MedWorm: Orthopaedics

Kyphoplasty feasible even with loss of wall integrity

MedWire News - Bone Health — Fri, 20 Nov 2009 14:54:01 +0100

Kyphoplasty is suitable even for patients whose osteoporotic vertebral fractures have loss of vertebral wall integrity, say Chinese clinicians. (Source: MedWire News - Bone Health)

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Index

Orthopedic Clinics of North America — Thu, 19 Nov 2009 15:03:17 +0100

(Source: Orthopedic Clinics of North America)

Soft Tissue and Biomechanical Challenges Encountered with the Management of Distal Tibia Nonunions

Orthopedic Clinics of North America — Thu, 19 Nov 2009 15:03:17 +0100

A thoughtful treatment algorithm is required to optimally treat distal tibia nonunion. A healthy respect for the tenuous soft tissue envelope, compromised vascularity, and challenging mechanical environment is advisable. Achieving osseous union and improved functionality requires an individualized plan of care based on the personality of the nonunion and host. Attention must be focused on providing mechanical stability at the site of nonunion and providing biologic supplementation. (Source: Orthopedic Clinics of North America)

Managing Bone Deficiency and Nonunions of the Proximal Femur

Orthopedic Clinics of North America — Thu, 19 Nov 2009 15:03:17 +0100

This article presents a technique of deformity correction, bone graft techniques that reconstitute residual defects, and definitive fixation using load-sharing devices that provide immediate stability for bone healing and early rehabilitation. Preoperative planning and the potential advantages and disadvantages of newer fixed-angled plates versus established implants are discussed. With proper planning, surgical execution with proved techniques, augmented by the addition of newer graft harvesting techniques, anatomic restoration, and bone reconstitution with healing, has invariably been the result. (Source: Orthopedic Clinics of North America)

RIA: One Community's Experience

Orthopedic Clinics of North America — Thu, 19 Nov 2009 15:03:17 +0100

The Reamer Irrigator Aspirator (RIA) has three main indications in our community trauma practice. The most common indication for RIA is harvesting of autololgous bone graft from the femur for nonstructural bone graft. The second most common indication is for irrigation and debridement of intramedullary osteomyelitis. The final indication for RIA is for acute nailing of femoral shaft fractures in patients with multiple long bone fractures with or without pulmonary injury. If one pays careful attention to the details of the technique, RIA is a safe and effective method of harvesting autologous bone graft with minimal morbidity. Autologous bone graft harvested with RIA is our graft of choice for nearly all of our bone grafting cases. (Source: Orthopedic Clinics of North America)

Quantitative Analysis of Growth Factors from a Second Filter Using the Reamer-Irrigator-Aspirator System: Description of a Novel Technique

Orthopedic Clinics of North America — Thu, 19 Nov 2009 15:03:17 +0100

We report on our novel technique of using a second filter containing beta-tricalcium phosphate (TCP) as a graft extender while using the RIA system. We also quantify growth factor concentrations in the collections from the TCP filter. A second filter attached in series with the standard RIA filtration system yields TCP with substantial concentrations of bioactive proteins that are equal to those seen in the bone graft that is harvested in the first filter. (Source: Orthopedic Clinics of North America)

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Autologous Bone Graft: When Shall We Add Growth Factors?

Orthopedic Clinics of North America — Thu, 19 Nov 2009 15:03:17 +0100

Although the unquestionable value of autologous bone grafting and the analogous value of the reaming by-products in nonunion treatment have been mentioned extensively in the literature, there is ongoing vivid discussion for the treatment of those case scenarios where the fracture nonunion is complicated by other local environment adverse circumstances. The graft expansion with growth factors as the bone morphogenetic proteins (BMPs) offers the possibility to reduce the number of operative procedures, complications, length of hospital stay, and time to union. In this article, we consider the potential clinical scenarios for graft expansion with BMPs. (Source: Orthopedic Clinics of North America)

Autograft and Nonunions: Morbidity with Intramedullary Bone Graft versus Iliac Crest Bone Graft

Orthopedic Clinics of North America — Thu, 19 Nov 2009 15:03:17 +0100

This article focuses on comparing patient morbidity with harvesting bone graft for the treatment of nonunions from three different sites. Anterior iliac crest graft is the most commonly used site; however, the posterior iliac crest and intramedullary canal provide greater quantities of bone. The anterior and posterior iliac crests also have some donor site complications such as nerve injury and persistent pain. The intramedullary canal, when compared with anterior and posterior iliac crest, offers the largest quantity of bone graft with the least amount of patient donor site morbidity. The intramedullary canal also appears to be a bone graft source that can be reharvested, unlike the anterior and posterior iliac crest donor sites. (Source: Orthopedic Clinics of North America)

Treatment of Large Segmental Bone Defects with Reamer-Irrigator-Aspirator Bone Graft: Technique and Case Series

Orthopedic Clinics of North America — Thu, 19 Nov 2009 15:03:17 +0100

Treatment of large segmental defects using conventional autogenous iliac crest bone graft can be limited by volume of cancellous bone and donor site morbidity. The reamer-irrigator-aspirator (RIA) technique allows access to a large volume of cancellous bone graft containing growth factors with potency equal to or greater than autograft material from the iliac crest. The purpose of this study was to evaluate the effectiveness of RIA-harvested autogenous bone graft for treating large segmental defects of long bones. (Source: Orthopedic Clinics of North America)

Biological Rationale for the Intramedullary Canal as a Source of Autograft Material

Orthopedic Clinics of North America — Thu, 19 Nov 2009 15:03:17 +0100

Bone harvested by intramedullary reaming offers a minimally invasive alternative to harvesting bone from the iliac crest, which has long been considered the gold standard for autogenous bone grafting. The biologic potential of intramedullary reaming material has been studied both in vitro and in vivo. The material provides osteogenic, osteoinductive, and osteoconductive properties that are comparable to the material harvested from the iliac crest. In addition to the ability to obtain a large volume of bone, the graft harvested by the Reamer-Irrigator-Aspirator has been shown to be rich in growth factors, including BMP-2, TGF-β1, IGF-I, FGFa, and PDGFbb. (Source: Orthopedic Clinics of North America)

Use of the Induced Membrane Technique for Bone Tissue Engineering Purposes: Animal Studies

Orthopedic Clinics of North America — Thu, 19 Nov 2009 15:03:16 +0100

Animal experiments using the induced membrane procedure for bone tissue engineering purposes have provided evidence that the membrane has structural characteristics and biologic properties that may be used for bone tissue engineering purposes. Clinically relevant animal models have demonstrated that standardized particulate bone constructs can be used to repair large bone defects using the procedure and that the osteogenic ability of these constructs partially approaches that of bone autografts. (Source: Orthopedic Clinics of North America)

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Clinical Use of Resorbable Polymeric Membranes in the Treatment of Bone Defects

Orthopedic Clinics of North America — Thu, 19 Nov 2009 15:03:16 +0100

The reconstruction of large bone defects remains a clinically challenging condition. Although many treatment approaches exist, they all have limitations. Recently, bioresorbable polylactide membranes have become commercially available. These membranes, when applied to bone defects, enhance bone healing by direct osteoconduction, exclusion of nonosseous tissues, and enhancing the osteogenic environment for autologous grafts. When combined with appropriate internal fixation and autologous bone graft, bioresorbable polylactide membranes allow for single-step reconstruction of large bone defects. (Source: Orthopedic Clinics of North America)

The Concept of Induced Membrane for Reconstruction of Long Bone Defects

Orthopedic Clinics of North America — Thu, 19 Nov 2009 15:03:16 +0100

Clinical, experimental, and fundamental studies have shown the interest of a foreign body-induced membrane to promote the consolidation of a conventional cancellous bone autograft for reconstruction of long bone defects. The main properties of the membrane are to prevent the resorption of the graft and to secrete growth factors. The induced membrane appears as a biological chamber, which allows the conception of numerous experimental models of bone reconstruction. This concept could probably be extended to other tissue repair. (Source: Orthopedic Clinics of North America)

Use of Solid and Cancellous Autologous Bone Graft for Fractures and Nonunions

Orthopedic Clinics of North America — Thu, 19 Nov 2009 15:03:16 +0100

This article describes the use of solid and cancellous bone graft in the treatment of acute bone loss and nonunion. (Source: Orthopedic Clinics of North America)

Viable Bone and Circulatory Factors Required for Survival of Bone Grafts

Orthopedic Clinics of North America — Thu, 19 Nov 2009 15:03:16 +0100

The healing of fractures and nonunions has significant science background to it; however, the application of the products in the surgeon's hands should be considered an art in the science of bone healing. The surgeon must choose adequate fixation for stability and to promote healing by not making the construct too stiff. If a bone graft substitute is necessary, the surgeon must choose the type of bone graft substitute depending on patient factors and surgeon factors involving the treatment of the fracture. (Source: Orthopedic Clinics of North America)

Bone Defects Caused by High-energy Injuries, Bone Loss, Infected Nonunions, and Nonunions

Orthopedic Clinics of North America — Thu, 19 Nov 2009 15:03:16 +0100

This article discusses bone defects caused by high-energy injuries, bone loss, infected nonunions, and nonunions. (Source: Orthopedic Clinics of North America)

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Preface

Orthopedic Clinics of North America — Thu, 19 Nov 2009 15:03:16 +0100

The management of traumatic bone defect continues to be a tremendous challenge to orthopedic trauma surgeons. Although many products that stimulate the growth of bone and replace defects have become available within the past decades, autologous bone continues to have ideal biologic properties. Although some of the well-described techniques to grow bone, such as distraction osteogenesis, have incurrent risks of infections, newer methods have become available to treat bone defects in the presence of an infection. (Source: Orthopedic Clinics of North America)

Forthcoming issues

Orthopedic Clinics of North America — Thu, 19 Nov 2009 15:03:16 +0100

(Source: Orthopedic Clinics of North America)

Orthopedic Clinics of North America — Thu, 19 Nov 2009 15:03:16 +0100

(Source: Orthopedic Clinics of North America)

Peak BMD may explain Indian osteoporosis rate

MedWire News - Bone Health — Thu, 19 Nov 2009 15:03:06 +0100

Research suggests that peak bone mineral density in Indian men and women is lower than expected, which may explain why osteoporosis is more common in India than in Western populations. (Source: MedWire News - Bone Health)

Physical examination of the foot and ankle by orthopaedic and accident and emergency clinicians [Injury 2009;40(2):136–8]

Injury — Thu, 19 Nov 2009 15:02:52 +0100

We thank Mr Borland for his comments. We agree that a sound knowledge of limb anatomy is of interest to the vast majority of doctors and not just orthopaedic surgeons. Mr Borland says that 60% of undergraduates will end up as general practitioners, we would argue that a significant amount of a general practitioner's workload are “musculoskeletal” related problems and so it is of utmost importance that they have a good knowledge of limb anatomy to provide good patient care. (Source: Injury)

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Are we failing our students?

Injury — Thu, 19 Nov 2009 15:02:52 +0100

I read the study performed by Roche et al. published in February's edition with great interest. As a medical student I was assured that due to the ‘modernisation’ of undergraduate medical training, the focus of study would be less on basic science and more on applied clinical knowledge. As a result I failed to learn much about the anatomy of the human body which was not within the torso. But of course that was fine as 60% of us would go on to be general practitioners and would not need such unimportant facts cluttering up our brains. Of course, as irony would have it, 40% have not gone on to be GPs and found that studying for our basic science MRCS/MRCP was slightly tricky. (Source: Injury)

Reconstruction of finger-pulp defect with a homodigital laterodorsal fasciocutaneous flap distally based on the dorsal branches of the proper palmar digital artery

Injury — Thu, 19 Nov 2009 15:02:52 +0100

Conclusion: The homodigital laterodorsal fasciocutaneous flap based on the dorsal branch of the proper palmar digital artery is an ideal alternative to reconstruct the finger-pulp for single-stage reconstruction without sacrificing the proper palmar digital artery and nerve. (Source: Injury)

Learning the lessons from conflict: Pre-hospital cervical spine stabilisation following ballistic neck trauma

Injury — Thu, 19 Nov 2009 15:02:52 +0100

Conclusions: Penetrating ballistic trauma to the neck is associated with a high mortality rate. Our data suggests that it is very unlikely that penetrating ballistic trauma to the neck will result in an unstable cervical spine in survivors. In a hazardous environment (e.g. shooting incidents or terrorist bombings), the risk/benefit ratio of mandatory spinal immobilisation is unfavourable and may place medical teams at prolonged risk. In addition cervical collars may hide potential life-threatening conditions. (Source: Injury)

Factors affecting results of patients with humeral proximal end fractures undergoing primary hemiarthroplasty: A retrospective study in 42 patients

Injury — Thu, 19 Nov 2009 15:02:52 +0100

Abstract: Aim: Our study reports long-term results and factors related to patient satisfaction in the case of primary hemiarthroplasty for humeral proximal end fractures.Patients and methods: We retrospectively evaluated 42 patients with humeral proximal end fractures who underwent primary hemiarthroplasty in our clinic from February 1994 to March 2004. Of the 42 patients, 14 (33%) were male and 28 (67%) female. The mean age was 68.9±5.57 years (age range: 59–81 years). The mean follow-up period was 78.8±26.6 months (range: 48–118 months). We evaluated the following parameters: fracture type according to the Neer classification, the time interval between the fracture and the operation, postoperative radiological examination, the Neer outcome assessment criteria for patient satisfacti...

Removal of erythropoietin from anaemia trauma practice guideline does not increase red blood cell transfusions and decreases hospital utilization costs

Injury — Thu, 19 Nov 2009 15:02:51 +0100

Abstract: Introduction: We previously demonstrated that utilization of erythropoietin (r-EPO) did not significantly reduce blood utilization in trauma patients. We undertook this study to analyze blood utilization 1 year after r-EPO removal from our trauma service anaemia practice management guideline.Methods: Electronic records of patients admitted to the trauma service were retrospectively reviewed for units of packed red blood cells (pRBCs) transfused and for units of r-EPO administered 12 months before the initiation of an anaemia practice guideline (PRE), 12 months during the use of an anaemia guideline (GUIDE), and 12 months following removal of r-EPO from the guideline (POST). Hospital acquisition cost was also reviewed for the respective time periods. Nominal data were analyzed usi...

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Recovery of brachial plexus injury after shoulder dislocation

Injury — Thu, 19 Nov 2009 15:02:51 +0100

Abstract: Brachial plexus injury is an underestimated complication from anterior dislocation of the shoulder. To our knowledge, there is limited information available about the factors that influence neurological recovery of this injury. We reviewed 15 upper extremities in 14 patients with brachial plexus injuries caused by anterior shoulder dislocation. Two-thirds of the cases had total brachial plexus palsy. With the conservative treatment, the motor recoveries of all cases are full or nearly full within 20 months except intrinsic muscle of the hand. Intrinsic muscle recovery may be better in a younger age group (less than 50 years). Nerve exploration is usually unnecessary. However, reconstructive surgery for the residual neurological deficit can provide improvement of hand function. (S...

Ulnar artery distal cutaneous descending branch as free flap in hand reconstruction

Injury — Thu, 19 Nov 2009 15:02:51 +0100

Summary: These authors aimed to evaluate the method and therapeutic effects of surgical hand-wound repair using free vascularised flaps based on the descending ramus of the above-wrist cutaneous branch of the ulnar artery. We retrospectively reviewed records of 75 patients with 79 finger defects who had received hand surgery between January 2001 and December 2007. Soft-tissue defects of the hand were repaired using free flaps with the descending ramus of the above-wrist cutaneous branch of the ulnar artery as the vascular pedicle. Intra-operative and postoperative variations in vascular anatomy were observed and surgical outcomes were compared. All flaps were vascularised and survived, including one in which the distal end showed partial necrosis that healed after skin grafting. Three anat...

The incidence of scaphoid fracture in a military population

Injury — Thu, 19 Nov 2009 15:02:51 +0100

Discussion/conclusions: When compared to the previous data on scaphoid fractures, our study showed a greater incidence of scaphoid fracture at 1.21/1000 person-years in the US military population. These data are derived from a large database which effectively captures the population at risk. Males, the younger age group and the white race were associated with higher rates of scaphoid injury in this specialised military population. (Source: Injury)

Factors affecting infection after calcaneal fracture fixation

Injury — Thu, 19 Nov 2009 15:02:51 +0100

Abstract: A retrospective study of 178 operatively managed intra-articular calcaneal fractures was undertaken. The primary purpose of the study was to investigate whether delay prior to surgery was related to the prevalence of post-operative deep infection although other factors related to infection were also examined.The deep infection rate was 5.6% but there was no statistical correlation between surgical delay and deep infection. However analysis of the results showed that surgical experience did correlate with deep infection. The infection rate for a group of inexperienced surgeons was 14.3% compared with 2.8% for the most experienced surgeon in the study. Analysis also indicated a trend towards more socially deprived patients having a higher rate of infection but it was only in drug a...

Treatment of unstable distal clavicle fractures using two suture anchors and suture tension bands

Injury — Thu, 19 Nov 2009 15:02:51 +0100

Conclusion: Coracoclavicular reconstruction using two suture anchors and supplementary interfragmentary fixation using two non-absorbable suture tension bands for acute distal clavicle fracture are reliable techniques for restoring stability in patients with acute distal clavicle fracture. (Source: Injury)

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Prospective analysis of a new minimally invasive technique for paediatric Gartland type III supracondylar fracture of the humerus

Injury — Thu, 19 Nov 2009 15:02:51 +0100

Conclusion: Minimally invasive surgery with the assistance of mosquito forceps for the reduction of severely displaced supracondylar fracture of the humerus in children was shown to be a safe and effective alternative method. The final functional outcome was the same as that of the standard technique. (Source: Injury)

Complications when using threaded K-wire fixation for displaced intra-articular calcaneal fractures

Injury — Thu, 19 Nov 2009 15:02:51 +0100

Abstract: A retrospective chart review was performed on patients treated at a level one trauma centre for displaced intra-articular calcaneal fractures by a single trauma surgeon between January 1998 and July 2007. Patients were treated with open reduction and internal fixation utilising the extended lateral incision and a new type of fixation not described before. Threaded 1.575mm (0.062in.) Kirschner wires (K-wires) were used for fixation post-operatively along with standard plates, screws and bone substitute.There were 278 fractures in 246 patients that were treated with ORIF for displaced intra-articular calcaneal fractures during this 9-year period. Standard calcaneal lateral approach and hardware was supplemented with percutaneous threaded K-wires. An average of 5.0 fully threaded 1....

Mid-term results of internal fixation of proximal humeral fractures with the Philos plate

Injury — Thu, 19 Nov 2009 15:02:51 +0100

Conclusions: Internal fixation with the Philos plate seems to be a reliable option in the operative treatment of upper end humeral fractures, especially in osteoporotic bone. It allows secure fracture fixation and quick shoulder mobilisation, while quick and uneventful fracture healing and very satisfactory clinical results are achieved. (Source: Injury)

Percutaneous plating in paediatric tibial fractures

Injury — Thu, 19 Nov 2009 15:02:50 +0100

Abstract: Background: Although non-operative treatment is a mainstay of tibial fracture management in children, certain fractures require a surgical approach. However, choices concerning optimal methods and implants are difficult. The purpose of this study was to determine the effectiveness of percutaneous plating of tibial fractures in children.Materials and methods: Sixteen tibial fractures treated using the percutaneous plating technique between 2000 and 2007 were reviewed. The mean age at operation was 10 years 9 months (range: 6–16 years). There were eight open and closed fractures each. Operative indications were acute fractures with associated injuries or fractures, open fractures and compartment syndrome. Nonunions or failures following other treatments were also indicated. Witho...

Three-dimensional computed tomography imaging increases the reliability of classification systems for tibial plateau fractures

Injury — Thu, 19 Nov 2009 15:02:50 +0100

Conclusion: Three-dimensional CT is a more reliable radiographic modality than 2D CT in evaluation of fracture patterns in tibial plateau fractures. This finding seems to show that more sophisticated imaging techniques can improve the reliability of fracture classification systems. (Source: Injury)

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Volar locking plates versus Kirschner wires for distal radial fractures—A cost analysis study

Injury — Thu, 19 Nov 2009 15:02:50 +0100

Conclusion: With use of a locked volar plate for patients under the age of 70 years there is a loss of £652 for the Trust with the present NHS tariffs. (Source: Injury)

Injuries sustained at a temporary ice-skating rink: Prospective study of the Winchester experience 2007–2008

Injury — Thu, 19 Nov 2009 15:02:50 +0100

This study was undertaken to assess, prospectively, the workload created as a consequence of ice-rink injuries, when the facility was reopened over Christmas 2007.All patients attending from the ice-rink were included and their injuries reviewed. Costs of care were calculated based on ED attendance, out-patient appointments (OPA's), radiography, plaster immobilisation and government tariffs for surgical procedures.The ice-rink was open for 39 days welcoming 43,000 skaters. Sixty-two accidents were recorded in the accident book, 43 attended the ED. Radiographic investigation was necessary for 31 patients. Nineteen had diagnoses of soft tissue injury, 3 of head/facial injuries. T&O received 23 referrals; all fractures were in the upper limb, 6 requiring admission and surgery. Fifty-eight ED,...

A health economic analysis of the use of rhBMP-2 in Gustilo–Anderson grade III open tibial fractures for the UK, Germany, and France

Injury — Thu, 19 Nov 2009 15:02:50 +0100

Abstract: The purpose of this study was to determine the cost savings from a societal perspective for recombinant human Bone Morphogenetic Protein-2 (rhBMP-2) in grade III A and B open tibial fractures treated with a locked intramedullary nail and soft-tissue management in the UK, Germany, and France. Health care system costs (direct health care costs) and costs for productivity losses (indirect health care costs) were calculated using the raw data from the Bone Morphogenetic Protein Evaluation Group in Surgery for Tibial Trauma “BESTT study”. Return-to-work time for estimation of productivity losses was assumed to correspond with the time of fracture healing. For calculation of secondary interventions costs and productivity losses the respective 2007/2008 national tariffs for surgical...

Examination tests predictive of bone injury in patients with clinically suspected occult scaphoid fracture

Injury — Thu, 19 Nov 2009 15:02:50 +0100

Conclusion: The two above-mentioned manoeuvres were most indicative of bone injury in patients with clinically suspected occult scaphoid fracture. These examinations may reduce the number of unnecessary MRI examinations. (Source: Injury)

Fresh-frozen vs. irradiated allograft bone in orthopaedic reconstructive surgery

Injury — Thu, 19 Nov 2009 15:02:50 +0100

Abstract: The use of allograft bone is increasingly common in orthopaedic reconstruction procedures. The optimal method of preparation of allograft bone is subject of great debate. Proponents of fresh-frozen graft cite improved biological and biomechanical characteristics relative to irradiated material, whereas fear of bacterial or viral transmission warrants some to favour irradiated graft. Careful review of the literature is necessary to appreciate the influence of processing techniques on bone quality. Whereas limited clinical trials are available to govern the selection of appropriate bone graft, this review presents the argument favouring the use of fresh-frozen bone allograft as compared to irradiated bone. (Source: Injury)

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Maxillofacial trauma—Developments, innovations and controversies

Injury — Thu, 19 Nov 2009 15:02:50 +0100

Abstract: Despite seat belt and alcohol legislation, craniofacial trauma still remains a common health problem and significant workload in many maxillofacial units. Although management has evolved considerably from “wiring teeth together”, complex fractures can still result in cosmetic and functional deformity. Today's challenge is to consistently restore patients back to their pre-injury form and function—but this is not always possible. Greater understanding and developments have significantly improved outcomes, although controversy still exists in some areas. This review outlines some of these topics. (Source: Injury)

Management, complications and clinical results of femoral head fractures

Injury — Thu, 19 Nov 2009 15:02:49 +0100

Abstract: A systematic review of the literature was conducted to investigate data regarding femoral head fractures, particularly focusing on their management, complications and clinical results.Twenty-nine eligible articles, meeting prespecified inclusion criteria, reported on 453 femoral head fractures in 450 patients (mean age of 38.9 years with a mean follow-up of 55.6 months). 84.3% of patients had been victims of an automobile accident. The most widespread classification scheme used was that of Pipkin (65.4% of cases) whereas clinical results were evaluated mainly according to Thompson–Epstein criteria (63.3% of cases).Fracture-dislocations, in their majority, were managed with emergent closed reduction, followed by definite treatment (closed or open), aiming at anatomic restoration...

Fracture healing and bone regeneration: Autologous bone grafting or BMPs?

Injury — Thu, 19 Nov 2009 15:02:49 +0100

In 1915, autologous bone grafting was introduced as a useful surgical technique in the clinical setting. It was not long before its efficacy and safety was recognised and nowadays it is no surprise that over half a million graft harvesting procedures are performed annually in the USA. Common autologous bone graft harvesting sites include the pelvis (anterior/posterior iliac crest), proximal tibia, femur, and distal radius. (Source: Injury)

Editorial Board

Injury — Thu, 19 Nov 2009 15:02:49 +0100

(Source: Injury)

Surgical advances in periacetabular osteotomy for treatment of hip dysplasia in adults.

Acta Orthopaedica — Thu, 19 Nov 2009 13:28:03 +0100

Authors: Troelsen A PMID: 19919373 [PubMed - as supplied by publisher] (Source: Acta Orthopaedica)

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The Scandinavian Sarcoma Group.

Acta Orthopaedica — Thu, 19 Nov 2009 13:28:03 +0100

Authors: Alvegård T, Hall KS, Bauer H, Rydholm A PMID: 19919379 [PubMed - as supplied by publisher] (Source: Acta Orthopaedica)

On the diagnosis and treatment of femoral neck fractures.

Acta Orthopaedica — Thu, 19 Nov 2009 13:28:03 +0100

Authors: Frihagen F PMID: 19919380 [PubMed - as supplied by publisher] (Source: Acta Orthopaedica)

Evolution of the hip and pelvis.

Acta Orthopaedica — Thu, 19 Nov 2009 13:28:03 +0100

Authors: Hogervorst T, Bouma HW, de Vos J PMID: 19919389 [PubMed - as supplied by publisher] (Source: Acta Orthopaedica)

The expression of Gli3, regulated by HOXD13, may play a role in idiopathic congenital talipes equinovarus

BMC Musculoskeletal Disorders — Thu, 19 Nov 2009 00:00:00 +0100

Conclusions: Our findings suggest that HoxD13 directly interacts with the promoter of Gli3. The increase of Gli3 expression in ICTEV model animal might result from the low expression of HoxD13. (Source: BMC Musculoskeletal Disorders)

[Principles of treatment for deep infections of the diabetic foot.]

Der Orthopade — Thu, 19 Nov 2009 00:00:00 +0100

Authors: Kessler S, Delhey P, Volkering C Infections are the typical complications of ulcers related to the neuropathic diabetic foot. The loss of the foot or sepsis is the consequence due to the progression of an untreated infection. Therefore, prophylaxis of ulcer formation is the key to lower the rate of amputation. If infection has occurred antibiotics and non-weight bearing are indicated. Abscesses and phlegmons can be localized by the clinical findings, ultrasound, x-rays, computer tomography and MRI and immediate surgical treatment is necessary to prevent further spreading. In the chronic phase dead tissue, necrotic tendons and bones need to be resected. Closure of the skin can be achieved by secondary healing or other methods of plastic surgery. Persistent bony prominences have...

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[Reconstructive surgery for Charcot foot : Long-term 5-year outcome.]

Der Orthopade — Thu, 19 Nov 2009 00:00:00 +0100

CONCLUSION: By using a fixateur externe many amputations could be avoided and patient's activity could be improved. The interdisciplinary teamwork between an orthopedic surgeon, orthopedic shoemaker and orthopedic technician is essential for long term success. PMID: 19921507 [PubMed - as supplied by publisher] (Source: Der Orthopade)

Middle-age weight changes predict forearm BMD

MedWire News - Bone Health — Wed, 18 Nov 2009 15:05:54 +0100

Forearm bone loss is common in middle-aged women who lose weight, suggests research published in the journal Menopause. (Source: MedWire News - Bone Health)

Successful ACL reconstruction with a variant of the pes anserinus

Journal of Orthopaedics and Traumatology — Wed, 18 Nov 2009 09:28:52 +0100

Abstract An anatomical variant of the pes anserinus encountered during anterior cruciate ligament reconstructive surgery which has not been previously described is discussed. During routine harvesting, the sartorius fascia was incised and the semitendinosus and gracilis tendons were identified. At the distal portion, it was noted that each tendon gave off an additional tendinous slip. The slip from the semitendinosus tendon had attached to the gracilis tendon and vice versa, thereby creating a double pes anserinus. This variant was used to construct the graft, and at 1 year review the patient had returned to full sporting activities with no complications encountered. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s10195-009-0075-1Authors Shelain Patel...

Odontoid metastasis: a potential lethal complication

Journal of Orthopaedics and Traumatology — Wed, 18 Nov 2009 09:28:49 +0100

We describe a 40-year-old woman with a history of breast cancer who presented with neck and shoulder pain of 1 week duration with no neurological deficit. Following clinical examination, radiographs taken of the cervical spine was normal. Radiographs repeated 3 weeks later revealed a large lytic lesion of the odontoid occupying 70–80% of the peg. Further investigation including magnetic resonance imaging and bone scan showed no further spinal lesions. She underwent cyclical radiotherapy with complete resolution of the odontoid peg lesion and clinically was asymptomatic at 2 years. Metastatic lesions of the odontoid are atypical, and this case reinforces the necessity of early detection to evade disastrous consequences. Content Type Journal ArticleCategory Case Rep...

Pregabalin, celecoxib, and their combination for treatment of chronic low-back pain

Journal of Orthopaedics and Traumatology — Wed, 18 Nov 2009 09:28:48 +0100

Conclusions Combination of celecoxib and pregabalin is more effective than monotherapy for chronic low-back pain, with similar adverse effects. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10195-009-0077-zAuthors Carlo Luca Romanò, Istituto Ortopedico I.R.C.C.S. Galeazzi Via Riccardo Galeazzi, 4 20166 Milan ItalyDelia Romanò, Istituto Ortopedico I.R.C.C.S. Galeazzi Via Riccardo Galeazzi, 4 20166 Milan ItalyCristina Bonora, Istituto Ortopedico I.R.C.C.S. Galeazzi Via Riccardo Galeazzi, 4 20166 Milan ItalyGiuseppe Mineo, Università degli Studi di Milano Istituto Ortopedico I.R.C.C.S. Galeazzi Via Riccardo Galeazzi, 4 20166 Milan Italy Journal Journal of Orthopaedics and TraumatologyOnline ISSN 1590-9999Print ISSN 1590-9921 (Source: Journal ...

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Stem modularity alone is not effective in reducing dislocation rate in hip revision surgery

Journal of Orthopaedics and Traumatology — Wed, 18 Nov 2009 09:28:48 +0100

Conclusions The use of an increased-modularity revision stem alone did not prove to be effective in reducing the risk of postoperative dislocation. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10195-009-0076-0Authors Dario Regis, University School of Medicine Department of Orthopaedic Surgery Verona ItalyAndrea Sandri, University School of Medicine Department of Orthopaedic Surgery Verona ItalyPietro Bartolozzi, University School of Medicine Department of Orthopaedic Surgery Verona Italy Journal Journal of Orthopaedics and TraumatologyOnline ISSN 1590-9999Print ISSN 1590-9921 (Source: Journal of Orthopaedics and Traumatology)

Predictors of new vertebral endplate signal (Modic) changes in the general population

European Spine Journal — Wed, 18 Nov 2009 09:23:44 +0100

Abstract Vertebral endplate signal changes (VESC), also known as Modic changes, have been reported to be associated with low back pain (LBP). However, little is known about predisposing factors for the development of new VESC. The aim of this study was to investigate the predictive value of lifestyle factors and disc-related magnetic resonance imaging (MRI) findings in relation to the development of new VESC. This prospective observational study included 344 people from the Danish general population who had an MRI and completed LBP questionnaires at the age of 40 and again at 44 years. Potential predictors of new VESC were female gender, disc-related MRI findings (disc degeneration, disc bulges, disc herniation, and other endplate changes) and lifestyle factors [high ...

How do we define the condition ‘recurrent low back pain’? A systematic review

European Spine Journal — Wed, 18 Nov 2009 09:23:42 +0100

Abstract Recurrent low back pain (recurrent LBP) is a common condition, however, it is unclear if uniform definitions are used in studies investigating the prevalence and management of this condition. The aim of this systematic review was to identify how recurrent LBP is defined in the literature. A literature search was performed on MEDLINE, EMBASE, CINAHL, AMED, and PEDro. Studies were considered eligible if they investigated a cohort of subjects with recurrent LBP or if they were measuring the prevalence of recurrent LBP. Two independent reviewers assessed inclusion of studies and extracted definitions of recurrent LBP. Forty-three studies met the inclusion criteria. The majority of studies (63%) gave an explicit definition of recurrent LBP; however, the definitions var...

Last-Resort Lower-Body Amputation Effective In Extreme Cases Of Bone Infection

Bones / Orthopaedics News From Medical News Today — Wed, 18 Nov 2009 09:00:00 +0100

A landmark, 25-year review of cases in which surgeons had to remove the lower portion of the body from the waist down for severe pelvic bone infections shows the therapy can add years and quality of life to survivors, say researchers at UT Southwestern Medical Center. The rarely performed surgery is called a hemicorporectomy or translumbar amputation, and involves removing the entire body below the waist, including legs, pelvic bone and urinary system. (Source: Bones / Orthopaedics News From Medical News Today)

Acute non-displaced fractures of the scaphoid: earlier return to activities after operative treatment. A controlled multicenter cohort study

Archives of Orthopaedic and Trauma Surgery — Wed, 18 Nov 2009 00:07:48 +0100

Conclusion Operative treatment therefore primarily facilitates earlier return to previous activity level, as well as better functional status, less pain and higher patient satisfaction, yet conservative treatment seems to be safer and associated with a lower complication rate. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-1004-8Authors Michael Schädel-Höpfner, University Hospital Department of Trauma and Hand Surgery Moorenstrasse 5 40225 Düsseldorf GermanyMarta Marent-Huber, AO Clinical Investigation and Documentation Stettbachstrasse 6 8600 Dübendorf SwitzerlandEmre Gazyakan, University of Heidelberg Department of Hand, Plastic, and Reconstructive Surgery, Burn Center, BG Trauma Centre Ludwig-Guttmann-Strasse 13 67071 Ludwigshafe...

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Diagnostic imaging and unforeseen associated lesions in astragalo-scaphoid dislocation: a case report

Archives of Orthopaedic and Trauma Surgery — Wed, 18 Nov 2009 00:07:47 +0100

Abstract A case of an isolated astragalo-scaphoid dislocation following a fall from a motorbike is reported. Due to the diagnostic obscurity of the full extent of the injury, computed tomography (CT) with 3D reconstruction was utilized to precisely visualize the articular condition and revealed the presence of small intra-articular bone fragments and calcaneo-cuboid subluxation. Furthermore, the detailed imaging offered valuable information for preoperative planning. Patient has healed without sequelae. In light of the good outcome in this case, we suggest utilizing CT with 3D reconstruction when there is a risk to overlook foot dislocation and potential associated lesions. Content Type Journal ArticleCategory Trauma SurgeryDOI 10.1007/s00402-009-1003-9Authors Andrea E...

Passive navigation principle for orthopedic interventions with MR fluoroscopy

Archives of Orthopaedic and Trauma Surgery — Wed, 18 Nov 2009 00:07:47 +0100

Conclusion The MR-assisted retrograde drilling of osteochondral lesions may enable precise and safe treatment without radiation exposure. This passive navigation technique for MR fluoroscopy is potentially applicable for many orthopedic interventions and may present an alternative to other navigation methods. Especially, the treatment of pediatric and adolescent patients may benefit from the typical MRI properties. Content Type Journal ArticleCategory Basic ScienceDOI 10.1007/s00402-009-1006-6Authors Hermann J. Bail, Charité, Universitätsmedizin Berlin Center for Musculoskeletal Surgery Campus Virchow Klinikum, Augustenburgerplatz 1 13353 Berlin GermanyUlf K. M. Teichgräber, Charité, Universitätsmedizin Berlin Department of Radiology Campus Mitte, Charitéplatz ...

Fracture of the tibial bone block after posterior cruciate ligament allograft reconstruction using double cross pins

Archives of Orthopaedic and Trauma Surgery — Wed, 18 Nov 2009 00:07:47 +0100

We report the fracture of the tibial bone block after posterior cruciate ligament reconstruction using double cross pins for bone block fixation in the postoperative period. The possible reasons include the size of bone block, direction of cross pin or the quality of bone block. This case emphasizes the biomechanical properties and failure of modes of double cross pin. Content Type Journal ArticleCategory Arthroscopy and Sports MedicineDOI 10.1007/s00402-009-1005-7Authors Hong Chul Lim, Korea University College of Medicine, Guro Hospital Department of Orthopaedic Surgery 80 Guro-dong, Guro-gu Seoul 152-703 Republic of KoreaJi Hoon Bae, Korea University College of Medicine, Guro Hospital Department of Orthopaedic Surgery 80 Guro-dong, Guro-gu Seoul 152-703 Republic of KoreaJoon Ho Wa...

Arthroplasty: critical scientometric analysis of current benchmarking and evaluation procedures

Archives of Orthopaedic and Trauma Surgery — Wed, 18 Nov 2009 00:07:46 +0100

Content Type Journal ArticleCategory Letter to the EditorDOI 10.1007/s00402-009-1007-5Authors Norman Schöffel, Charité-Universitätsmedizin Berlin, Free University Berlin, Humboldt-University Berlin Department of Sports Medicine, The Institute of Occupational Medicine Thielallee 69-73 14195 Berlin GermanyMichael Spallek, Charité-Universitätsmedizin Berlin, Free University Berlin, Humboldt-University Berlin Department of Sports Medicine, The Institute of Occupational Medicine Thielallee 69-73 14195 Berlin GermanyCristian Scutaru, Charité-Universitätsmedizin Berlin, Free University Berlin, Humboldt-University Berlin Department of Sports Medicine, The Institute of Occupational Medicine Thielallee 69-73 14195 Berlin GermanyStefanie Mache, Charité-Universitätsmedizin Berlin, Free Un...

Evolution of open-wedge high-tibial osteotomy: experience with a special angular stable device for internal fixation without interposition material

International Orthopaedics — Wed, 18 Nov 2009 00:05:52 +0100

In conclusion, we believe that open-wedge high-tibial osteotomy using the TomoFix® plate has proved to be successful in treating unicompartmental gonarthrosis, even without bone grafts or bone-substitute material. Content Type Journal ArticleCategory Original PaperDOI 10.1007/s00264-009-0902-2Authors Alex E. Staubli, Orthopaedic Surgery, Privatklinik Sonnmatt Hemschlenstrasse 6000 Lucerne 15 SwitzerlandHilaire A. C. Jacob, Orthop. Biomechanics Gernstrasse 128 8409 Winterthur Switzerland Journal International OrthopaedicsOnline ISSN 1432-5195Print ISSN 0341-2695 (Source: International Orthopaedics)

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American Academy Of Orthopaedic Surgeons Wins Prestigious CLIO Award

Bones / Orthopaedics News From Medical News Today — Wed, 18 Nov 2009 00:00:00 +0100

The first-ever CLIO Healthcare Award - a new category of the internationally distinguished CLIO Awards -- has awarded the American Academy of Orthopaedic Surgeons (AAOS), a Silver CLIO for the Academy's year-long campaign "75 Years of Orthopaedic History. (Source: Bones / Orthopaedics News From Medical News Today)

High pressure may inhibit periprosthetic osteogenesis

Journal of Bone and Mineral Metabolism — Tue, 17 Nov 2009 23:58:22 +0100

Abstract Mechanical effects have been demonstrated to activate periprosthetic osteoclasts and hence to promote bone resorption. However, the periprosthetic mechanical effect on osteoblast function is not clearly understood. The purpose of this study was to explore whether the high pressure on bone caused by a prosthesis affects periprosthetic osteoblast function. We applied static pressure of various magnitudes to SV40-transfected human fetal osteoblast cells, then assayed bioactivities compared to cells cultured without pressure (control). The results showed that osteoblast proliferation, differentiation, apoptosis, necrosis, and mineralization were all sensitive to static pressure, and the effects were magnitude dependent. Low-level static pressure (20 kPa) enhanced ...

Treatment of osteoporosis: recognizing and managing cutaneous adverse reactions and drug-induced hypersensitivity

Osteoporosis International — Tue, 17 Nov 2009 23:47:01 +0100

Conclusion With early recognition and proper management, including immediate and permanent withdrawal of the culprit agent, accompanied by hospitalization and rehydration and systemic corticosteroids if necessary, the prognosis is good. Content Type Journal ArticleCategory ReviewDOI 10.1007/s00198-009-1097-5Authors P. Musette, Charles Nicolle University Hospital Department of Dermatology and INSERM Unit 905 Rouen FranceM. L. Brandi, University of Florence Department of Internal Medicine Florence ItalyP. Cacoub, AH-HP, Hôpital Pitié Salpétrière, and Université Pierre et Marie Curie Department of Internal Medicine Paris 6 Paris FranceJ. M. Kaufman, UZ Gent Department of Internal Medicine Ghent BelgiumR. Rizzoli, Geneva University Hospitals Geneva SwitzerlandJ.-Y. Re...

Effect of alendronate on bone metabolic indices and bone mineral density in patients treated with high-dose glucocorticoid: a prospective study

Osteoporosis International — Tue, 17 Nov 2009 23:47:01 +0100

Conclusion Alendronate was effective in suppressing bone resorption and subsequent BMD decrease at the lumbar spine in patients with high-dose GC treatment. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00198-009-1110-zAuthors H. Kaji, Kobe University Graduate School of Medicine Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine 7-5-2 Kusunoki-cho, Chuo-ku Kobe 650-0017 JapanY. Kuroki, Kobe Century Memorial Hospital Internal Medicine Kobe JapanY. Murakawa, Shimane University Faculty of Medicine Internal Medicine 3 Izumo JapanI. Funakawa, National Hyogo-Chuo Hospital Sanda JapanY. Funasaka, Kobe University Graduate School of Medicine Division of Dermatology 7-5-2 Kusunoki-cho, Chuo-ku Kobe 650-0017 JapanF. Kanda, Kobe...

Measurement uncertainty for the analysis of serum 25-hydroxyvitamin D

Osteoporosis International — Tue, 17 Nov 2009 23:47:01 +0100

Content Type Journal ArticleCategory Letter to the EditorDOI 10.1007/s00198-009-1099-3Authors H. C. M. Stepman, Ghent University Laboratory for Analytical Chemistry, Faculty of Pharmaceutical Sciences Harelbekestraat 72 9000 Ghent BelgiumL. M. Thienpont, Ghent University Laboratory for Analytical Chemistry, Faculty of Pharmaceutical Sciences Harelbekestraat 72 9000 Ghent Belgium Journal Osteoporosis InternationalOnline ISSN 1433-2965Print ISSN 0937-941X (Source: Osteoporosis International)

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Measurement uncertainty for the analysis of serum 25-hydroxyvitamin D: response to Stepman and Thienpont

Osteoporosis International — Tue, 17 Nov 2009 23:46:59 +0100

Content Type Journal ArticleCategory Letter to the EditorDOI 10.1007/s00198-009-1098-4Authors E. Cavalier, University Hospital of Liège Department of Clinical Chemistry, University of Liège Domaine du Sart-Tilman 4000 Liège BelgiumP. Delanaye, University Hospital of Liège Department of Nephrology, Dialysis and Hypertension, University of Liège Liège BelgiumC. Cormier, Hôpital Cochin Department of Rheumatology Paris FranceJ. C. Souberbielle, Hôpital Necker-Enfants Malades Laboratoire d’Explorations Fonctionnelles Paris France Journal Osteoporosis InternationalOnline ISSN 1433-2965Print ISSN 0937-941X (Source: Osteoporosis International)

Cross-sectional geometry of weight-bearing tibia in female athletes subjected to different exercise loadings

Osteoporosis International — Tue, 17 Nov 2009 23:46:59 +0100

Conclusions High-impact, odd-impact, and repetitive low-impact exercise loadings were associated with thicker cortex at the distal tibia. At the tibial shaft, impact loading was not only associated with thicker cortex, but also a larger cross-sectional area. High-magnitude exercise loading did not show such associations at either site but was comparable to repetitive non-impact loading and reference data. Collectively, the relevance of high strain rate together with moderate-to-high strain magnitude as major determinants of osteogenic loading of the weight-bearing tibia is implicated. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00198-009-1101-0Authors R. Nikander, UKK Institute for Health Promotion Research Bone Research Group Kaupinpuistonkatu...

Hepatitis C- and Human Immunodeficiency Virus-Induced Hypersensitivity Vasculitis

HSS Journal — Tue, 17 Nov 2009 23:39:57 +0100

Content Type Journal ArticleCategory Clinical Pathology ConferenceDOI 10.1007/s11420-009-9141-8Authors Roodabeh Michelle Koolaee, St. Luke’s–Roosevelt Hospital Center Department of Internal Medicine 1000 10th Avenue New York NY 10019 USAOra Singer, Hospital for Special Surgery Department of Rheumatology 535 East 70th Street New York NY 10021 USAAnne Bass, Hospital for Special Surgery Department of Rheumatology 535 East 70th Street New York NY 10021 USARobert Winchester, Columbia University New York Presbyterian Hospital Department of Rheumatology 630 West 168th Street New York NY 10032 USASurya Seshan, Weill-Cornell New York Presbyterian Hospital Department of Pathology 546 East 68th Street New York NY 10021 USADoruk Erkan, Hospital for Special Surgery Department of Rheumatology 53...

Musculoskeletal Complications of Hemophilia

HSS Journal — Tue, 17 Nov 2009 23:39:56 +0100

Abstract The most important clinical strategy for management of patients with hemophilia is the avoidance of recurrent hemarthroses by means of continuous, intravenous hematological prophylaxis. When only intravenous on-demand hematological treatment is available, frequent evaluations are necessary for the early diagnosis and treatment of episodes of intra-articular bleeding. The natural history of the disease in patients with poorly controlled intra-articular bleeding is the development of chronic synovitis and, later, multi-articular hemophilic arthropathy. Once arthropathy develops, the functional prognosis is poor. Treatment of these patients should be conducted through a comprehensive program by a multidisciplinary hemophilia unit. Although continuous prophylaxis can ...

Presence of a Deletion Mutation (c.716delA) in the Ligand Binding Domain of the Vitamin D Receptor in an Indian Patient with Vitamin D-Dependent Rickets Type II

Calcified Tissue International — Tue, 17 Nov 2009 23:39:07 +0100

Abstract Vitamin D-dependent rickets type II (VDDR-type II) is a rare disorder caused by mutations in the vitamin D receptor (VDR) gene. Here, we describe a patient with VDDR-type II with severe alopecia and rickets. She had hypocalcemia, hypophosphatemia, secondary hyperparathyroidism, and elevated serum alkaline phosphatase and 1,25-dihydroxyvitamin D3. Sequence analysis of the lymphocyte VDR cDNA revealed deletion mutation c.716delA. Sequence analysis of her genomic DNA fragment amplified from exon 6 of the VDR gene incorporating this mutation confirmed the presence of the mutation in homozygous form. This frameshift mutation in the ligand binding domain (LBD) resulted in premature termination (p.Lys240Argfs) of the VDR protein. The mutant protein contained 246 amino aci...

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Cytokine Receptor-Like Factor 1 is Highly Expressed in Damaged Human Knee Osteoarthritic Cartilage and Involved in Osteoarthritis Downstream of TGF-β

Calcified Tissue International — Tue, 17 Nov 2009 23:39:05 +0100

Abstract Osteoarthritis (OA) is the most prevalent joint disease and is characterized by pain and functional loss of the joint. However, the pathogenic mechanism of OA remains unclear, and no drug therapy for preventing its progress has been established. To identify genes related to the progress of OA, the gene expression profiles of paired intact and damaged cartilage obtained from OA patients undergoing joint substitution were compared using oligo microarrays. Using functional categorization combined with gene ontology and a statistical analysis, five genes were found to be highly expressed in damaged cartilage (HBEGF, ASUS, CRLF1, LOX, CDA), whereas three genes were highly expressed in intact tissues (CHST2, PTPRD, CPAN6). Among these genes, the upregulated expression of ...

MicroRNA mutation causes rare form of primary osteoporosis

MedWire News - Bone Health — Tue, 17 Nov 2009 14:59:02 +0100

Chinese scientists have identified a micro RNA mutation that plays a key role in primary osteoporosis by promoting osteoblast differentiation. (Source: MedWire News - Bone Health)

Biographical Sketch: Virgil Pendelton Gibney, MD, 1847-1927.

Clinical Orthopaedics and Related Research — Tue, 17 Nov 2009 00:00:00 +0100

Authors: Brand RA This biographical sketch on Virgil Pendelton Gibney corresponds to the historic text, The Classic: Chapter XVIII. Operative Treatment in Chronic Articular Ostitis, available at DOI 10.1007/s11999-009-1165-3 . PMID: 19921344 [PubMed - as supplied by publisher] (Source: Clinical Orthopaedics and Related Research)

P Value and the Theory of Hypothesis Testing: An Explanation for New Researchers.

Clinical Orthopaedics and Related Research — Tue, 17 Nov 2009 00:00:00 +0100

Authors: Biau DJ, Jolles BM, Porcher R In the 1920s, Ronald Fisher developed the theory behind the p value and Jerzy Neyman and Egon Pearson developed the theory of hypothesis testing. These distinct theories have provided researchers important quantitative tools to confirm or refute their hypotheses. The p value is the probability to obtain an effect equal to or more extreme than the one observed presuming the null hypothesis of no effect is true; it gives researchers a measure of the strength of evidence against the null hypothesis. As commonly used, investigators will select a threshold p value below which they will reject the null hypothesis. The theory of hypothesis testing allows researchers to reject a null hypothesis in favor of an alternative hypothesis of some effect. As comm...

Protocol for the ProFHER (PROximal Fracture of the Humerus: Evaluation by Randomisation) trial: a pragmatic multi-centre randomised controlled trial of surgical versus non-surgical treatment for proximal fracture of the humerus in adults

BMC Musculoskeletal Disorders — Mon, 16 Nov 2009 00:00:00 +0100

This article presents the protocol for a multi-centre randomised controlled trial. It gives extensive details of, and the basis for, the chosen methods, and describes the key measures taken to avoid bias and to ensure validity.Trial RegistrationCurrent Controlled Trials ISRCTN50850043 (Source: BMC Musculoskeletal Disorders)

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Subaxial cervical pedicle screw insertion with newly defined entry point and trajectory: accuracy evaluation in cadavers

European Spine Journal — Sat, 14 Nov 2009 20:38:34 +0100

In conclusion, high success rate of subaxial cervical pedicle screw placement can be achieved using the recently proposed operative guideline and oblique views of fluoroscopy. However, careful preoperative planning and good surgical skills are still required to ensure screw placement accuracy and to reduce the risk of neural and vascular injury. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00586-009-1213-4Authors Xiujun Zheng, Foundation for the Advancement of Spine Knowledge 913 E 26th St, Piper Building, Suite 600 Minneapolis MN 55404 USARahul Chaudhari, Twin Cities Spine Center 913 E 26th St, Piper Building, Suite 600 Minneapolis MN 55404 USAChunhui Wu, Foundation for the Advancement of Spine Knowledge 913 E 26th St, Piper Building, Suite 600 Minneapolis MN ...

Paediatric forearm and distal radius fractures: risk factors and re-displacement—role of casting indices

International Orthopaedics — Sat, 14 Nov 2009 20:37:53 +0100

Abstract Forearm fractures represent one of the most common fractures in children aside from clavicle fractures, and the distal radius is the most common fracture site accounting for 20–30% of these fractures. Maintaining acceptable reduction is not always possible, and re-displacement or re-angulation is the most commonly reported complication. Factors leading to this complication can be broadly divided into three groups: fracture-, surgeon- and patient-related. The quality of casting has been historically measured subjectively. The description of several casting indices by different authors has been a major undertaking, attempting to address objective assessment of this factor. The following have been described: cast index, padding index, gap index, three point index a...

Hip fracture surgery beneficial for all ages

MedWire News - Bone Health — Sat, 14 Nov 2009 14:54:51 +0100

Hip fracture surgery is feasible even in very elderly individuals with serious comorbidities, study findings from Canada suggest. (Source: MedWire News - Bone Health)

Biology and Clinical Significance of Tartrate-Resistant Acid Phosphatases: New Perspectives on an Old Enzyme

Calcified Tissue International — Sat, 14 Nov 2009 06:58:49 +0100

Abstract Type 5 tartrate-resistant acid phosphatase (TRAP) has been a clinically relevant biomarker for about 50 years. It has always been a reliable and specific cytochemical marker for hairy cell leukemia and for differentiated cells of monocytic lineage. Only recently has the test for serum TRAP activity been accepted as sensitive and specific enough for clinical use as a marker of osteoclasts and bone resorption. This has come about through steady advances in knowledge about TRAP enzymology, structure, function, and molecular regulation and a consequent appreciation that TRAP isoforms 5a and 5b have very different clinical significance. As a measure of osteoclast number and bone resorption, TRAP 5b has diagnostic and prognostic applications in osteoporosis, cancer...

Is ultrasound screening for DDH in babies born breech sufficient?

Journal of Children's Orthopaedics — Sat, 14 Nov 2009 06:55:03 +0100

Conclusions Retrospectively, we found that, at approximately 6 weeks of age, ultrasound screening of breech patients with clinically stable hips produces an incidence of DDH of 27%. In those patients with a normal ultrasound, 29%, at 4–6 months radiographic follow-up, were found to have dysplasia requiring treatment. This data supports breech as the most important risk factor for hip dysplasia and we, therefore, recommend careful and longitudinal evaluation of these patients with: a careful newborn physical examination, an ultrasound at age 6 weeks, and an anteroposterior (AP) pelvis and frog lateral radiograph at 6 months, as the risk of subsequent dysplasia is too high to discharge patients after a normal ultrasound. Content Type Journal Artic...

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The resident’s ridge as an arthroscopic landmark for anatomical femoral tunnel drilling in ACL reconstruction

Knee Surgery, Sports Traumatology, Arthroscopy — Sat, 14 Nov 2009 06:53:34 +0100

Abstract The purposes of this study were to establish the technique to arthroscopically identify the resident’s ridge without bony notchplasty even in patients with chronic ACL insufficiency and to elucidate if the ridge could be used as a landmark for anatomical femoral tunnel for ACL graft. There were 50 consecutive patients undergoing arthroscopic ACL reconstruction. With the thigh kept horizontal using a leg holder, a meticulous effort was made to find out a linear ridge running proximo-distal in a posterior one-third of the lateral notch wall, after removal of superficial soft tissue with radiofrequency energy. If the ridge was found, a socket with a rectangular aperture of 5 × 10 mm was created just behind the ridge. At 3–4-weeks post surgery, thr...

Changes in ACL length at different knee flexion angles: an in vivo biomechanical study

Knee Surgery, Sports Traumatology, Arthroscopy — Sat, 14 Nov 2009 06:53:33 +0100

Abstract Recently, there has been a tremendous impetus on anatomical reconstruction of the anterior cruciate ligament (ACL), and the double-bundle reconstruction concept has been advocated by many authors. It is, therefore, important to understand how the lengths of the two bundles of the ACL vary during different knee flexion angles as this could influence the angle of graft fixation during surgery. The aim of this study is to determine the change in length of the ACL bundles during different knee flexion angles. Ten subjects with normal knees were evaluated. A high-resolution computer tomography scan was performed, and 3D knee images were obtained. These images were then imported to customized software, and digital length measurement of four virtual bundles (anatomical s...

Peroneal nerve damage by bicortical tibial screw in ACL reconstruction

Knee Surgery, Sports Traumatology, Arthroscopy — Sat, 14 Nov 2009 06:53:32 +0100

Abstract Arthroscopically assisted anterior cruciate ligament reconstruction is regarded as a minimally invasive surgery with low morbidity but complications still occur. Reports of neurovascular injuries related to graft harvesting, tunnel placement, or graft fixation are limited. A rare case of peroneal nerve injury related to hardware used for graft fixation in the tibial in a 28-year-old female patient who underwent an anterior cruciate ligament reconstruction surgery using a patellar tendon graft (bone-tendon-bone graft) is presented. Post-operatively, the patient presented with clinical signs of peroneal nerve damage and a reduced range of motion of the knee. Plain radiographs of the knee showed the bicortical screw which used for tibial fixation of the graft, penetr...

ACL prosthesis: any promise for the future?

Knee Surgery, Sports Traumatology, Arthroscopy — Sat, 14 Nov 2009 06:53:28 +0100

This article provides a review of the history of the use of prosthetics with respect to ACL reconstruction grafts including Carbon Fibre, Gore-Tex and Dacron prosthetics, as well as the Leeds-Keio Artificial Ligament and the Kennedy Ligament Augmentation Device (LAD). Emphasis is placed on the ligament advanced reinforcement system (LARS) as preliminary investigations of its use have been encouraging. Significant progress has been made recently with respect to the understanding of ACL anatomy, composition, biomechanics, and healing processes, leading to innovative techniques using approaches based in tissue engineering principles. Most of grafts that have been developed to date have failed due to unsatisfactory long-term physiological and functional performance. Most permanent ACL p...

[Rehabilitation and prosthetic fitting in patients suffering from diabetic foot syndrome.]

Der Orthopade — Sat, 14 Nov 2009 00:00:00 +0100

Authors: Greitemann B Rehabilitation of patients suffering from diabetic foot syndrome requires a holistic team approach. Besides the treatment of the local problems the treatment of the basic disease with education, correct nutrition and best possible drug treatment is of importance to prevent subsequent complications. A diabetic foot schooling is of importance to prevent secondary ulcers. Correct wound care with broad knowledge of wound healing stages, a variety of wound dressings and skilled knowledge in prosthetic and orthopedic shoe fitting plays a predominant role. The treatment is completed by physiotherapeutic gait training including the correction of gait deviations, psychological support and proper care. PMID: 19911165 [PubMed - as supplied by publisher] (Source: Der Orth...

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The Geometry of the Trochlear Groove.

Clinical Orthopaedics and Related Research — Sat, 14 Nov 2009 00:00:00 +0100

CONCLUSIONS: Our study shows the importance of reliable femoral orientation when reporting the shape of the trochlear groove. PMID: 19915941 [PubMed - as supplied by publisher] (Source: Clinical Orthopaedics and Related Research)

Altered lumbar spine structure, biochemistry, and biomechanical properties in a canine model of mucopolysaccharidosis type VII

Journal of Orthopaedic Research — Sat, 14 Nov 2009 00:00:00 +0100

The objective of this study was to examine potential associations between abnormal lumbar spine matrix structure and composition in MPS VII, and spine segment and tissue-level mechanical properties, using a naturally occurring canine model with a similar clinical phenotype to the human form of the disorder. Segments from juvenile MPS VII and unaffected dogs were allocated to: radiography, gross morphology, histology, biochemistry, and mechanical testing. MPS VII spines had radiolucent lesions in the vertebral body epiphyses. Histologically, this corresponded to a GAG-rich cartilaginous region in place of bone and elevated GAG staining was seen in the annulus fibrosus. Biochemically, MPS VII samples had elevated GAG in the outer annulus fibrosus and epiphyses, low calcium in the epiphyses, ...

Cerebrospinal fluid leakage and pneumocephalus secondary to spine stab wounds

Journal of Orthopaedics and Traumatology — Fri, 13 Nov 2009 18:27:36 +0100

We describe two cases of spinal stab wounds complicated by cerebro-spinal fluid leakage, one of them developing into severe pneumocephalus. Both patients recovered completely with the following treatment protocol: (a) trendelenburg positioning of the patient, (b) insertion of a continuous-drainage cerebro-spinal fluid catheter into the lumbar thecal sac, (c) primary suture of the leaking skin wound, (d) IV antibiotic therapy. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s10195-009-0070-6Authors Nimrod Rahamimov, Western Galilee Hospital Spine Surgery Unit P.O. Box 21 Naharia 22100 IsraelHani Mulla, Western Galilee Hospital Spine Surgery Unit P.O. Box 21 Naharia 22100 IsraelShay Freiman, Western Galilee Hospital Spine Surgery Unit P.O. Box 21 Naharia 22100 Israel ...

Abstracts of the 23rd National Congress on Spinal Surgery

European Spine Journal — Fri, 13 Nov 2009 18:22:45 +0100

Content Type Journal ArticleCategory AbstractsDOI 10.1007/s00586-009-1206-3 Journal European Spine JournalOnline ISSN 1432-0932Print ISSN 0940-6719 (Source: European Spine Journal)

Should We Screen Low Risk Patients for Methicillin Resistant Staphylococcus Aureus?

Medscape Orthopaedics Headlines — Fri, 13 Nov 2009 17:00:00 +0100

Since April 2009, all patients electively admitted to English hospitals must be screened for MRSA. Is universal screening effective? BMJ (Clinical research ed.) (Source: Medscape Orthopaedics Headlines)

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Study Provides First Clear Idea Of How Rare Bone Disease Progresses

Bones / Orthopaedics News From Medical News Today — Fri, 13 Nov 2009 09:00:00 +0100

An international team of scientists, led by researchers at the University of Pennsylvania School of Medicine, is taking the first step in developing a treatment for a rare genetic disorder called fibrodysplasia ossificans progressiva (FOP), in which the body's skeletal muscles and soft connective tissue turns to bone, immobilizing patients over a lifetime with a second skeleton. (Source: Bones / Orthopaedics News From Medical News Today)

Local Soft Tissue Compression Enhances Fracture Healing in a Rabbit Fibula

HSS Journal — Fri, 13 Nov 2009 07:47:38 +0100

We report a preliminary study assessing the relationship between constant soft tissue compression and enhanced fracture healing in an osteotomy model designed to minimize confounding variables. Fibulae of nine New Zealand white rabbits were bilaterally osteotomized, openly stabilized, and fitted with spandex stockinets. Soft tissue at the osteotomy site was unilaterally compressed using a deforming element (load = 26 mmHg). The contralateral side was saved as the control and was not compressed. Osteotomies were monitored with weekly radiographs. All fibulae in both groups were healed 6 weeks postoperatively. Micro-CT analysis of bone mineral density (BMD) and bone volume (BV) was then performed on both the experimental and control sides. Radiographic measurement of tran...

Microarchitecture of the Radial Head and Its Changes in Aging

Calcified Tissue International — Fri, 13 Nov 2009 07:47:17 +0100

Abstract Fractures of the radial head are common; however, it remains to be determined whether the radial head has to be considered as a typical location for fractures associated with osteoporosis. To investigate whether the human radial head shows structural changes during aging, we analyzed 30 left and 30 right human radial heads taken from 30 individuals. The specimens taken from the left side were analyzed by peripheral quantitative computed tomography (pQCT) and micro-CT. The specimens taken from the right elbow joint were analyzed by radiography and histomorphometry. In these specimens pQCT revealed a significant decrease of total and cortical bone mineral density (BMDto BMDco) with aging, regardless of sex. Histomorphometry revealed a significant reduction of cortica...

Lateral shelf acetabuloplasty in the treatment of Legg–Calvé–Perthes disease: improving mid-term outcome in severely deformed hips

Journal of Children's Orthopaedics — Fri, 13 Nov 2009 07:44:52 +0100

Conclusion Lateral shelf acetabuloplasty improves the outcome of hips with severe LCP. The combined procedure insures a better and lasting coverage and remodeling of the femoral head, while preserving acetabular roof growth. Content Type Journal ArticleCategory Original Clinical ArticleDOI 10.1007/s11832-009-0216-3Authors Ismat Ghanem, Saint Joseph University Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital Achrafieh, Beirut LebanonElias Haddad, Saint Joseph University Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital Achrafieh, Beirut LebanonRachid Haidar, American University of Beirut Medical Center Department of Orthopaedic Surgery Beirut LebanonSuha Haddad-Zebouni, Saint Joseph University Department of Radiology, Hôtel-Dieu de Fran...

The use of 2-octylcyanoacrylate (Dermabond®) for the treatment of nail bed injuries in children: results of a prospective series of 30 patients

Journal of Children's Orthopaedics — Fri, 13 Nov 2009 07:44:50 +0100

Conclusions In the OCA technique, meticulous primary detersion and exact anatomic positioning of the damaged nail bed is mandatory before applying the cyanoacrylate adhesive. In our experience, we found that the OCA technique provided a fast and safe result in nail bed lesions. The final cosmetic appearance, function and patient satisfaction were good in our series. In these lesions, discomfort and inconvenience associated with suture removal could be avoided by the use of OCA. Content Type Journal ArticleCategory Original Clinical ArticleDOI 10.1007/s11832-009-0218-1Authors Jean Langlois, Pierre and Marie Curie Paris 6 University, Armand Trousseau Hospital Department of Paediatric Orthopaedics 26 avenue du Dr. Arnold Netter 75571 Paris Cedex 12 FranceCamille Theveni...

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Unmet Needs and Waiting List Prioritization for Knee Arthroplasty.

Clinical Orthopaedics and Related Research — Fri, 13 Nov 2009 00:00:00 +0100

CONCLUSIONS: The data suggested the prioritization system was more beneficial than assigning surgery by waiting time only. The 5-year projection of the volume of unmet needs for knee arthroplasty remained stable, despite the increase in the need for contralateral knee arthroplasty. LEVEL OF EVIDENCE: Level II, economic and decision analyses. See Guidelines for Authors for a complete description of levels of evidence. PMID: 19911242 [PubMed - as supplied by publisher] (Source: Clinical Orthopaedics and Related Research)

Prevalence and Predictors of Osteoporosis Risk in Orthopaedic Patients.

Clinical Orthopaedics and Related Research — Fri, 13 Nov 2009 00:00:00 +0100

CONCLUSIONS: Low bone mineral density is common among orthopaedic outpatients. Age, female gender, smoking, wrist fractures, and spinal deformities are independent risk factors for osteoporosis. We present a probability model designed to assist orthopaedic surgeons in identifying high-risk patients and initiating adequate preventative measures. LEVEL OF EVIDENCE: Level I, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence. PMID: 19911243 [PubMed - as supplied by publisher] (Source: Clinical Orthopaedics and Related Research)

Does the Taylor Spatial Frame Accurately Correct Tibial Deformities?

Clinical Orthopaedics and Related Research — Fri, 13 Nov 2009 00:00:00 +0100

CONCLUSIONS: Gradual correction of all tibial deformities with the TSF was accurate and with few complications. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID: 19911244 [PubMed - as supplied by publisher] (Source: Clinical Orthopaedics and Related Research)

Minimally Invasive Subvastus Approach: Improving the Results of Total Knee Arthroplasty: A Prospective, Randomized Trial.

Clinical Orthopaedics and Related Research — Fri, 13 Nov 2009 00:00:00 +0100

CONCLUSIONS: The minimally invasive subvastus approach can result in improved long-term Knee Society scores and range of motion of total knee arthroplasty without increased risk of component malalignment, surgical time, or complication rate. LEVEL OF EVIDENCE: Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. PMID: 19911245 [PubMed - as supplied by publisher] (Source: Clinical Orthopaedics and Related Research)

Papers Presented at the Hip Society Meetings 2009: Editorial Comment.

Clinical Orthopaedics and Related Research — Fri, 13 Nov 2009 00:00:00 +0100

Authors: Hanssen AD PMID: 19911246 [PubMed - as supplied by publisher] (Source: Clinical Orthopaedics and Related Research)

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Recombinant human bone morphogenetic protein-7 enhances fracture healing in an ischemic environment

Journal of Orthopaedic Research — Fri, 13 Nov 2009 00:00:00 +0100

In conclusion, our results indicate that rhBMP7 is a promising treatment for fractures with severely disrupted blood supply. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res (Source: Journal of Orthopaedic Research)

Influence of bone-derived matrices on generation of bone in an ectopic rat model

Journal of Orthopaedic Research — Fri, 13 Nov 2009 00:00:00 +0100

In conclusion, organic components of bone are needed for marrow-directed osteogenesis. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res (Source: Journal of Orthopaedic Research)

Mechanobiological response of tendon stem cells: Implications of tendon homeostasis and pathogenesis of tendinopathy

Journal of Orthopaedic Research — Fri, 13 Nov 2009 00:00:00 +0100

Tendons are constantly subjected to mechanical loading in vivo. Recently, stem cells were identified in human, mouse, and rabbit tendons, but the mechanobiological responses of tendon stem cells (TSCs) are still undefined. Using an in vitro system capable of mimicking in vivo loading conditions, it was determined that mechanical stretching increased TSC proliferation in a stretching magnitude-dependent manner. Moreover, low mechanical stretching at 4% ("clamp-to-clamp" engineering strain) promoted differentiation of TSCs into tenocytes, whereas large stretching at 8% induced differentiation of some TSCs into adipogenic, chondrogenic, and osteogenic lineages, as indicated by upregulated expression of marker genes for adipocytes, chondrocytes, and osteocytes. Thus, low mechanical stretching ...

Lack of quadriceps dysfunction in women with early knee osteoarthritis

Journal of Orthopaedic Research — Fri, 13 Nov 2009 00:00:00 +0100

Quadriceps dysfunction, specifically weakness and central activation failure (CAF), has been implicated in the development and progression of knee osteoarthritis (OA), though few data are available to confirm its presence in early OA. The purpose of this study was to determine the presence and magnitude of quadriceps dysfunction in those with and without early knee OA. Thirty-five female volunteers were classified into two groups, OA (n = 22) and control (n = 13), based on the presence [Kellgren-Lawrence (K-L) grade 2] or absence (K-L grade 0-1) of mild OA, respectively. Isometric quadriceps strength and central activation ratio (CAR) were assessed and compared between groups utilizing a one-way ANOVA. Frequency statistics and Fisher's exact test were used to compare the percentage of wome...

Comparative study of carpal tunnel compliance in the human, dog, rabbit, and rat

Journal of Orthopaedic Research — Fri, 13 Nov 2009 00:00:00 +0100

The purpose of this study was to measure the compliance of the carpal tunnel in candidate animal models of carpal tunnel syndrome (CTS), by measuring the resistance when passing a tapered metal rod through the carpal tunnel. Forepaws from 10 dogs, 10 rabbits, and 10 rats with intact carpal tunnels, and 10 fresh frozen human wrist cadavers were used. The slopes of the linear part of the force-displacement curve (a measure of stiffness), normal force, and increasing area ratio (InAR) were significantly different among the four species (p < 0.05). Post hoc analysis indicated that the mean slopes for the human carpal tunnel were the largest, indicating the least compliance, whereas those of the rat were the least (p < 0.05). The features of the compliance for the dog carpal tunnel were closest...

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Repair of large osteochondral defects in rabbits using porous hydroxyapatite/collagen (HAp/Col) and fibroblast growth factor-2 (FGF-2)

Journal of Orthopaedic Research — Fri, 13 Nov 2009 00:00:00 +0100

This article reports the development of a porous hydroxyapatite/collagen (HAp/Col) scaffold as a bone void filler and a vehicle for drug administration. The scaffold consists of HAp nanocrystals and type I atelocollagen. The purpose of this study was to investigate the efficacy of porous HAp/Col impregnated with FGF-2 to repair large osteochondral defects in a rabbit model. Ninety-six cylindrical osteochondral defects 5 mm in diameter and 5 mm in depth were created in the femoral trochlear groove of the right knee. Animals were assigned to one of four treatment groups: porous HAp/Col impregnated with 50 µl of FGF-2 at a concentration of 10 or 100 µg/ml (FGF10 or FGF100 group); porous HAp/Col with 50 µl of PBS (HAp/Col group); and no implantation (defect group). The defect areas were exa...

[Preserving foot surgery for diabetics.]

Der Orthopade — Fri, 13 Nov 2009 00:00:00 +0100

Authors: Müller S, Wenz W The reconstruction of a diabetic foot is still a challenge for the orthopedic surgeon. Untreated fractures, dislocations and foot and ankle deformities with consequent ulcerations may increase the risk of limb amputation. For patients who refuse a major amputation a surgical reconstruction can be started using bone grafts, angle stable locking plates and ankle arthrodesis nails. The goal of reconstruction in all patients is to avoid amputation. PMID: 19908026 [PubMed - as supplied by publisher] (Source: Der Orthopade)

Expectations, perceptions, and physiotherapy predict prolonged sick leave in subacute low back pain

BMC Musculoskeletal Disorders — Fri, 13 Nov 2009 00:00:00 +0100

Conclusions: It appears that return to work is highly dependant on individual and cognitive factors. Patients not returning to work after the interventions were characterized by negative expectations, perceptions about pain and disability, and previous physiotherapy treatment. This is the first study reporting that previous treatment by physiotherapists is a risk factor for long-term sick leave. This has not been reported before and is an interesting finding that deserves more scrutiny. (Source: BMC Musculoskeletal Disorders)

Expression of TRAIL and death receptor DR4 in Palmer type 2 TFCC lesions

Archives of Orthopaedic and Trauma Surgery — Thu, 12 Nov 2009 18:38:30 +0100

Conclusion This is the first study that shows that TFCC cells express TRAIL and DR4, which suggests that apoptosis, as well as, mechanical trauma are involved in the development of disc perforation. The TRAIL/DR4 receptor system is a molecular mediator of apoptosis induction in TFC cells and therefore plays a role in cell loss in degenerative disc lesions. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-0988-4Authors Frank Unglaub, University Erlangen Department of Plastic and Hand Surgery Krankenhausstrasse 12 91054 Erlangen GermanySusanne B. Thomas, University Erlangen Department of Plastic and Hand Surgery Krankenhausstrasse 12 91054 Erlangen GermanyMarkus W. Kroeber, Kantonsspital St. Gallen Department of Orthopaedic Surgery St. Gall...

Muscle activity unaltered by jaw osteoporosis

MedWire News - Bone Health — Thu, 12 Nov 2009 15:05:03 +0100

Osteoporosis of the jaw does not significantly alter muscle activity when chewing, suggest the results of an electromyographic study. (Source: MedWire News - Bone Health)

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[Preventive measures and organization of a regional shared-care system for foot treatment.]

Der Orthopade — Thu, 12 Nov 2009 00:00:00 +0100

Authors: Zink K, Haak T A shared-care system should be established to treat diabetic foot wounds. This means including different professions and institutions to optimize the treatment of these patients in respect of medical, psychological and social aspects. This procedure is very well described in the national guidelines of treatment of type 2 diabetes to prevent and treat diabetic foot complications. In the treatment of the diabetic foot syndrome the establishment of such a shared-care system has to recognize the wound classification and the underlying risk of patients. In this article the stage-adjusted approach and the duties of the different levels of responsibility are described. PMID: 19908025 [PubMed - as supplied by publisher] (Source: Der Orthopade)

Tonsillar ectopia in adolescent idiopathic scoliosis: does it play a role in the pathogenesis and prognosis or is it only an incidental finding?

Scoliosis — Thu, 12 Nov 2009 00:00:00 +0100

Conclusion: As tonsillar ectopia is significantly more frequent among patients with AIS and may exhibit some prognostic utility in patients with neurological deficit, we conclude that tonsillar ectopia may play a role in the development of the deformity in some patients with AIS. However, occurrence of tonsillar ectopia among 13 % of controls precludes stating a definitive role of ectopia in the pathogenesis of AIS. Some patients with AIS, tonsillar ectopia and neurological deficit showed neurological improvement following the surgical correction of scoliosis. (Source: Scoliosis)

Time-course of exercise and its association with 12-month bone changes

BMC Musculoskeletal Disorders — Thu, 12 Nov 2009 00:00:00 +0100

Background: Exercise has been shown to have positive effects on bone density and strength. However, knowledge of the time-course of exercise and bone changes is scarce due to lack of methods to quantify and qualify daily physical activity in long-term. The aim was to evaluate the association between exercise intensity at 3, 6 and 12 month intervals and 12-month changes in upper femur areal bone mineral density (aBMD) and mid-femur geometry in healthy premenopausal women. Methods: Physical activity was continuously assessed with a waist-worn accelerometer in 35 healthy women (35-40 years) participating in progressive high-impact training. To describe exercise intensity, individual average daily numbers of impacts were calculated at five acceleration levels (range 0.3-9.2g) during time inter...

Age has greatest impact on women’s hip fracture risk

MedWire News - Bone Health — Wed, 11 Nov 2009 15:04:52 +0100

Research shows that women experience a sharp rise in their risk for hip fracture between their sixth and eight decades, regardless of menopausal factors. (Source: MedWire News - Bone Health)

Carb Intake Does Not Curb High Altitude Muscle Loss

Medscape Orthopaedics Headlines — Wed, 11 Nov 2009 13:33:23 +0100

Dietary carbohydrate supplementation fails to reduce muscle loss at high altitude, UK researchers report following a medical expedition to the Himalayas. Reuters Health Information (Source: Medscape Orthopaedics Headlines)

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Zosano Pharma, Inc. Announces Publication Of Positive Phase 2 Study Of Its ZP-PTH Patch For Osteoporosis Therapy

Bones / Orthopaedics News From Medical News Today — Wed, 11 Nov 2009 09:00:00 +0100

Zosano Pharma, Inc., a privately held pharmaceutical company developing products using a novel transdermal delivery technology, announced publication in the current issue of the Journal of Clinical Endocrinology and Metabolism of results from a positive phase 2 study of its rapid-delivery transdermal patch (ZP-PTH) for the treatment of postmenopausal osteoporosis. The study by authors Felicia Cosman, Nancy E. Lane, Michael A. Bolognese, Jose R. Zanchetta, Pedro A. (Source: Bones / Orthopaedics News From Medical News Today)

Does computer-assisted surgery benefit leg length restoration in total hip replacement? Navigation versus conventional freehand

International Orthopaedics — Wed, 11 Nov 2009 07:05:32 +0100

Abstract Leg length discrepancy following total hip replacement (THR) can contribute to poor hip function. Abnormal gait, pain, neurological disturbance and patient dissatisfaction have all been described as a result of leg length inequality after THR. The purpose of this study was to determine whether the use of computer navigation in THR can improve limb length restoration and early clinical outcomes. We performed a matched-pair study comparing 48 computer-assisted THR with 48 THRs performed using a traditional freehand alignment method. The same implant with a straight non-modular femoral stem was used in all cases. The navigation system used allowed the surgeon to monitor both acetabular cup placement and all the phases of femoral stem implantation including rasping. P...

Hip fracture risk highlighted in heart failure patients

MedWire News - Bone Health — Wed, 11 Nov 2009 00:00:00 +0100

Patients with heart failure are twice as likely to experience hip fracture as those without, with hip fracture representing a significant cause of mortality in this group, US researchers have found. (Source: MedWire News - Bone Health)

[Kyphoplasty in osteoporotic spinal fractures.]

Der Unfallchirurg — Wed, 11 Nov 2009 00:00:00 +0100

Authors: Prokop A, Löhlein F, Chmilniecki M, Volbracht J, Manner M Kyphoplasty has been the standard procedure for osteoporotic fractures for more than 5 years but the material costs are still very high. The aim of this study was to clarify whether pain reduction could be achieved without increasing the rate of new fractures and also in what areas costs could possibly be reduced. From 15.01.2007 until 15.01.2008, a total of 100 patients with 126 recent osteoporotic spinal fractures were treated by kyphoplasty with an average operation time of 38 min and follow-up times up to 12 months. During this follow-up period 15 lateral and 2 dorsal cement leakages remained asymptomatic and 1 dorsal leakage caused an incomplete paraparesis, which was finally cured completely. All patients wer...

Scoliosis in Pediatric Patients: Comorbid Disorders and Screening

Medscape Orthopaedics Headlines — Tue, 10 Nov 2009 17:00:00 +0100

This article is a guide to screening for comorbid conditions when scoliosis is encountered in a child or adolescent. Pediatric Health (Source: Medscape Orthopaedics Headlines)

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Vascular Remodeling in Response to 12 Wk of Upper Arm Unilateral Resistance Training

Medscape Orthopaedics Headlines — Tue, 10 Nov 2009 17:00:00 +0100

Does resistance training of the nondominant arm elicit an increase in diameter of the brachial artery? Does unilateral training induce arterial remodeling in the contralateral arm? Medicine and Science in Sports and Exercise® (Source: Medscape Orthopaedics Headlines)

Cytokinetics Announces Advancement Of CK-2017357 In Phase I Clinical Trials

Bones / Orthopaedics News From Medical News Today — Tue, 10 Nov 2009 09:00:00 +0100

Cytokinetics, Incorporated (NASDAQ: CYTK) announced the initiation of a double-blind, randomized, placebo-controlled, multiple-dose Phase I clinical trial to investigate the pharmacokinetic profile of CK-2017357. Cytokinetics also announced that the company has initiated the second part, or "Part B", of a previously initiated first-time-in-humans, Phase I clinical trial of CK-2017357 in healthy male volunteers. (Source: Bones / Orthopaedics News From Medical News Today)

Early Menopause No Predictor Of Hip Fracture

Bones / Orthopaedics News From Medical News Today — Tue, 10 Nov 2009 08:00:00 +0100

Women who have an early menopause are unlikely to have a long term increased risk of hip fractures associated with menopausal bone density weakening, according to a new study from The Australian National University. For decades medical practitioners have understood a link between menopause and a decrease in bone density. (Source: Bones / Orthopaedics News From Medical News Today)

Plasma disc decompression for contained cervical disc herniation: a randomized, controlled trial

European Spine Journal — Tue, 10 Nov 2009 07:55:09 +0100

Abstract Prospective case series studies have shown that plasma disc decompression (PDD) using the COBLATION SpineWand device (ArthroCare Corporation, Austin, TX) is effective for decompressing the disc nucleus in symptomatic contained cervical disc herniations. This prospective, randomized controlled clinical trial was conducted to evaluate the clinical outcomes of percutaneous PDD as compared to conservative care (CC) through 1 year. Patients (n = 115) had neck/arm pain >50 on the visual analog scale (VAS) pain scale and had failed at least 30 days of failed CC. Patients were randomly assigned to receive either PDD (n = 62) or CC (n = 58). Clinical outcome was determined by VAS pain score, neck disability index (NDI) score, and SF...

Comparative analysis between shape memory alloy-based correction and traditional correction technique in pedicle screws constructs for treating severe scoliosis

European Spine Journal — Tue, 10 Nov 2009 07:55:08 +0100

This study is a retrospective matched cohort study to evaluate the advantages of Nitinol shape memory alloy (SMA) rod-based correction by comparing the clinical and radiographic results obtained from using a temporary SMA rod and those from a standard rod in the correction of severe scoliosis. From May 2004 to September 2006, patients with matched curve type, ages at surgery, operative methods and fusion levels in our institute and instrumented with either SMA rods (n = 14) or traditional correction techniques (n = 16) were reviewed. In SMA group, the SMA rods served as a temporary intraoperative tool for deformity correction and were replaced by standard rods. The blood loss at surgery averaged 778 ± 285 ml in the traditional group and 585 ±&n...

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The impact of intra-operative sternum vertical displacement on the sagittal curves of the spine

European Spine Journal — Tue, 10 Nov 2009 07:55:08 +0100

The objective of this study was to evaluate the impact of SVD utilization on the sagittal curves of the spine. Experimental testing was performed on six healthy volunteers. Lateral radiographs were taken in the neutral and sternum raised positions and then analyzed in order to compare the values of sagittal curves. The displacement of volunteers and surgical frame components between positions was recorded using an optoelectronic device. Finally, interface pressures between the volunteers and surgical frame cushions were recorded using a force sensing array. Average results show that passing from the neutral to sternum raised positions caused an increase of 53% in thoracic kyphosis and 24% in lumbar lordosis; both statistically significant. Sensors showed that the sternum was raised a...

The transtibial versus the anteromedial portal technique in the arthroscopic bone-patellar tendon-bone anterior cruciate ligament reconstruction

Knee Surgery, Sports Traumatology, Arthroscopy — Tue, 10 Nov 2009 07:54:28 +0100

Abstract The transtibial (TT) drilling of the femoral tunnel in the bone-patellar tendon-bone (BPTB) anterior cruciate ligament (ACL) reconstruction was found to place the tunnel non-anatomically. The use of the anteromedial portal (AMP) for the femoral drilling would provide the surgeon with more freedom to anatomically place the tunnel in the real femoral ACL footprint. The purpose of this study was to compare the clinical outcomes of BPTB ACL reconstruction using the AMP or the TT technique for the femoral tunnel drilling. A Medline search was not able to identify any study directly comparing the clinical outcomes of the AMP and the TT techniques. The literature search identified experimental and quasi-experimental studies published from 1966 to March 2009 where at leas...

Patterns of analgesic use, pain and self-efficacy: a cross-sectional study of patients attending a hospital rheumatology clinic

BMC Musculoskeletal Disorders — Tue, 10 Nov 2009 00:00:00 +0100

Background: Many people attending rheumatology clinics use analgesics and non-steroidal anti-inflammatories for persistent musculoskeletal pain. Guidelines for pain management recommend regular and pre-emptive use of analgesics to reduce the impact of pain. Clinical experience indicates that analgesics are often not used in this way. Studies exploring use of analgesics in arthritis have historically measured adherence to such medication. Here we examine patterns of analgesic use and their relationships to pain, self-efficacy and demographic factors. Methods: Consecutive patients were approached in a hospital rheumatology out-patient clinic. Pattern of analgesic use was assessed by response to statements such as 'I always take my tablets every day.' Pain and self-efficacy (SE) were measured...

Mattress suture-bridge technique for bursal-side partial-thickness rotator cuff tears

Archives of Orthopaedic and Trauma Surgery — Mon, 09 Nov 2009 19:13:33 +0100

Abstract The standard procedure used to repair partial-thickness tears involves initial progression of the lesion to a full-thickness tear prior to tendon repair. However, the option for a bursal-side partial-thickness rotator cuff tear includes the preservation of as much of the remaining intact fibers as possible. Instead of inserting suture anchors in the medial row, as in the conventional suture-bridge technique, two mattress sutures are inserted into the rotator cuff. Full-thickness access is achieved using a percutaneous spinal needle and medial mattress sutures to preserve the articular bone attachment of the remnant fibers and to compress the repaired tendon on the footprint. Our method can help preserve the remnant rotator cuff tendon without tissue damage and can...

Anterior-inferior plating of middle-third fractures of the clavicle

Archives of Orthopaedic and Trauma Surgery — Mon, 09 Nov 2009 19:13:32 +0100

Conclusion Anterior-inferior plating is an effective treatment modality for middle-third clavicle fractures, with few complications and early return of shoulder function. The procedure provides stable fixation, avoids risk to vital structures below the clavicle, and is associated with a low rate of implant-prominence problems. Content Type Journal ArticleCategory Trauma SurgeryDOI 10.1007/s00402-009-0993-7Authors Chin-En Chen, Golden Hospital Department of Orthopedic Surgery 12-2, Minsheng E. Rd. Pingtung 900 Taiwan, ROCRei-Jahn Juhn, Golden Hospital Department of Orthopedic Surgery 12-2, Minsheng E. Rd. Pingtung 900 Taiwan, ROCJih-Yang Ko, Department of Orthopedic Surgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center Kaohsiung Taiwan, ROC Journal Arch...

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Percutaneous fixation of selected scaphoid fractures by dorsal approach

International Orthopaedics — Mon, 09 Nov 2009 19:12:13 +0100

Abstract The aim of our study was to evaluate clinical, radiological and functional outcomes of selected cases of percutaneous fixation of scaphoid fractures via a dorsal approach. Percutaneous fixation by dorsal approach was done in 32 patients (mean age 32.2 years) involving both fresh and late scaphoid fracture presentations (mean 17 days). Fourteen cases of B1 type, ten cases of B2 and eight cases of C type (Herbert’s classification) were treated. The patients were prospectively followed up clinically and radiologically for a minimum follow-up of 14 months (mean 16 months), and functional outcome and complications were assessed. All fractures united over an average of nine weeks. There was no avascular necrosis or screw cutout with preservation of wrist...

Gaining Weight Does Not Reduce Joint Space in Knee OA

Medscape Orthopaedics Headlines — Mon, 09 Nov 2009 16:57:34 +0100

Although obesity is a risk factor for osteoarthritis (OA) of the knee, in obese women, greater body mass index (BMI) does not subsequently lead to reduced joint space, French and US researchers report in the November issue of Annals of the Rheumatic Diseases. Reuters Health Information (Source: Medscape Orthopaedics Headlines)

Female, lumbar spine paraplegics at greatest risk for disuse osteoporosis

MedWire News - Bone Health — Mon, 09 Nov 2009 15:13:20 +0100

UK researchers have identified patterns of disuse osteoporosis in patients with spinal cord injury, with women and patients with lumbar injury at particular risk for bone loss. (Source: MedWire News - Bone Health)

Functional outcome of PFC Sigma fixed and rotating-platform total knee arthroplasty. A prospective randomised controlled trial

International Orthopaedics — Sun, 08 Nov 2009 08:04:02 +0100

This study shows that there is no statistically significant difference in functional outcome between the two types of implants at short-term follow-up. Content Type Journal ArticleCategory Original PaperDOI 10.1007/s00264-009-0901-3Authors Birgit Hanusch, The James Cook University Hospital Department of Trauma & Orthopaedics Middlesbrough UKThai Nurn Lou, The James Cook University Hospital Department of Trauma & Orthopaedics Middlesbrough UKGary Warriner, DePuy International Leeds UKAnthony Hui, The James Cook University Hospital Department of Trauma & Orthopaedics Middlesbrough UKPaul Gregg, The James Cook University Hospital Department of Trauma & Orthopaedics Middlesbrough UK Journal International OrthopaedicsOnline ISSN 1432-5195Print ISSN 0341-2695 (Source: International ...

[Diagnostics and therapy of the diabetic foot syndrome from a vascular surgery perspective.]

Der Orthopade — Sun, 08 Nov 2009 00:00:00 +0100

This article describes the diagnostics and therapy of the diabetic foot syndrome from a vascular surgical point of view. The importance of endovascular, vascular surgical as well as combined (hybrid) procedures of revascularization is emphasized. PMID: 19898833 [PubMed - as supplied by publisher] (Source: Der Orthopade)

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["Und was wir alleine nicht schaffen, das schaffen wir dann zusammen" (Xavier Naidoo) : Interdisciplinary therapy of diabetic foot syndrome.]

Der Orthopade — Sun, 08 Nov 2009 00:00:00 +0100

Authors: Sabo D PMID: 19898834 [PubMed - as supplied by publisher] (Source: Der Orthopade)

Collagen hydrolysates does not boost postmenopausal bone metabolism

MedWire News - Bone Health — Sat, 07 Nov 2009 14:47:13 +0100

Dietary supplementation with collagen hydrolysates does not have a beneficial effect on bone metabolism in postmenopausal women with low bone mineral density, suggest results from a Brazilian study. (Source: MedWire News - Bone Health)

$11 Million NIH Grant For Stem Cell Research Awarded To Rhode Island Hospital

Bones / Orthopaedics News From Medical News Today — Sat, 07 Nov 2009 09:00:00 +0100

Rhode Island Hospital has received an $11 million grant to fund research that will lead to a general understanding of stem cell biology and identify unique approaches to tissue regeneration in lung and marrow diseases. The 5-year grant, awarded to Peter Quesenberry, MD, director of hematology/oncology at Rhode Island Hospital, also provides funding for the development of a major stem cell research center at Rhode Island Hospital. (Source: Bones / Orthopaedics News From Medical News Today)

Analysis of Association of LRP5, LRP6, SOST, DKK1, and CTNNB1 Genes with Bone Mineral Density in a Slovenian Population

Calcified Tissue International — Sat, 07 Nov 2009 07:54:40 +0100

Abstract The Wnt pathway has a bifunctional role in bone mass regulation, influencing osteoblasts and osteoclasts. The Wnt pathway genes are therefore candidate genes for susceptibility to osteoporosis. In our study, we focused on the effects of polymorphisms in selected Wnt pathway genes: low-density lipoprotein receptor-related proteins 5 and 6 (LRP5 and LRP6), Dickkopf1 (DKK1), sclerostin (SOST), and β-catenin (CTNNB1). We genotyped 652 subjects for the following polymorphisms: A1330V in LRP5; I1062V in LRP6; E232K in DKK1; D32Y, G34V, and N287S in CTNNB1; and -1397_-1396insGGA in SOST. Bone mineral density (BMD) was also measured. The allele frequencies were as follows: for A1330V C:T = 87%:13%, for I1062V C:T = 20%:80%, and for -1397_-1396insGGA-:GGA...

Knee flexor strength after ACL reconstruction: comparison between hamstring autograft, tibialis anterior allograft, and non-injured controls

Knee Surgery, Sports Traumatology, Arthroscopy — Sat, 07 Nov 2009 07:48:51 +0100

This study compared the mean peak isometric knee flexor torque of the following three groups: subjects 2 years following ACL reconstruction using semitendinosus–gracilis autografts (Group 1), subjects 2 years following ACL reconstruction using tibialis anterior allografts (Group 2), and a non-injured, activity-level-matched control group (Group 3). We hypothesized that Group 1 would have greater mean involved lower extremity peak isometric knee flexor torque deficits than the other groups. Handheld dynamometry with subjects in prone and the test knee at 90° flexion was used to determine bilateral peak isometric knee flexor torque. Group 1 (86.4 ± 11) and Group 2 (80.5 ± 13) had similar 2000 IKDC Subjective Knee Evaluation Form scores (P = ...

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Will a Vascularized Greater Trochanter Graft Preserve the Necrotic Femoral Head?

Clinical Orthopaedics and Related Research — Sat, 07 Nov 2009 00:00:00 +0100

CONCLUSIONS: We believe vascularized greater trochanter bone grafting is appropriate for young selected patients with mild to moderate collapse of the femoral head. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. PMID: 19898910 [PubMed - as supplied by publisher] (Source: Clinical Orthopaedics and Related Research)

High Stress Conditions Do Not Increase Wear of Thin Highly Crosslinked UHMWPE.

Clinical Orthopaedics and Related Research — Sat, 07 Nov 2009 00:00:00 +0100

Authors: Kelly NH, Rajadhyaksha AD, Wright TM, Maher SA, Westrich GH Introduction of highly crosslinked polyethylene has increased interest in large femoral heads, because thin acetabular liners can be used while maintaining low wear rates and larger heads decrease the incidence of instability. However, crosslinking and subsequent thermal treatments can cause decreased mechanical properties that might obviate the reduced wear under extreme conditions. To examine whether increased contact pressures would adversely affect wear in thin liners, we tested thin and thick highly crosslinked liners (3.8 mm thickness/44-mm head and 7.9 mm thickness/36-mm head, respectively) to 5 million cycles on a hip simulator under near impingement conditions. Conventional polyethylene liners (7.9 mm thickne...

Effect of limb rotation on radiographic alignment in total knee arthroplasties

Archives of Orthopaedic and Trauma Surgery — Fri, 06 Nov 2009 18:56:23 +0100

Discussion Limb rotation had a highly statistically significant effect on measured anatomic alignment and mechanical angles. A correlation between limb rotation, anatomic mechanical angle, mechanical angles measured at femur and tibia and the femoral component distance ratio was established. As the anatomic mechanical angle and the femoral component distance ratio change linearly in the range of 20° internal and external limb rotation, a calculation of the femoral component distance ratio could be used to re-calculate the limb rotation at the time of radiographic assessment to evaluate the evidence of a long leg radiograph. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-0999-1Authors Kerstin Radtke, Hannover Medical School Department...

Urine toxicology screening in Austrian trauma patients: a prospective study

Archives of Orthopaedic and Trauma Surgery — Fri, 06 Nov 2009 18:56:20 +0100

Conclusion Drug use is widespread in patients presenting to urban trauma centers in Austria. Physicians should maintain a high index of suspicion that their patients may be intoxicated and should perform drug testing routinely. Content Type Journal ArticleCategory Trauma SurgeryDOI 10.1007/s00402-009-0995-5Authors Markus Figl, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Trauma Research Center of the Austrian Workers′ Compensation Board Vienna AustriaLinda E. Pelinka, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Trauma Research Center of the Austrian Workers′ Compensation Board Vienna AustriaPatrick Weninger, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Trauma Research Center of th...

MedWorm: Orthopaedics

Kyphoplasty feasible even with loss of wall integrity

Index

Soft Tissue and Biomechanical Challenges Encountered with the Management of Distal Tibia Nonunions

Managing Bone Deficiency and Nonunions of the Proximal Femur

RIA: One Community's Experience

Quantitative Analysis of Growth Factors from a Second Filter Using the Reamer-Irrigator-Aspirator System: Description of a Novel Technique

Autologous Bone Graft: When Shall We Add Growth Factors?

Autograft and Nonunions: Morbidity with Intramedullary Bone Graft versus Iliac Crest Bone Graft

Treatment of Large Segmental Bone Defects with Reamer-Irrigator-Aspirator Bone Graft: Technique and Case Series

Biological Rationale for the Intramedullary Canal as a Source of Autograft Material

Use of the Induced Membrane Technique for Bone Tissue Engineering Purposes: Animal Studies

Clinical Use of Resorbable Polymeric Membranes in the Treatment of Bone Defects

The Concept of Induced Membrane for Reconstruction of Long Bone Defects

Use of Solid and Cancellous Autologous Bone Graft for Fractures and Nonunions

Viable Bone and Circulatory Factors Required for Survival of Bone Grafts

Bone Defects Caused by High-energy Injuries, Bone Loss, Infected Nonunions, and Nonunions

Preface

Forthcoming issues

Contents

Peak BMD may explain Indian osteoporosis rate

Physical examination of the foot and ankle by orthopaedic and accident and emergency clinicians [Injury 2009;40(2):136–8]

Are we failing our students?

Reconstruction of finger-pulp defect with a homodigital laterodorsal fasciocutaneous flap distally based on the dorsal branches of the proper palmar digital artery

Learning the lessons from conflict: Pre-hospital cervical spine stabilisation following ballistic neck trauma

Factors affecting results of patients with humeral proximal end fractures undergoing primary hemiarthroplasty: A retrospective study in 42 patients

Removal of erythropoietin from anaemia trauma practice guideline does not increase red blood cell transfusions and decreases hospital utilization costs

Recovery of brachial plexus injury after shoulder dislocation

Ulnar artery distal cutaneous descending branch as free flap in hand reconstruction

The incidence of scaphoid fracture in a military population

Factors affecting infection after calcaneal fracture fixation

Treatment of unstable distal clavicle fractures using two suture anchors and suture tension bands

Prospective analysis of a new minimally invasive technique for paediatric Gartland type III supracondylar fracture of the humerus

Complications when using threaded K-wire fixation for displaced intra-articular calcaneal fractures

Mid-term results of internal fixation of proximal humeral fractures with the Philos plate

Percutaneous plating in paediatric tibial fractures

Three-dimensional computed tomography imaging increases the reliability of classification systems for tibial plateau fractures

Volar locking plates versus Kirschner wires for distal radial fractures—A cost analysis study

Injuries sustained at a temporary ice-skating rink: Prospective study of the Winchester experience 2007–2008

A health economic analysis of the use of rhBMP-2 in Gustilo–Anderson grade III open tibial fractures for the UK, Germany, and France

Examination tests predictive of bone injury in patients with clinically suspected occult scaphoid fracture

Fresh-frozen vs. irradiated allograft bone in orthopaedic reconstructive surgery

Maxillofacial trauma—Developments, innovations and controversies

Management, complications and clinical results of femoral head fractures

Fracture healing and bone regeneration: Autologous bone grafting or BMPs?

Editorial Board

Surgical advances in periacetabular osteotomy for treatment of hip dysplasia in adults.

The Scandinavian Sarcoma Group.

On the diagnosis and treatment of femoral neck fractures.

Evolution of the hip and pelvis.

The expression of Gli3, regulated by HOXD13, may play a role in idiopathic congenital talipes equinovarus

[Principles of treatment for deep infections of the diabetic foot.]

[Reconstructive surgery for Charcot foot : Long-term 5-year outcome.]

Middle-age weight changes predict forearm BMD

Successful ACL reconstruction with a variant of the pes anserinus

Odontoid metastasis: a potential lethal complication

Pregabalin, celecoxib, and their combination for treatment of chronic low-back pain

Stem modularity alone is not effective in reducing dislocation rate in hip revision surgery

Predictors of new vertebral endplate signal (Modic) changes in the general population

How do we define the condition ‘recurrent low back pain’? A systematic review

Last-Resort Lower-Body Amputation Effective In Extreme Cases Of Bone Infection

Acute non-displaced fractures of the scaphoid: earlier return to activities after operative treatment. A controlled multicenter cohort study

Diagnostic imaging and unforeseen associated lesions in astragalo-scaphoid dislocation: a case report

Passive navigation principle for orthopedic interventions with MR fluoroscopy

Fracture of the tibial bone block after posterior cruciate ligament allograft reconstruction using double cross pins

Arthroplasty: critical scientometric analysis of current benchmarking and evaluation procedures

Evolution of open-wedge high-tibial osteotomy: experience with a special angular stable device for internal fixation without interposition material

American Academy Of Orthopaedic Surgeons Wins Prestigious CLIO Award

High pressure may inhibit periprosthetic osteogenesis

Treatment of osteoporosis: recognizing and managing cutaneous adverse reactions and drug-induced hypersensitivity

Effect of alendronate on bone metabolic indices and bone mineral density in patients treated with high-dose glucocorticoid: a prospective study

Measurement uncertainty for the analysis of serum 25-hydroxyvitamin D

Measurement uncertainty for the analysis of serum 25-hydroxyvitamin D: response to Stepman and Thienpont

Cross-sectional geometry of weight-bearing tibia in female athletes subjected to different exercise loadings

Hepatitis C- and Human Immunodeficiency Virus-Induced Hypersensitivity Vasculitis

Musculoskeletal Complications of Hemophilia

Presence of a Deletion Mutation (c.716delA) in the Ligand Binding Domain of the Vitamin D Receptor in an Indian Patient with Vitamin D-Dependent Rickets Type II

Cytokine Receptor-Like Factor 1 is Highly Expressed in Damaged Human Knee Osteoarthritic Cartilage and Involved in Osteoarthritis Downstream of TGF-β

MicroRNA mutation causes rare form of primary osteoporosis

Biographical Sketch: Virgil Pendelton Gibney, MD, 1847-1927.