOD: In this retrospective study 53 patients were included and divided into a resurfaced group (n = 31) and a non-resurfaced group (n = 22). Both groups were matched on age and longevity of follow up. Patients were clinically assessed using the Knee Society Score (KSS) at various time points. At final follow up patients were also assessed once using the Dynaport Knee Test and the Minimod Gait Test. RESULTS: The Dynaport Knee Test showed a significant functional advantage for patients with a resurfaced patella [44 vs. 39.7 (P = 0.042)], whereas KSS and The Minimod were not significant (P values ranging from 0.07 to 0.75). Similar to other reports in literature, using the KSS, it was not possible to identify significant difference between patella resurfacing or retaining in total knee arthroplasty, however using a performance based test it was possible to determine significant difference. The found advantage of patella resurfacing may be less due to pain relief but due to a functional benefit during demanding motion tasks. This finding indicates that current measurement tools may not be accurate or specific enough to detect this difference. Therefore, we recommend complementing the classic evaluation tools with an objective functional test, when conducting a randomized trial to answer the indecision whether to resurface the patella or not |
0 | Active involvement of alarmins S100A8 and S100A9 in the regulation of synovial activation and joint destruction during mouse and human osteoarthritis | OAK 3 - Non-arthroplasty tx of OAK | OBJECTIVE: To investigate whether alarmins S100A8 and S100A9 are involved in mediating cartilage destruction during murine and human osteoarthritis (OA).
METHODS: Two different murine models of OA that differed in terms of synovial activation were compared. Cartilage destruction was measured histologically. Synovial biopsy and serum samples from OA patients were derived from the Cohort Hip and Cohort Knee (CHECK) patients with symptomatic early OA. Expression of mediators in the synovium was measured by reverse transcription-polymerase chain reaction analysis and immunolocalization.
RESULTS: In collagenase-induced OA, which showed marked synovial activation, interleukin-1beta was expressed at significant levels only during the early stages of disease, whereas S100A8 and S100A9 expression remained high for a prolonged period of time (up to day 21 after induction). In S100A9-knockout mice, we found a major impact of S100A8 and S100A9 on synovial activation (62% inhibition) and OA cartilage destruction (45-73% inhibition) as compared to wild-type controls. In contrast, in the surgically induced destabilized medial meniscus model, in which synovial involvement is scant, we found no role of S100A8 and S100A9 in the focal OA cartilage destruction. Examination of arthroscopic synovial biopsy samples from patients in the early symptomatic OA CHECK cohort revealed substantial levels of S100A8 and S100A9 messenger RNA and protein, which correlated significantly with synovial lining thickness, cellularity in the subintima, and joint destruction. Levels of S100A8/A9 serum protein were significantly enhanced (19%) at baseline in patients who had pronounced progression of joint destruction after 2 years.
CONCLUSION: Our data suggest that the S100A8 and S100A9 proteins are crucially involved in synovial activation and cartilage destruction during OA and that high levels may predict joint destruction in humans with OA. |
0 | Operative Repair of Medial Patellofemoral Ligament Injury Versus Knee Brace in Children With an Acute First-Time Traumatic Patellar Dislocation: A Randomized Controlled Trial | OAK 3 - Non-arthroplasty tx of OAK | BACKGROUND: A lateral patellar dislocation (LPD) is the most common traumatic knee injury with hemarthrosis in children. The redislocation rate is high. Varying operative and nonoperative treatments have been advocated with no consensus on the best treatment.
PURPOSE: (1) To evaluate if arthroscopic-assisted repair of the medial patellofemoral ligament (MPFL) in patients with an acute first-time traumatic LPD would reduce the recurrence rate and offer better objective/subjective knee function compared with a knee brace without repair. (2) To study the presence of anatomic patellar instability risk factors (APIFs) and their association with a redislocation.
STUDY DESIGN: Randomized controlled trial; Level of evidence, 1.
METHODS: This was a prospective series of 74 skeletally immature patients aged 9 to 14 years (38 girls and 36 boys; mean age, 13.1 years) with a first-time traumatic LPD, with clinical examinations, radiographs, magnetic resonance imaging, and diagnostic arthroscopic surgery performed within 2 weeks of the index injury. The child was randomized to either (1) a knee brace (KB group) for 4 weeks and physical therapy or (2) arthroscopic-assisted repair (R group) of the MPFL with anchors, 4 weeks with a soft cast splint, and physical therapy. The follow-up time was 2 years.
RESULTS: The redislocation rate was significantly lower in the R group than in the KB group at final follow-up: 8 patients (22%) versus 16 patients (43%), respectively ( P = .047). The Knee injury and Osteoarthritis Outcome Score for children sport/play and quality of life subscales had lower scores in the R group compared with the KB group; the significant differences were among those with redislocations. The mean Kujala score was excellent in the KB group (95.9) and good in the R group (90.9). An impaired Limb Symmetry Index (median, 83%) for concentric quadriceps torque at 90 deg/s was found only in the R group. Eighty-one percent of the study patients had >=2 APIFs. Trochlear dysplasia (trochlear depth <3 mm) had the highest odds ratio for redislocations (2.35 [95% CI, 0.69-8.03]), with no significant association between APIFs and a redislocation.
CONCLUSION: Operative repair of an MPFL injury in the acute phase in skeletally immature children with a primary traumatic LPD significantly reduced the redislocation rate but did not improve subjective or objective knee function compared with a knee brace without repair. The majority of the patients in both groups were satisfied with their knee function. There was a high representation of APIFs, which needs to be considered when evaluating the risk of redislocations. Registration: ISRCTN 39959729 (Current Controlled Trials). |
1 | Vascular Reconstruction Is Not Warranted in Most Civilian Traumatic Shank Vascular Injuries | DoD LSA (Limb Salvage vs Amputation) | BACKGROUND: Operative management of traumatic shank vascular injuries (SVI) evolved significantly in the past few decades, thereby leading to a dramatic decrease in amputation rates. However, there is still controversy regarding the minimum number of patent shank arteries sufficient for limb salvage. METHODS: Between January 2006 and September 2011, 191 adult trauma patients presented to an urban level I trauma center in Miami, Florida, with traumatic lower extremity vascular injuries. Variables collected included age, gender, mechanism of injury, and clinical status at presentation. Surgical data included vessel injury, technical aspects of repair, associated complications, and outcomes. RESULTS: A total of 48 (25.1%) patients were identified comprising 66 traumatic shank arterial injuries. Mean age was 38.2 +/- 13.4 years, and the majority of patients were men (40 patients, 83.3%) presenting with blunt injuries (35 patients, 72.9%). Ligation was performed in 38 injured arteries (57.6%) and no vascular intervention was required in 20% of the patients. Vascular reconstruction was performed in only 6 patients (9.1%): 4 (6.1%) with concurrent popliteal trauma, 1 (1.5%) isolated anterior tibial, and 1 (1.5%) 3-vessel injury. Autogenous venous interposition conduit and polytetrafluoroethylene grafting were performed in 5 (7.6%) and 1 (1.5%) patient, respectively. All amputations (8 patients, 16.7%) occurred in blunt trauma patients presenting with unsalvageable limbs. The overall mortality rate in this series was 2.1%. CONCLUSIONS: Civilian shank arterial injuries are associated with acceptable rates of limb loss. Patients with a single-vessel patent inflow did not require vascular reconstruction in this series. Arterial reconstruction may no longer be determinant for successful management of isolated and double arterial SVI, whereas it is yet essential in the presence of 3-vessel or concurrent above-the-knee vascular injuries. Further investigation including larger number of patients is still warranted to define the role of conservative management in these complex injuries. |
1 | Collaborative Establishment of an Integrated Orthotic and Rehabilitation Pathway | DoD LSA (Limb Salvage vs Amputation) | Returning to active military duty and to recreational activities has been difficult for service members sustaining combat-related high-energy lower extremity trauma (HELET). The Return to Run (RTR) clinical pathway was introduced in 2009 with favorable results in returning active duty service members to running, sports participation, active duty, and deployments. The RTR pathway was introduced at a second institution in 2011 to determine if the pathway could be reproduced at a different institution. In this study, a series of patients is presented who underwent limb salvage procedures after sustaining HELET at an outside military treatment facility and subsequently participated in the authors' RTR protocol. They received a novel orthotic device from the San Antonio Military Medical Center and returned to their home institution for rehabilitation. In this cohort, an improvement in functional capability was obtained in nearly all patients. In conclusion, successful translation of the integrated orthotic and rehabilitation initiative to outside institutions is possible. |
0 | Elbow capsulectomy for posttraumatic elbow stiffness | Glenohumeral Joint OA | PURPOSE: To determine factors associated with diminished elbow function and upper-extremity-specific health status after elbow capsulectomy for posttraumatic stiffness.
METHODS: Forty-six adult patients with posttraumatic elbow stiffness were evaluated an average of 48 months after open capsular excision. A second capsular excision was performed in 9 patients (29%). Stepwise multiple linear regression analysis was used to identify predictors of the American Shoulder and Elbow Surgeons Elbow Score, the Mayo Elbow Performance Index, and the Disabilities of the Arm, Shoulder, and Hand scores after all procedures.
RESULTS: The average improvement in ulnohumeral motion after the index surgery for capsular release was 53 degrees . (The average flexion was 98 degrees .) The 9 patients who had subsequent repeat elbow contracture release gained an additional 24 degrees , leading to a final average flexion arc for the entire cohort of 103 degrees . Multiple linear regression identified the American Shoulder and Elbow Surgeons pain score, persistent ulnar nerve dysfunction, and duration of follow-up evaluation after the initial capsular release as independent predictors of a higher Disabilities of the Arm, Shoulder, and Hand questionnaire score; flexion arc and pain score as independent predictors of the Mayo Elbow Performance Index; and flexion arc, forearm arc, pain score, and persistent ulnar neuropathy as independent predictors of the American Shoulder and Elbow Surgeons score.
CONCLUSIONS: Open elbow capsulectomy for posttraumatic elbow stiffness restores a near-100 degrees flexion arc on average. Second elbow releases provide limited additional motion in most patients. Final motion influences physician-based rating scales but not patient-specific health status (Disabilities of the Arm, Shoulder, and Hand questionnaire), which is dominated by pain and persistent ulnar neuropathy.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV. |
0 | Analysis of the hemoglobin level drop in patients with hip fracture after admission | Hip Fx in the Elderly 2019 | The studies that evaluated blood loss during hip surgery found a relatively small loss that does not explain the large hemoglobin drop postoperatively. The aim of this study was to determine the fall in hemoglobin level after admission and rehydration in patients with hip fractures and to identify the patients that need blood transfusion. This retrospective study included data on 374 patients with hip fracture with surgery delayed by more than 24 hours and complete blood count repeated prior to surgery after fluid resuscitation for a minimum of 24 hours. The hemoglobin level (g/L) was analyzed after admission and after rehydration. The results were compared by Student's ttest. The mean hemoglobin drop was 6.1 g/L, 12.05 g/L and 16.52 g/L for capsular, pertrochanteric and subtrochanteric fractures, respectively. This hemoglobin drop was statistically significant in all fracture types. The significant drop of preoperative hemoglobin should be taken in consideration when planning transfusion for hip fracture patients. Collection of blood sample after rehydration preoperatively would enable prompt diagnosis and treatment of anemia in these patients, along with proper transfusion planning and cross-matching. |
1 | Arthroscopic Joint Preservation in Severe Glenohumeral Arthritis Using Interpositional Human Dermal Allograft | Glenohumeral Joint OA | PURPOSE: To investigate the outcomes of arthroscopic glenoid resurfacing (AGR) for severe glenohumeral arthritis at short- to medium-term follow-up.
METHODS: We performed a multicenter retrospective review of consecutive patients undergoing AGR (2005-2013) with a minimum of 2 years' follow-up or until revision. Patients lost to follow-up and those included in a prior study were excluded. The indications for AGR were severe primary shoulder osteoarthritis without significant bone loss in younger, higher-demand patients. Outcome measures included revision, pain and American Shoulder and Elbow Surgeons (ASES) scores, and range of motion. Exact logistic regression was used to assess preoperative risk factors for revision.
RESULTS: Forty-three shoulders with an average of 60 months' clinical follow-up underwent AGR. The rate of revision to prosthetic arthroplasty was 23% (95% confidence interval [CI], 12%-39%) after a mean of 45 months. The visual analog scale pain score (0-10) improved from a median of 7 to 2 (median difference [DELTA], 4 [95% CI, 3-6]; P < .0001), representing pain relief similar to total shoulder arthroplasty in young patients. Improvements in the median ASES score (from 47 to 76; DELTA, 28 [95% CI, 17-40]; P < .0001), active forward elevation (from 110degree to 140degree; DELTA, 20degree [95% CI, 10degree-35degree]; P < .0001), and active external rotation (from 0degree to 20degree; DELTA, 10degree [95% CI, 5degree-20degree]; P < .0001) were noted. The mean age of revised shoulders (60 years [95% CI, 54-66 years]) was higher than that of surviving shoulders (53 years [95% CI, 50-57 years], P = .005). The preoperative ASES score of revised shoulders (34 [95% CI, 27-42]) was lower than that of surviving shoulders (47 [95% CI, 43-51], P = .006). No complications were noted.
CONCLUSIONS: AGR with dermal allograft is a safe option for joint preservation in selected patients, provides pain relief, and has an acceptable rate of revision to prosthetic arthroplasty at short-term to midterm follow-up. Increased age and lower preoperative ASES score were risk factors for failure of AGR.
LEVEL OF EVIDENCE: Level IV, therapeutic case series. |
0 | Case 17-2010: A 29-year-old woman with flexion of the left hand and foot and difficulty speaking | The Treatment of Pediatric Supracondylar Humerus Fractures AUC | A 29-year-old right-handed woman was seen in the neurology clinic of this hospital because of a 3-year history of involuntary flexion of the left hand and increasing difficulty moving the left foot. Examination revealed dystonic movements and posturing of the left arm, hand, and foot. Brain imaging was normal. During the next 2.5 years, symptoms gradually worsened, and difficulty swallowing and speaking developed. A diagnostic test was performed. Copyright (copyright) 2010 Massachusetts Medical Society |
0 | Surgical treatment of gynecomastia: mastectomy compared to liposuction technique | Panniculectomy & Abdominoplasty CPG | BACKGROUND: Gynecomastia is a benign enlargement of the male breast. Yet enlarged breasts cause anxiety, embarrassment, psychosocial discomfort, and fear of breast cancer. The aim of this study was to assess the experience of gynecomastia patients undergoing mastectomy and liposuction surgery. METHODS: Seven hundred thirty-three patients were analyzed for age, chief complaint, position, grade, operation approach, biopsy, and complication between mastectomy group and liposuction group, from 1990 to 2010. RESULTS: Four hundred two patients (436 breasts) were treated with mastectomy and 331 patients (386 breasts) were treated with liposuction techniques. Three hundred thirty (82%) patients complained of breast lump and lump with pain in mastectomy group, and 204 (61%) patients complained of enlargement breast and enlargement with pain in liposuction group (P < 0.05). All excision specimens were performed for routine histological analysis which showed pathologic diagnosis in patients with mastectomy (100%). One hundred fifty-nine (41%) patients with liposuction acquired pathologic diagnosis through fine needle aspiration and/or core biopsy (P < 0.05). The reoperation rates in mastectomy group and liposuction group were 1.4% and 0.5%, respectively. There were no nipple/areola necrosis and scars in liposuction group. CONCLUSIONS: The surgical treatment of gynecomastia required an individual approach, depending on symptoms (lump or enlargement) and requirements of patients. Patients who chose mastectomy were looking for reassurance that their pathologic diagnosis was benign. The increase in the number of liposuction patients was reflected in our study because it was associated with superior esthetic results and few complications. |
0 | Advance pre-operative chlorhexidine reduces the incidence of surgical site infections in knee arthroplasty | PJI DX Updated Search | Surgical site infections following elective knee arthroplasties occur most commonly as a result of colonisation by the patient's native skin flora. The purpose of this study was to evaluate the incidence of deep surgical site infections in knee arthroplasty patients who used an advance cutaneous disinfection protocol and who were compared to patients who had peri-operative preparation only. All adult reconstruction surgeons at a single institution were approached to voluntarily provide patients with chlorhexidine gluconate-impregnated cloths and a printed sheet instructing their use the night before and morning of surgery. Records for all knee arthroplasties performed between January 2007 and December 2008 were reviewed to determine the incidence of deep incisional and periprosthetic surgical site infections. Overall, the advance pre-operative protocol was used in 136 of 912 total knee arthroplasties (15%). A lower incidence of surgical site infection was found in patients who used the advance cutaneous preparation protocol as compared to patients who used the in-hospital protocol alone. These findings were maintained when patients were stratified by surgical infection risk category. No surgical site infections occurred in the 136 patients who completed the protocol as compared to 21 infections in 711 procedures (3.0%) performed in patients who did not. Patient-directed skin disinfection using chlorhexidine gluconate-impregnated cloths the evening before, and the morning of, elective knee arthroplasty appeared to effectively reduce the incidence of surgical site infection when compared to patients who underwent in-hospital skin preparation only |
0 | F wave velocity in the central segment of the median and ulnar nerves: a study in normal subjects and in patients with Charcot Marie Tooth disease | Diagnosis and Treatment of Carpal Tunnel Syndrome CPG | The F wave velocity in the central segment (axilla to spinal cord) of the median and ulnar nerves was studied in contrast to the conventional motor nerve conduction velocity in the proximal segment (axilla to elbow) and in the distal segment (elbow to wrist). In 33 normal subjects, the F wave velocity in the central segment (64.3 (plus or minus) 6.4 m/sec for median nerve; 63.1 (plus or minus) 5.9 m/sec for ulnar nerve) was about the same as the motor nerve conduction velocity in the proximal segment (63.3 (plus or minus) 6.0 m/sec; 61.3 (plus or minus) 6.8 m/sec) and slightly faster than that in the distal segment (56.0 (plus or minus) 5.0 m/sec; 55.9 (plus or minus) 5.1 m/sec). In 10 cases of Charcot Marie Tooth disease, slowing of the F wave velocity in the central segment (29.0 (plus or minus) 13.1 m/sec; 28.3 (plus or minus) 15.5 m/sec) was comparable to that of the motor nerve conduction velocity in the proximal segment (23.1 (plus or minus) 8.6 m/sec; 22.3 (plus or minus) 11.6 m/sec) and in the distal segment (21.2 (plus or minus) 8.0 m/sec; 20.5 (plus or minus) 11.1 m/sec) |
0 | Total knee arthroplasty for treatment of post-traumatic arthritis: Systematic review | PJI DX Updated Search | AIM: To review and report functional outcomes, complications, and survivorship associated with total knee arthroplasty (TKA) in the treatment of post-traumatic arthritis (PTA). METHODS: We conducted a systematic review according to the PRISMA guidelines. We searched PubMed, Cochrane Library, and SCOPUS in December 2015 for English-language clinical research studies, both prospective and retrospective, examining the use of TKA for the treatment of PTA. All relevant articles were accessed in full. The manual search included references of retrieved articles. We extracted data on patients' demographics and clinical outcomes, including preoperative diagnosis and pre- and post-operative functional scores. We summarized the data and reported the results in tables and text. RESULTS: Sixteen studies, four prospective and ten retrospective, examined patients who underwent TKA for PTA due to fractures of the proximal tibia, patella, and/or distal femur. Eleven studies utilized the Knee Society Scores criteria to assess functional outcomes. All studies utilizing these criteria reported an improvement in functional and knee scores of patients following TKA. Further, studies reported an increased range of motion (ROM) and reduction of pain following surgery. The most commonly reported complications with TKA included infection, stiffness, wound complications, intraoperative rupture of tendons, and osteolysis/polyethylene wear. The overwhelming majority of these complications occurred within the first two years following surgery. Six studies examined the survivorship of TKA with subsequent revision for any reason as an endpoint. Compared to patients with osteoarthritis, patients with PTA required more revisions, the majority for polyethylene wear. CONCLUSION: Although associated with higher complication rates, TKA is an effective treatment for PTA, as it improves ROM, pain and functional outcomes |
0 | Solitary amyloidoma related to THA | PJI DX Updated Search | Amyloidoma of soft tissues is rare, and no previously published reports describe it in relation to hip prostheses. This article presents the case of a 78-year-old woman with a medical history of myelodysplasia and mild renal failure who underwent a right-sided metal-on-polyethylene total hip arthroplasty in 2003. She presented to the outpatient clinic with a 1-year history of right anterior thigh pain. On examination, a large proximal anteromedial lump was palpable and was nontender, nonpulsatile, and firm. She had a positive Trendelenburg test but good hip range of motion. Plain radiographs showed signs of osteolysis around the hip prosthesis. Serology showed mildly raised liver function and renal function but a normal erythrocyte sedimentation rate and white blood cell count. Magnetic resonance imaging revealed a large mixed-signal soft tissue mass directly opposing the anterior cortex of the right femur, related to the hip prosthesis, measuring 16Ã-10Ã-7 cm. Associated destruction of the underlying cortex existed. Histological staining of a biopsy of the mass confirmed that the mass contained AL-type amyloid seen in primary amyloidosis. Mean patient age at diagnosis for amyloid tumors of soft tissues is 66 years. By definition, they start as solitary lesions. The types are important: AA type is related to infection and AL type is a primary process. Patients with AL amyloidomas have a poorer prognosis because they have a higher chance of malignancies. Early diagnosis can prevent long-term serious consequences of this condition |
0 | Evidence-based hydro- and balneotherapy in Hungary--a systematic review and meta-analysis | SR for PM on OA of All Extremities | Balneotherapy is appreciated as a traditional treatment modality in medicine. Hungary is rich in thermal mineral waters. Balneotherapy has been in extensive use for centuries and its effects have been studied in detail. Here, we present a systematic review and meta-analysis of clinical trials conducted with Hungarian thermal mineral waters, the findings of which have been published by Hungarian authors in English. The 122 studies identified in different databases include 18 clinical trials. Five of these evaluated the effect of hydro- and balneotherapy on chronic low back pain, four on osteoarthritis of the knee, and two on osteoarthritis of the hand. One of the remaining seven trials evaluated balneotherapy in chronic inflammatory pelvic diseases, while six studies explored its effect on various laboratory parameters. Out of the 18 studies, 9 met the predefined criteria for meta-analysis. The results confirmed the beneficial effect of balneotherapy on pain with weight bearing and at rest in patients with degenerative joint and spinal diseases. A similar effect has been found in chronic pelvic inflammatory disease. The review also revealed that balneotherapy has some beneficial effects on antioxidant status, and on metabolic and inflammatory parameters. Based on the results, we conclude that balneotherapy with Hungarian thermal-mineral waters is an effective remedy for lower back pain, as well as for knee and hand osteoarthritis |
0 | Repair of osteochondral defects in joints--how to achieve success | OAK 3 - Non-arthroplasty tx of OAK | Osteochondral defects in the knee are difficult to repair because intrinsic healing of cartilage is poor and gradual progression to "early-onset" osteoarthritis leads to severe pain and disability. Of all methods tested to achieve regeneration of hyaline cartilage and long-lasting repair, autologous chondrocyte transplantation (ACI-C and MACI) has been the most successful with 80% of good results and graft survival in this unit in a very large series over 10 years. The repair mechanism is unclear but our work shows that the criteria for success are: young patient age, no previous operative procedures on the defect, no obesity, no smoking, defect on femoral condyles or trochlea and no pre-existing degenerative joint changes. Future research is aimed at non-transplantation, single-stage procedures aided by use of new scaffolds and growth factors and the extension of such techniques into arthritic joints. |
0 | A comparison of open reduction and closed reduction in treating distal radius fractures in elderly patients | Distal Radius Fractures | OBJECTIVE: To discuss the relationship between recovery of anatomical integrity and functional outcome in elderly patients with distal radius fractures by comparing the effects of open reduction and closed reduction. METHODS: The clinical data were retrospectively analyzed from 78 elderly patients with distal radius fractures treating with noâ?operation and operation from February 2005 to March 2009. Thirtyâ?seven patients underwent closed reduction and splintlet fixation or cast application (nonâ?operation group), and fortyâ?one patients underwent open reduction and internal fixation (operation group). In nonâ?operation group, there were 15 males and 22 females with an average age of 73 years (60â?83 years). According to the AO classification system for fracture, there were 8 cases of type A2, 7 cases of type A3, 7 cases of type B1, 4 cases of type B2, 2 cases of type B3, 4 cases of type C1, 2 cases of type C2, and 3 cases of type C3. The time from injury to admission was between 30 minutes and 3 days with a mean time of 1 day. In operation group, there were 18 males and 23 females with an average age of 71 years (62â?80 years). According to the AO classification system for fracture, there were 5 cases of type A2, 7 cases of type A3, 7 cases of type B1, 6 cases of type B2, 3 cases of type B3, 4 cases of type C1, 5 cases of type C2, and 4 cases of type C3. The time from injury to admission was between 30 minutes and 7 days with a mean time of 1 day. There were no significant differences (P > 0.05) in sex, age, disease course and fracture classification between two groups. RESULTS: All incisions obtained healing by first intention after operation in operation group. All patients were followed up for 9â?36 months (20 months on average). Fracture healing was achieved within 8 to 15 weeks, with an average of 11 weeks. There were no significant differences (P > 0.05) in fracture healing time between nonâ?operation group [(10.8 +/â? 2.0) weeks] and operation group [(11.7 +/â? 2.5) weeks]. At last followâ?up, the palmar tilt angle was (5.6 +/â? 2.0) degrees and (8.6 +/â? 3.0) degrees, the radial inclination angle was (19.1 +/â? 4.9) degrees and (21.8 +/â? 2.0) degrees, and the radial length was (8.3 +/â? 1.3) mm and (10.4 +/â? 1.4) mm in nonâ?operation group and operation group, respectively; showing significant differences (P < 0.05) between two groups. According to the Gartlandâ?Werley score, the results were excellent in 9 cases, good in 21 cases, fair in 5 cases, and poor in 2 cases in nonâ?operation group, the excellent and good rate was 81.1%; in operation group, the results were excellent in 13 cases, good in 25 cases, fair in 2 cases, and poor in 1 case, the excellent and good rate was 92.7%, showing no significant difference (P > 0.05) between two groups. There were no significant differences (P > 0.05) in flexion and extension activity of wrist, radioulnar partial activity, pronationâ?supination activity, grip and pinch strength between two groups. CONCLUSION: Open reduction and closed reduction can achieve satisfactory functional outcomes, but closed reduction was inferior to open reduction in anatomic reduction for treating distal radius fractures in elderly patients. |
0 | Operative principles for optimizing results in circumferential body contouring with ultrasound-assisted lipoplasty | Panniculectomy & Abdominoplasty CPG | The optimization of results in body contouring requires simultaneous visualization of all body regions. This goal is achieved through a circumferential and balanced surgical approach. Adjacent areas must blend together to evoke a smooth contour silhouette. The anatomic differences between men and women, patient selection, markings, access incisions, and technique must all be addressed. |
0 | Risk of conjunctival contamination in total joint arthroplasty | Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures | This study arose from a concern about the transmission of infection through conjunctival contamination during total joint arthroplasty surgery. A prospective analysis of 110 sets of personal face and eye protective equipment (Sterishields) used for 29 total hip arthroplasties (THA) and 26 total knee arthroplasties (TKA) were examined for macroscopic contamination. In additition, a postal questionnaire regarding the perceived risk of eye contamination and current practice of eye protection used during TKA and THA surgery was sent to 1500 Fellows of the British Orthopaedic Association. All Sterishields demonstrated macroscopic contamination with an average of 203 blood and fat spots. The number of these was significantly higher in the lower half of the Sterishields. Of the 834 useable replies, 48% of respondents did not use adequate eye protection routinely. Twenty-eight percent felt that no eye protection was needed, while 45% felt that the eye protection available compromised their vision and so did not use it. One hundred and seven respondents (13%) reported being aware of eye contamination, while 21 (2.5%) respondents were aware of at least one case of conjunctival infection following contamination. This study demonstrates that there is a high risk of conjunctival contamination with fat and blood in major total joint arthroplasty. The reported use of appropriate eye and face protection in the UK has been shown to be low (52%) |
0 | Mortality following bone metastasis and skeletal-related events among patients 65 years and above with lung cancer: A population-based analysis of U.S. Medicare beneficiaries, 1999-2006 | MSTS 2022 - Metastatic Disease of the Humerus | Background: To quantify the impact of bone metastasis and skeletal-related events (SREs) on mortality among older patients with lung cancer. Materials and Methods: Using the linked Surveillance, Epidemiology and End Results-Medicare database, we identified patients aged 65 years or older diagnosed with lung cancer between July 1, 1999 and December 31, 2005 and followed them to determine deaths through December 31, 2006. We classified patients as having possible bone metastasis and SREs using discharge diagnoses from inpatient claims and diagnoses paired with procedure codes from outpatient claims. We used Cox regression to estimate mortality hazards ratios (HR) among patients with bone metastasis with or without SRE, compared to patients without bone metastasis. Results: Among 126,123 patients with lung cancer having a median follow-up of 0.6 years, 24,820 (19.8%) had bone metastasis either at lung cancer diagnosis (9,523, 7.6%) or during follow-up (15,297, 12.1%). SREs occurred in 12,665 (51%) patients with bone metastasis. The HR for death was 2.4 (95% CI = 2.4-2.5) both for patients with bone metastasis but no SRE and for patients with bone metastasis plus SRE, compared to patients without bone metastasis. Conclusions: Having a bone metastasis, as indicated by Medicare claims, was associated with mortality among patients with lung cancer. We found no difference in mortality between patients with bone metastasis complicated by SRE and patients with bone metastasis but without SRE. |
0 | Advances and challenges in the diagnosis and treatment of polymyalgia rheumatica | Glenohumeral Joint OA | Polymyalgia rheumatica (PMR) is a common inflammatory condition that often affects people over the age of 50 years. Characteristic symptoms are shoulder and hip girdle pain and prolonged morning stiffness. Markers of inflammation are often elevated. Clinicians are often faced with the challenge of distinguishing PMR from other conditions, particularly rheumatoid arthritis and spondyloarthropathy that can mimic symptoms of PMR in older people. Additionally, there is an association between PMR and giant cell arteritis, a common large-vessel vasculitis which also affects people over the age of 50 years. Imaging of the large vessels in asymptomatic patients with PMR often reveals findings of subclinical vasculitis.Presently, there are no tests that are specific for the diagnosis of PMR and clinicians rely on a combination of history, physical examination, laboratory tests and imaging studies to make a diagnosis. A recent undertaking by the European League Against Rheumatism/American College of Rheumatology has led to the publication of provisional classification criteria of PMR. Ultrasonography, which is being increasingly used by rheumatologists, can greatly aid in the diagnosis of PMR and often shows changes of synovitis and tenosynovitis.Treatment consists of low doses of glucocorticoids which are associated with morbidity. Evaluation of newer biologic therapies targeting inflammatory cytokines is underway. Despite treatment, relapses are common. © The Author(s), 2013. |
0 | Risk factors for secondary hyperparathyroidism in a nursing home population | Management of Hip Fractures in the Elderly | OBJECTIVE: Secondary hyperparathyroidism may cause bone loss and structural deterioration of bone and may thus be a cause of fracture in the elderly. Vitamin D deficiency, renal impairment and medications are potential causes of hyperparathyroidism and may also directly predispose to fracture. We present the first findings of an ongoing study of hip fracture, vitamin D deficiency and hyperparathyroidism in a large Australian nursing home. DESIGN: Descriptive prevalence study. PATIENTS: Two hundred and fifty-one nursing home residents were eligible for inclusion. Informed consent and successful venepuncture were obtained for 99. Residents were of median age 83 years with interquartile range (IR) 77-89 years. MEASUREMENTS: 25-Hydroxyvitamin D (25OHD), intact parathyroid hormone (PTH), creatinine and biochemistry, demographic data and current medications. RESULTS: Fifty-two per cent of 99 subjects had 25OHD below the reference range of 28-165 nmol/l and 96.5% were below the reference range mean. Those with low 25OHD had lower plasma calcium corrected for albumin than those with normal 25OHD (medians 2.34 vs 2.41 mmol/l, 95% confidence interval for the difference between medians (CI) -0.10 to -0.04 mmol/l, P = 0.0001) and higher PTH (medians 5.8 vs 3.9 pmol/l, CI 0.10-2.6 pmol/l, P = 0.0360). Twenty-eight per cent of 97 residents had PTH above the upper reference range limit of 6.5 pmol/l. Residents receiving frusemide had higher PTH than other residents (medians 6.95 vs 3.45 pmol/l, CI 1.9-4.2 pmol/l, P < 0.0001). In linear modelling, the most important predictor of the natural logarithm of PTH was daily frusemide dose, adjusted R2 (Ra2) = 31.8%, F = 39.3, P < 0.001. Creatinine and the reciprocal of 25OHD were other significant predictors with the final Ra2 = 39.4%, F = 17.7, P < 0.001. CONCLUSIONS: Vitamin D deficiency is a common risk factor for secondary hyperparathyroidism in nursing home residents despite a climate in which vitamin D nutrition is thought to be ample. However, the daily frusemide dose is a more important predictor of PTH in this population |
0 | Titanium niobium nitride knee implants are not inferior to chrome cobalt components for primary total knee arthroplasty | OAK 3 - Non-arthroplasty tx of OAK | Background: Metal allergy in total knee arthroplasty (TKA) is still a controversial topic. Oxinium, ceramic or titanium niobium nitride (TiNbN) coated implants are available for some knee systems. The hypothesis of this study was that the use of TiNbN-coated components would not lead to inferior results compared to conventional implants and that none of the allergic patients receiving TiNbN-coated implants would require revision for metal allergy. Materials and methods: This study was a retrospective, 2 to 1 matched pairs study with 40 titanium niobium nitride-coated TKA compared with 80 conventional cobalt chrome implants. No demographic differences between these groups were observed. The mean follow-up for this study was 2Â years. Results: No differences in clinical, radiological, or patient-reported outcome measurements were observed between the two groups. No patients have been revised at this short- to medium-term outcome evaluation. Discussion: Metal allergy leading to contact or systemic dermatitis is especially linked to chrome and cobalt allergy. Nickel allergy because of knee implants rarely gives cutaneous symptoms, but could potentially lead to peri-prosthetic osteolysis and loosening. The use of titanium niobium nitride implants in case of a positive history of metal allergy could avoid this devastating complication. Conclusion: The use of titanium niobium nitride-coated implants for primary knee osteoarthritis shows similar clinical and radiological outcomes as conventional TKA without revision for loosening at short- to medium-term follow-up. Level of evidence Level IV study. |
0 | Higher serum uric acid as a protective factor against incident osteoporotic fractures in Korean men: A longitudinal study using the National Claim Registry | DoD PRF (Psychosocial RF) | In this large longitudinal study of 16,078 Korean men aged 50 years or older, we observed that baseline elevation of serum uric acid level significantly associated with a lower risk of incident fractures at osteoporosis-related sites during an average follow-up period of 3 years. Introduction: Male osteoporosis and related fractures are becoming recognized as important public health concerns. Oxidative stress has detrimental effects on bone metabolism, and serum uric acid (UA) is known to be a strong endogenous antioxidant. In the present study, we performed a large longitudinal study with an average follow-up period of 3 years to clarify the role of UA on the risk of incident osteoporotic fractures (OFs). Methods: A total of 16,078 Korean men aged 50 years or older who had undergone comprehensive routine health examinations were enrolled. Incident fractures at osteoporosis-related sites (e.g., hip, spine, distal radius, and proximal humerus) that occurred after the baseline examinations were identified from the nationwide claims database of the Health Insurance Review and Assessment Service of Korea by using selected International Classification of Diseases, 10th revision codes. Results: In total, 158 (1.0 %) men developed incident OFs. The event rate was 33.1 per 10,000 person-years. Subjects without incident OFs had 6.0 % higher serum UA levels than subjects with OFs (Pâ??=â??0.001). Multivariable-adjusted Cox proportional hazard analyses adjusted for age, body mass index, glomerular filtration rate, lifestyle factors, medical and drug histories, and the presence of baseline radiological vertebral fractures revealed that the hazard ratio per standard deviation increase of baseline UA levels for the development of incident OFs was 0.829 (95 % CIâ??=â??0.695-0.989, Pâ??=â??0.038). Conclusions: These data provide the epidemiological evidence that serum UA may act as a protective factor against the development of incident OFs in Korean men. © 2014 International Osteoporosis Foundation and National Osteoporosis Foundation. |
0 | The rates of osteolysis and loosening associated with a modular posterior stabilized knee replacement. Results at five to fourteen years | Surgical Management of Osteoarthritis of the Knee CPG | BACKGROUND: Osteolysis and increased polyethylene wear have been reported in association with several designs of modular total knee prostheses. The purpose of the present study was to evaluate a modular posterior stabilized prosthesis to determine its clinical performance as well as the rates of component loosening and osteolysis. METHODS: We performed a prospective, consecutive study of 193 knees in 131 patients who were managed with the modular Insall-Burstein II posterior stabilized total knee prosthesis by one surgeon. The mean age of the patients at the time of surgery was sixty-eight years, and the mean duration of follow-up was seven years (range, five to fourteen years). Clinical evaluation was performed with use of standard knee-scoring systems. Radiographs were evaluated for the presence of radiolucent lines, osteolysis, and loosening. RESULTS: The overall result (as determined with the Hospital for Special Surgery scoring system) was rated as excellent for 112 knees, good for sixty, fair for fifteen, and poor for six. The mean postoperative flexion was 112 degrees. No clinical or radiographic loosening of the tibial component was noted. Eight knees had osteolytic lesions of the tibia. Thin, incomplete, nonprogressive radiolucent lines were noted around thirty tibial components (16%). There were three reoperations. CONCLUSIONS: Despite previous reports of osteolysis, polyethylene wear, and loosening in association with some modular total knee implant designs, there was no loosening in this series of posterior stabilized total knee replacements and only eight knees had tibial osteolysis after a mean duration of follow-up of seven years. We believe that total knee arthroplasties that are performed with use of cemented modular posterior stabilized components can have a high rate of intermediate-term success. Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence |
0 | Cumulative Childhood Trauma and Adult Sexual Satisfaction: Mediation by Affect Dysregulation and Sexual Anxiety in Men and Women | DoD PRF (Psychosocial RF) | Childhood cumulative trauma (CCT) refers to an amalgam of childhood maltreatment experiences that can lead to a range of symptoms and problems in adulthood. The current study examined an integrative model of CCT for its relevance to psychosexual adjustment in adult survivors. A total of 620 participants aged 18 years and over completed a questionnaire assessing early life experiences, affect dysregulation, sexual anxiety, and sexual satisfaction. Path analyses confirmed the hypothesis that CCT is associated with affect dysregulation and sexual anxiety that, in turn, predict lower levels of sexual satisfaction. The validity of this mediational model was demonstrated for different operationalizations of CCT. The results suggested that sex therapists, who are likely to encounter CCT survivors in their practice, should consider targeting affect dysregulation in their efforts to decrease sexual anxiety and increase sexual satisfaction. |
0 | The Management of Osteoarthritis: An Overview and Call to Appropriate Conservative Treatment | Surgical Management of Osteoarthritis of the Knee CPG | Despite its growing prevalence, osteoarthritis (OA) remains a poorly understood disease, and recent doubts about the safety of several commonly prescribed OA medications have served to highlight deficiencies in the traditional medical approach to management. This article presents a general outline for the management of the patient who has OA in the form of a narrative review considering diagnosis, investigation, and treatment. It provides the clinician with an overview of the available treatments in line with the guidelines of the Osteoarthritis Research Society International and the European League Against Rheumatism. (copyright) 2008 Elsevier Inc. All rights reserved |
1 | Analgesia and functional outcome after total knee arthroplasty: periarticular infiltration vs continuous femoral nerve block | AAHKS (9/10) Regional Nerve Blocks | BACKGROUND: Capacity to ambulate represents an important milestone in the recovery process after total knee arthroplasty (TKA). The purpose of this study was to determine the analgesic effect of two analgesic techniques and their impact on functional walking capacity as a measure of surgical recovery.
METHODS: Forty ASA II-III subjects undergoing TKA were enrolled in a randomized, double-blind, single-centre study receiving 48 h postoperative analgesia with either periarticular infiltration of local anaesthetic (Group I) or continuous femoral nerve block (Group F). Breakthrough pain relief was achieved with patient-controlled analgesia (PCA) morphine. The main outcome was postoperative morphine consumption. Early (postoperative days 1-3) and late (6 weeks) functional walking capacity (2 and 6 min walk tests, 2MWT and 6MWT, respectively), degree of physical activity (CHAMPS), health-related quality of life (SF-12), and clinical indicators of knee function (WOMAC, Knee Society evaluation, and range of motion) were measured.
RESULTS: Patients in Group F used the PCA less (P=0.02) to achieve adequate analgesia. Postoperative 2MWT was similar in both groups (P=0.27). Six weeks after surgery, recovery of 6MWT, physical activity, and knee function were significantly improved in Group F (P<0.05). Preoperative walking capacity, physical activity and early total walking time were the independent predictors of early recovery. Distance and time spent walking were the predictors of functional walking exercise capacity at 6 weeks after surgery.
CONCLUSIONS: Femoral block is associated with lower opioid consumption and a better recovery at 6 weeks than periarticular infiltration. Early postoperative activity measures (2MWT and walking time) were proved to be possible indicators of knee function recovery at 6 weeks after surgery. |
0 | Flexion Contractures: Getting It Straight | Surgical Management of Osteoarthritis of the Knee CPG | The importance of correcting soft tissue imbalance at the time of total knee arthroplasty is well recognized. Fixed knee flexion contractures are common preoperatively and can make balancing more challenging for the surgeon. In addition, restoration of full passive knee extension is required at the time of total knee arthroplasty to achieve optimal function. The objective of this article is to give the reader a stepwise approach, based on the degree of flexion contracture, to effectively attain full extension in the operating room. (copyright) 2009 Elsevier Inc. All rights reserved |
1 | Complications Post Abdominoplasty After Surgical Versus Non-surgical Massive Weight Loss: a Comparative Study | Panniculectomy & Abdominoplasty CPG | PURPOSE: This study aims to investigate the rate of short- and long-term complications as well as the need for operative revisions after abdominoplasty for patients following surgical versus non-surgical weight loss methods. METHODS: This is a retrospective chart review that enrolled consecutive patients undergoing abdominoplasty across a 5-year period, aged 18 years and above, opting for abdominoplasty after weight loss achieved through bariatric surgery or diet and exercise alone. RESULTS: A total of 364 patients lost weight through bariatric surgery and 106 by diet and exercise alone. There were no significant differences in comorbidity status, but past body mass index (BMI) was higher for the surgical weight loss (SW) group (47.6?±?10.2 and 40.4?±?8.6, respectively; p value?<?0.0001). Percent excess weight loss (EWL) was 68?±?14.5 for the SW group and 55.7?±?19.4 for the NSW group, p value?<?0.0001. Pre- and postoperative blood hemoglobin levels were significantly lower in the SW group (p?<?0.05). Neither short-term complications (thromboembolic events, wound complications, or infections) nor long-term complications (umbilical deformity, delayed wound healing, or infection) and operative revisions were significantly different across both groups (p?>?.05). CONCLUSION: Bariatric surgery does not increase the risk of short- or long-term complications or the need for operative revision after abdominoplasty. |
0 | Complex wound closure by plastic surgery following resection of spinal neoplasms minimizes postoperative wound complications in high-risk patients | MSTS 2022 - Metastatic Disease of the Humerus | OBJECTIVE: Wound breakdown and infection are common postoperative complications following resection of spinal neoplasms. Accordingly, it has become common practice at some centers for plastic surgeons to assist with closure of large posterior defects after spine tumor resection. In this study, the authors tested the hypothesis that plastic surgery closure of complex spinal defects improves wound outcomes following resection of spinal neoplastic disease.
METHODS: Electronic medical records of consecutive patients who underwent resection of a spinal neoplasm between June 2015 and January 2019 were retrospectively reviewed. Patients were separated into two subpopulations based on whether the surgical wound was closed by plastic surgery or neurosurgery. Patient demographics, preoperative risk factors, surgical details, and postoperative outcomes were collected in a central database and summarized using descriptive statistics. Outcomes of interest included rates of wound complication, reoperation, and mortality. Known preoperative risk factors for wound complication in spinal oncology were identified based on literature review and grouped categorically. The presence of each category of risk factors was then compared between groups. Univariate and multivariate linear regressions were applied to define associations between individual risk factors and wound complications.
RESULTS: One hundred six patients met inclusion criteria, including 60 wounds primarily closed by plastic surgery and 46 by neurosurgery. The plastic surgery population included more patients with systemic metastases (58% vs 37%, p = 0.029), prior radiation (53% vs 17%, p < 0.001), prior chemotherapy (37% vs 15%, p = 0.014), and sacral region tumors (25% vs 7%, p = 0.012), and more patients who underwent procedures requiring larger incisions (7.2 +/- 3.6 vs 4.5 +/- 2.6 levels, p < 0.001), prolonged operative time (413 +/- 161 vs 301 +/- 181 minutes, p = 0.001), and greater blood loss (906 +/- 1106 vs 283 +/- 373 ml, p < 0.001). The average number of risk factor categories present was significantly greater in the plastic surgery group (2.57 vs 1.74, p < 0.001). Despite the higher relative risk, the plastic surgery group did not experience a significantly higher rate of wound complication (28% vs 17%, p = 0.145), reoperation (17% vs 9%, p = 0.234), or all-cause mortality (30% vs 13%, p = 0.076). One patient died from wound-related complications in each group (p = 0.851). Regression analyses identified diabetes, multilevel instrumentation, and BMI as the factors associated with the greatest wound complications.
CONCLUSIONS: Involving plastic surgery in the closure of spinal wounds after resection of neoplasms may ameliorate expected increases in wound complications among higher-risk patients. |
0 | Transfixation pinning and casting of radial-ulnar fractures in calves: A review of three cases | Distal Radius Fractures | We reviewed the medical records of three calves with radial-ulnar fractures which were reduced and stabilized by transfixation pinning and casting. Multiple Steinmann pins were placed transversely through proximal and distal fracture fragments and the pin ends were incorporated in fiberglass cast material after fracture reduction. Cast material was placed from proximal to distal radius and served as an external frame to maintain pin position and fracture reduction.At the time of injury, the calves ranged in age from one day to two months and weighed from 37-102 kg. Two fractures were comminuted and one was transverse. All fractures were closed. After surgery, all calves could walk within 24 hours. Radiographic and clinical evidence of fracture healing was present five to seven weeks (mean 6) after surgery. At that time, the pins and cast material were removed. Return to normal function was rapid and judged to be excellent at follow-up evaluation five to nine months later.Advantages of transfixation pinning and casting in management of radial-ulnar fractures include flexibility in pin positioning, adequate maintenance of reduction, early return to weight-bearing status, preservation of joint mobility, and ease of ambulation. The inability to adjust fixation and alignment after cast application is a disadvantage of this technique compared with other external fixators. We concluded that transfixation pinning is a useful means of stabilizing radial-ulnar fractures in pediatric bovine patients. |
0 | Skin Grafting in the Treatment of Diabetic Foot Soft Tissue Defects | DoD LSA (Limb Salvage vs Amputation) | Background: According to the World Health Organization, cases of diabetes have risen from 108 million in 1980 to 422 million in 2014, with a more rapid rising in middle- and low-income countries. Diabetes causes yearly approximately 1.6 million deaths, and is a major cause of heart attacks, stroke, kidney failure, blindness and lower limb amputation. This article provides information on the treatment of a frequent complication related to diabetes, namely toe/ partial foot amputation. Broad, deep operative defects of the diabetic foot represent a reconstructive challenge. The aim of the study is to analyse the efficiency of healing methods using splitted skin graft corroborated with negative pressure therapy for wounds resulted after diabetic foot surgery. Second of all, the study intends to highlight the role of a sequence of the multidisciplinary approach, in this case general surgeon-plastic surgeon, in assuring the functionality of the pelvic limb. Methods: 63 diabetic patients were retrospectively analysed, patients that were admitted in Dr.I.Cantacuzino and Bagdasar-Arseni Clinical Hospitals, with different types of wounds resulted after diabetic foot surgery, between January 2016 and December 2017. Results: The reconstructions were successful in 56 patients, and, during the follow-up period, there were no complications. From the 7 patients with complications (skin graft necrosis, skin graft infection), one had an auto avulsion of the skin graft. Conclusion: Direct closure is feasible for small-sized wounds. Skin grafts provide effective coverage for large wounds, although they may often produce concave, caved-in, non-aesthetic closures. NPWT (negative pressure wound therapy) is also a very helpful procedure. Flap reconstruction often provides superior functional and aesthetic appearance. Adjacent tissue transfers may be used to close many wounds, but dermal restraint may hinder motion and lead to closure tension. Alternative solution of repair remains the reconstruction with free flaps, which also poses problems, due to arteriopathy. |
0 | Preliminary results for the use of knee mega-endoprosthesis in the treatment of musculoskeletal complications of haemophilia | Pediatric Supracondylar Humerus Fracture 2020 Review | Complications of haemophilia in the knee region are rare and difficult to treat. Use of surgical treatments such as total knee arthroplasty cannot satisfactorily restore knee function in patients with these complications, which include massive haemophilic pseudotumour, fracture around the knee and haemarthrosis. To analyse the postoperative results of patients suffering from complications of haemophilia and treated with a knee mega-endoprosthesis, to discuss and compare this type of surgical management with other types of treatments used in similar cases. We retrospectively analyse the surgical results of patients who were treated with a knee mega-endoprosthesis for complications of haemophilia. Three severe haemophilic arthritic knees, of which two were combined with femoral condylar fractures, were treated in a one-stage surgery, and another two knees which presented with massive haemophilic pseudotumours and bony defects were treated in a two-stage operation. Mean age at time of surgery was 28.5 years old and mean follow-up time was 22.8 months; the mega-endoprosthesis surgery was successfully performed in four cases and the mean range of motion increased from 29.5° preoperatively to 96.75° postoperatively. The Knee society score function score value increased from 25 to 82.5. One knee was amputated because of uncontrollable recurrent haemorrhage. Roentgenograms did not show any signs of loosening of the prostheses. Use of Mega-endoprosthesis in the treatment of complications of haemophilia can offer patients suffering from massive pseudotumours with bone defect, severe contracture knee haemophilic arthritis and fractures around a haemophilic knee a viable treatment option. |
0 | Stem cells: Novel players in the treatment of erectile dysfunction | AMP (Acute Meniscal Pathology) | Stem cells are defined by their capacity for both self-renewal and directed differentiation; thus, they represent great promise for regenerative medicine. Historically, stem cells have been categorized as either embryonic stem cells (ESCs) or adult stem cells (ASCs). It was previously believed that only ESCs hold the ability to differentiate into any cell type, whereas ASCs have the capacity to give rise only to cells of a given germ layer. More recently, however, numerous studies demonstrated the ability of ASCs to differentiate into cell types beyond their tissue origin. The aim of this review was to summarize contemporary evidence regarding stem cell availability, differentiation, and more specifically, the potential of these cells in the diagnosis and treatment of erectile dysfunction (ED) in both animal models and human research. We performed a search on PubMed for articles related to definition, localisation and circulation of stem cells as well as the application of stem cells in both diagnosis and treatment of ED. Strong evidence supports the concept that stem cell therapy is potentially the next therapeutic approach for ED. To date, a large spectrum of stem cells, including bone marrow mesenchymal stem cells, adipose tissue-derived stem cells and muscle-derived stem cells, have been investigated for neural, vascular, endothelial or smooth muscle regeneration in animal models for ED. In addition, several subtypes of ASCs are localized in the penis, and circulating endogenous stem cells can be employed to predict the outcome of ED and ED-related cardiovascular diseases. © 2012 AJA, SIMM &SJTU. All rights reserved. |
1 | Intravenous Iron May Improve Outcomes in Elderly Patients With Operative Hip Fractures | Hip Fx in the Elderly 2019 | Introduction: Hip fractures are common injuries with high morbidity and mortality rates. These patients often become anemic and require allogenic blood transfusion. Transfusions are costly with potential complications. This study examines the effect of intravenous (IV) iron on patients with hip fractures, undergoing surgery within 48 hours, and being treated with a highly restrictive transfusion protocol. Materials and Methods: A retrospective chart review performed on patients admitted to a level 1 tertiary care center with fractures of the proximal femur from December 2015 to December 2017 included 239 patients. Patients who received 300 mg of IV iron when their hemoglobin fell below 11 g/dL were compared to a control group of patients who never received IV iron with respect to transfusion rate, 30-day readmission rate, nosocomial infections, length of stay, and hospital costs. Results: There were no significant differences in transfusion rates (P =.118). There was a trend toward decreased length of stay (P =.063) and 30-day readmission rates (P =.051) with a 59% reduction in the odds of 30-day readmission when a patient received IV iron. There were no differences in nosocomial infection rates or cost of hospitalization. Discussion: This study presents a compelling argument for further research regarding the use of IV iron in elderly patients undergoing surgery for a hip fracture. Length of stay and transfusion rates are increased in patients with intertrochanteric fractures and undergoing intramedullary nailing. A higher number of these patients in the IV iron group may have falsely increased these rates. A prospective, randomized, controlled trial is needed to assess the true effects of perioperative IV iron. Conclusions: This study showed no significant benefit to IV iron use in elderly patients undergoing surgical treatment of hip fracture. The decrease in 30-day readmission rate should be further examined with a prospective randomized controlled trial. |
1 | Elective surgery in the time of COVID-19 | Coronavirus Disease 2019 (COVID-19) | The COVID-19 pandemic has placed a significant strain on the United States health care system, and frontline healthcare workers are rapidly altering their professional responsibilities to help meet hospital needs. In an effort to decrease disease transmission and conserve personal protective equipment (PPE), surgeons have witnessed one of the most dramatic changes in their practices with rapidly decreasing numbers of elective surgeries. |
0 | Short scar abdominoplasty update | Panniculectomy & Abdominoplasty CPG | Techniques for abdominal contouring have proliferated and evolved over the past 2 decades. Now more than ever, aesthetic operations are tailored to fit the anatomic features and aesthetic goals of each individual patient, stressing the absolute importance of patient selection. This short scar procedure relies on a combination of liposuction and modified skin resection and muscle tightening in the lower abdomen. It has been the author's experience that this results in a more rapid recovery in most patients. It is almost always performed in conjunction with liposuction of the posterior trunk to achieve a harmonious recontouring of the aesthetic unit of the trunk. The techniques employed are familiar to all plastic surgeons performing body contouring procedures. Patient selection is the absolute key to achieving successful outcomes. Short scar abdominoplasty results in significant contour improvement in the properly selected patient. The procedure relies on a combination of liposuction and modified excisional surgery to produce the desired outcome. |
1 | Endoscopic-Assisted Abdominoplasty | Panniculectomy & Abdominoplasty CPG | Advantages of standard endoscopic surgery include diminished incidence of scarring, numbness, bleeding, and edema, making endoscopic surgery preferable to the conventional suprapubic approach. Endoscopic-assisted abdominoplasty can also treat diastasis recti deformity with minimal excess skin. For enhanced results, a learning curve is expected to achieve optimal technical expertise. |
0 | Ultrasonic diagnosis of neonatal separation of the distal humeral epiphysis | The Treatment of Pediatric Supracondylar Humerus Fractures AUC | We report a case of neonatal separation of the distal humeral epiphysis in which non-invasive ultrasonic examination provided clear definition of the injury |
0 | Morphometry of adult human femur | Surgical Management of Osteoarthritis of the Knee CPG | Femur is the long bone studied and analysed for its importance in medico legal cases and forensic identification of an individual. The knowledge of normal anatomical features and morphometry of femur are pre-requisites for complete understanding of mechanics of hip and knee joint and diseases of these joints as well. Increased femoral anteversion can cause failure of treatment of congenital dislocation of hip (Morscher 1967) and if not appropriately cared for in the prosthesis then even in treatment of total hip replacement. This fact makes the morphometry of femur important not just for orthopaedicians but also radiologists who use neck shaft angle for diagnosis and managing hip diseases. The neck shaft angle is increased in congenital subluxation and dislocation of hip, idiopathic scoliosis, perthe's disease and slipped capital femoral epiphysis. For The now gold standard treatment of osteoarthritis and fracture neck of femur in elderly, total hip replacement, the normal morphometry of the upper end of femur like head diameter, neck shaft angle and angle of anteversion must be precisely known. Hence the extensive morphometric study on femur was undertaken by us the observations of which are given under |
0 | Immunophenotyping of Human B Lymphocytes in Blood and in Adipose Tissue | Panniculectomy & Abdominoplasty CPG | The human obese subcutaneous adipose tissue (SAT) contributes to systemic and B cell intrinsic inflammation, reduced B cell responses, and increased secretion of autoimmune antibodies. Immune cells are recruited to the SAT by chemokines released by both adipocytes and infiltrating immune cells. We describe here the characterization of B lymphocytes from the SAT and blood (control) of obese females undergoing weight reduction surgeries (breast reduction or panniculectomy). We show how to isolate the immune cells from the blood and SAT, how to characterize B cells and their subsets, and how to measure markers of activation and/or transcription factors in SAT-derived B cells and B cell subsets. We also show how to evaluate other immune cell types infiltrating the SAT, including T cells, NK cells, monocyte/macrophages, in order to measure relative proportions of these cell types as compared to the blood. |
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