Orthopedic News
Stratification of the Risk Factors of Community-Acquired Methicillin-Resistant Staphylococcus Aureus Hand Infection
Several recent studies showed an increase in methicillin-resistant Staphylococcus aureus (MRSA) hand infections. The purpose of this study was to determine the prevalence of community-acquired MRSA hand infections in an urban setting and to determine independent risk factors for such infections. In the patients studied, only intravenous drug use correlated with community-acquired MRSA hand infections. Patient education about intravenous drug use and empiric treatment with MRSA-appropriate antibiotics for intravenous drug users presenting with hand infections are recommended.
Knee ligament tears often need no surgery
Most people who have a common knee ligament injury fare just as well with intense physical therapy as they do with surgery, according to a study comparing the two techniques released on Wednesday. Researchers said that focusing on rehabilitation first could prevent more than half of operations done to repair a tear in the anterior cruciate ligament (ACL), which lies beneath the kneecap and attaches the thigh bone to the shin bone.
The anatomy of the short head of biceps - not a tendon
The short head of biceps brachii has been the subject of little investigation when compared to the long head or distal biceps tendons. The aim of this study out of the International Journal of Shoulder Surgery was to dissect and describe the origin and proximal portion of the short head of biceps brachii. They found that the origin of the short head of biceps consisted of muscle fibres attaching directly to the tip of the coracoid process, with a thin, tendinous aponeurosis covering its anterior surface, rather than a true tendon as previously described concluding that the short head of biceps does not attach to the coracoid process via a true tendon. These findings have implications for procedures that utilise the short head of biceps.
Which Method of Rotator Cuff Repair Leads to the Highest Rate of Structural Healing?
The purpose of rotator cuff repair is to diminish pain and restore function, and this most predictably occurs when the tendon is demonstrated to heal. Recent improvements in repair methods have led to improved biomechanical performance, but this has not yet been demonstrated to result in higher healing rates. The purpose of our study was to determine whether different repair methods resulted in different rates of recurrent tearing after surgery. An article in this months American Journal of Sports Medicine performed a systematic review of the literature and found double-row repair methods lead to significantly lower retear rates when compared with single-row methods for tears greater than 1 cm. Surgical approach has no significant effect on retear rate.
Effect of deferred treatment of supracondylar humeral fractures
Timing of surgery remains a controversial topic in the treatment of the supracondylar humeral fracture. In our institution, patients are not brought to theatre after midnight, except in the ‘life or limb’ situation. We hypothesised that time to surgery has no significant influence on complication rate with supracondylar fracture of the humerus.Overall there was no difference in complication rates when treatment of supracondylar fractures is delayed. Supracondylar fractures which are not grossly displaced, have no neurovascular deficit or risk of skin compromise, can be safely deferred without an increased risk of complication. Operative treatment of supracondylar fractures can be delayed until the next morning, except in the ‘life or limb’ situation.
Biomarkers in Osteoarthritis
Osteoarthritis is the most common joint disorder considered as the cumulative result of mechanical and biological events that induce an imbalance between the degradation and synthesis within articular joint tissues. The diagnosis of OA mainly based on physical examination and radiographs which provide semi quantitative assessment of disease state. Biomarkers are sensitive to minor changes so their measurement provides an accurate metabolic status of joint. As osteoarthritis mainly affects bone, cartilage, and synovium, biomarker related to their metabolism act as specific marker for osteoarthritis. Analyses of cartilage markers such as cartilage oligomeric matrix protein, keratan sulfate etc. provide a useful technique to diagnose osteoarthritis at early stages. Osteocalcin measurement provides information about bone while glucosyl- galactosyl pyridinoline reflect synovium turnover. The measurement of inflammatory markers such as YKL-40, matrixmetalloproteinases etc. help to detect target joints. The clinical utility of biomarkers described using BIPED approach. The biomarkers for osteoarthritis used to diagnose disease at an early stage, assess severity of disease and measure efficacy of treatments. Matrix metalloproteinases and pro matrix metalloproteinase are sensitive markers of disease severity and response to treatment.
The Clinics in Sports Medicine Focuses on Rehabilitation
Rehabilitation following many sports medicine operative procedures has received much less emphasis than the technical aspects of surgery. Often the approach in protocol for postoperative management is arbitrary and unproven. The data-driven approach most of us have adopted using leveled evidence has not been available. I do not expect to entirely rectify this in the current issue of the Clinics in Sports Medicine, but hope to provide directed “inside information” by topic from the best experts available. The format of this issue will be to structure these recommended protocols around a “Top Ten” list of procedures whose optimal rehabilitation has advanced or remains controversial. These procedures cover the anatomy from the toe to the top of the shoulder for the athlete.
Bilateral TKA associated with poor peri-operative outcome
Unilateral total knee arthroplasty (TKA) appears to be associated with better peri-operative morbidity and mortality than bilateral procedures, say researchers. They also found that staging bilateral TKA procedures during the same hospitalization offers no mortality benefit and may even increase morbidity compared with carrying out bilateral TKA on the same day.
Using antibiotics, doubling surgical gloves among ways to prevent periprosthetic infection
While the greatest risk for periprosthetic infection after hip and knee replacement procedures occur within the first few months after surgery, the risk of infection persists throughout the lifetime of the patient and the implant, according to an orthopedist from the Mayo Clinic College of Medicine, Rochester in Minnesota. “The one thing we can do most effectively to prevent periprosthetic infection is to give antibiotics,” Robert T. Trousdale, MD, said during his presentation at Orthopedics Today Hawaii 2010, here. He suggested that surgeons administer antibiotics to their patients within an hour before the skin incision.
Researchers identify protein involved in causing osteoporosis, arthritis
Investigators at the Hospital for Special Surgery in New York, along with several collaborators, reported that a gene called interferon regulator factor-8 (IRF-8) plays an important role in the development of diseases such as rheumatoid arthritis, osteoporosis and periodontitis (gum disease). The study, which appeared online Aug. 30 ahead of print in the journal Nature Medicine, could lead to new treatments, according to the authors.
Ibuprofen Bests Acetaminophen/Codeine for Kids' Broken Arms
Children treated for arm fractures said ibuprofen reduced the pain as effectively as a combination of acetaminophen and codeine (Tylenol 3), with fewer adverse effects, in a randomized, double-blind trial.
Surgery, 'Sham' Equal in Treating Compression Fracture Pain
Two new studies suggest that vertebroplasty, a widely used surgery to help heal compression fractures, is no better than "sham" surgery when it comes to relieving pain and improving daily function.
Anterior Cruciate Ligament Reconstruction Doesn't Harm NFL Career Length, Study Suggests
Knee injuries are a common problem in collegiate and professional football, often hindering an individual's career length and future. A study presented at the American Orthopaedic Society for Sports Medicine's Annual Meeting in Keystone.
