Orthopedic News
Outcome of Intramedullary Fixation of Clavicular Fractures
The authors of this article conducted a retrospective, single-center (tertiary referral center with associated level I trauma center) review to evaluate the outcome of open reduction and internal fixation (ORIF) with intramedullary (IM) clavicle pin of displaced clavicular fractures.Sixty-eight displaced midshaft clavicle fractures in 68 patients underwent ORIF with IM clavicle pins. Patients were identified through a perioperative database by searching for Current Procedural Terminology (CPT) codes. Union was the primary outcome. Secondary outcomes included time to union, pain, incidence of nonunion and delayed union, postoperative range of motion, and incidence of complications.S ixty-six fractures (97%) went on to union. Complications included painful hardware (44%), deep and superficial wound infections (10%), and hardware failure (4%), including pin breakage and extrusion. Postoperative shoulder pain was present in 10% of patients and limited shoulder range of motion in 12%. IM pin fixation can provide good outcomes, even for fractures with a significant amount of shortening and comminution.
Study identifies predictors of failure after ACL reconstruction in young athletes
Investigators from Pittsburgh have found a 13% failure rate after anatomic ACL reconstruction using allograft in young athletes. The findings, which were presented by Carola Francisca Van Eck, MD, at the 2011 Annual Meeting of the Arthroscopy Association of North America, noted that failure could be associated with a younger patient age, an earlier return to sport and a heavier body weight. “The purpose of this specific study was to determine the failure rate after anatomic single- and double-bundle ACL reconstruction with allograft and to identify factors associated with failure,” Van Eck said. Overall, 13% of patients had graft failure. On average, patients in the double-bundle group who had a failure were younger (19 years vs. 25 years old) and had returned to competition earlier (222 days vs. 267 days). Four patients (11%) in the single-bundle group failed, Van Eck added. These patients were younger (19 years vs. 24 years old) and heavier (83 kg vs. 65 kg).
Ultrasonographic measures of subacromial space in patients with rotator cuff disease
Recently sonography (US) has been used to measure the subacromial space outlet with a linear measurement of the acromiohumeral distance (AHD). The purpose of this article is to systematically review the literature on the influence of rotator cuff disease (RCD) on AHD using US. US images of AHD are smaller in patients with full-thickness tears than healthy individuals and subjects with subacromial impingement. AHD is potentially useful to prognosticate outcome in patients with subacromial impingement.
Outcomes of Arthroscopic Versus Open Rotator Cuff Repair: A Systematic Review of the Literature
Full-thickness rotator cuff tears are common. When symptomatic, they can affect quality of life. Surgical repair might improve patients’ overall health.
We systematically reviewed postoperative outcomes in 10 studies comparing mini-open repair and allarthroscopic repair techniques. Data regarding patient demographics, rotator cuff pathology, postoperative rehabilitation protocols, American Shoulder and Elbow Surgeons (ASES) scores, University of California Los Angeles (UCLA) scores, pain scores, and incidence of recurrent defects were extracted. This systematic literature review indicates there is no statistically significant difference in postoperative ASES, UCLA, or pain scores or incidence of recurrent rotator cuff tears in rotator cuffs repaired all-arthroscopically versus using the mini-open technique. However, there might be decreased short-term pain in patients who undergo arthroscopic repairs.
Bisphosphonate Use and the Risk of Subtrochanteric or Femoral Shaft Fractures in Older Women
Osteoporosis is associated with significant morbidity and mortality. Oral bisphosphonates have become a mainstay of treatment, but concerns have emerged that long-term use of these drugs may suppress bone remodeling, leading to unusual fractures. The authors sought determine whether prolonged bisphosphonate therapy is associated with an increased risk of subtrochanteric or femoral shaft fracture.
Overall it was found that among older women, treatment with a bisphosphonate for more than 5 years was associated with an increased risk of subtrochanteric or femoral shaft fractures; however, the absolute risk of these fractures is low.
Predictors of Bleeding From Stable Pelvic Fractures
Stable pelvic fractures (SPFs) that do not need operative fixation are only infrequently associated with significant bleeding (SigBleed). Our hypothesis is that simple indicators, easily detectable at the bedside, can alert the clinician about the likelihood of bleeding and the need for closer monitoring or early intervention in patients with SPFs. It was found that the incidence of SigBleed due to SPFs is low (5% in this study) and independently predicted by an admission hematocrit of 30% or lower, the presence of a pelvic hematoma on computed tomographic scan, and systolic blood pressure of 90 mm Hg or lower.
Year in Review: Where Spine Repair Stands Now
In August 2009, two studies were published in the New England Journal of Medicinethat contradicted overwhelming anecdotal evidence supporting vertebroplasty for the treatment of osteoporotic vertebral compression fractures. Both found that vertebroplasty, which involves injecting a medical cement into the fracture to stabilize the bone, fared no better than a sham procedure, igniting a debate that continues to pit believers of the anecdotal evidence against adherents to evidence-based medicine.
Cemented Thompson versus cemented bipolar prostheses for femoral neck fractures
This article compared early functional outcomes, complications, and mortality in elderly patients treated with the less costly, cemented Thompson prosthesis or the cemented bipolar prosthesis in order to identify factors affecting outcomes. Overall it found that in elderly patients with limited mobility, treatment with the bipolar prosthesis was not associated with better short-term outcomes than those receiving the Thompson prosthesis.
Minimum Five-Year Follow-Up Wear Measurement of Longevity Highly Cross-Linked Polyethylene Cup Against Cobalt-Chromium or Zirconia Heads
This article investigated the efficacy of combining highly cross-linked polyethylene with ceramic heads on further reduction in polyethylene wear compared with the combination with cobalt-chromium heads via PolyWare computer-assisted method. A prospective cohort study was performed on 102 cementless total hip arthroplasties using Longevity (Zimmer, Warsaw, Ind) highly cross-linked polyethylene liners. Either 26-mm zirconia heads or 26-mm cobalt-chromium heads were randomly used in 51 hips each. At a mean follow-up of 6.7 years, no significant differences were identified between the groups for total penetration rate and steady-state wear rate. Osteolysis was not observed in any hips in either group. In conclusion, no advantage was seen for the 26-mm zirconia head compared with the 26-mm cobalt-chromium head in this period.
Incidence and Risk Factors for Deep Surgical Site Infection After Primary Total Hip Arthroplasty
Although deep surgical site infection (SSI) is a major complication of primary total hip arthroplasty (THA), there are conflicting data regarding the incidence of deep SSI, and no comprehensive evaluation of the associated risk factors has been undertaken. We performed a systematic review of the literature; undertaking computer-aided searches of electronic databases, assessment of methodological quality, and a best-evidence synthesis. The incidence of SSI ranged from 0.2% before discharge to 1.1% for the period up to and including 5 years post surgery. Greater severity of a pre-existing illness and a longer duration of surgery were found to be independent risk factors for deep SSI. There is a need for high-quality, prospective studies to further identify modifiable risk factors for deep SSI after THA.
Topical Diclofenac a Safe Alternative to NSAIDs for High-Risk Patients With Knee Osteoarthritis
Topical diclofenac solution with the absorption enhancer dimethyl sulfoxide may represent an alternative to oral nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with osteoarthritis (OA) of the knee, especially in those at higher risk for serious gastrointestinal (GI) and cardiovascular side effects.
Outcome of orthopedic implant infections due to different staphylococci
Comparisons of different staphylococci in orthopedic implant infections have rarely been reported. In this study we assessed total joint arthroplasty infections and other orthopedic implant infections due to methicillin-sensitive Staphylococcus aureus (MSSA), methicillin-resistant Staphylococcus aureus (MRSA), and coagulase-negative staphylococci (CoNS).
This was a retrospective study performed at the Geneva University Hospitals for the period January 1996 to June 2008. There were 44 infections due to MRSA, 58 due to MSSA, and 61 due to CoNS. Overall cure was achieved in 57% (25/44) of MRSA infections, 72% (42/58) of MSSA infections, and 82% (50/61) of CoNS infections, after a minimum follow-up of 1 year. In the subgroup of arthroplasty infections only, cure was achieved in 39% (7/18) of MRSA, 60% (15/25) of MSSA, and 77% (30/39) of CoNS episodes. In orthopedic implant infections, S. aureus is more virulent than CoNS. MRSA has the worst outcome and CoNS the best.
Steroid Shots Bad for Tennis Elbow Long Term
Corticosteroid injections ease the pain of tennis elbow short term but may worsen it long term, according to a meta-analysis.
The injections significantly cut pain scores over the first four weeks with a standardized mean difference of 1.44 compared with no intervention (P<0.0001), Bill Vicenzino, PhD, of the University of Queensland in St. Lucia, Australia, and colleagues reported online in The Lancet.
Tanezumab for the Treatment of Pain from Osteoarthritis of the Knee
Increased expression of nerve growth factor in injured or inflamed tissue is associated with increased pain. This proof-of-concept study was designed to investigate the safety and analgesic efficacy of tanezumab, a humanized monoclonal antibody that binds and inhibits nerve growth factor.
When averaged over weeks 1 through 16, the mean reductions from baseline in knee pain while walking ranged from 45 to 62% with various doses of tanezumab, as compared with 22% with placebo. Tanezumab, as compared with placebo, was also associated with significantly greater improvements in the response to therapy as assessed with the use of the patients' global assessment measure (mean increases in score of 29 to 47% with various doses of tanezumab, as compared with 19% with placebo. In this proof-of-concept study, treatment with tanezumab was associated with a reduction in joint pain and improvement in function, with mild and moderate adverse events, among patients with moderate-to-severe osteoarthritis of the knee.
Sodium MRI gives new insights into detecting osteoarthritis
Researchers may have found a new, noninvasive method to diagnose knee osteoarthritis in its early stages through the examination of sodium ions in cartilage, according to a study recently published in the Journal of Magnetic Resonance. The new MRI method could also be used to help calibrate other, less direct measures of cartilage assessments, the study reported.
Vitallium Rods No Better Than Titanium in Reducing Image Artifact
After spinal fusion surgery, postoperative management often includes imaging with either computed tomography (CT) or magnetic resonance imaging (MRI) to assess the spinal canal and nerve roots. The metallic implants used in the fusion can cause artifact that interferes with this imaging, reducing their diagnostic value. Stainless steel is known to produce large amounts of artifact, whereas titanium is known to produce significantly less. Other alloys such as vitallium are now being used in spinal implants, but their comparison to titanium and stainless steel has not been well documented in the orthopedic literature. Titanium is a desirable metal because of its light weight and lower production of artifact on imaging, although it is not as stiff as stainless steel. Vitallium is proposed as a replacement for titanium because it has stiffness similar to stainless steel, while still being as light as titanium. Images produced after the insertion of vitallium rods and titanium screws as well as those with titanium rods and screws were found to have less artifact and a better overall diagnostic quality than those produced with stainless steel implants. Overall, there was not a difference between the amount of artifact in the spinal images with vitallium and titanium rods, with the exception of a few trials that showed small but statistically significant differences between the two metals, where titanium had slightly better images.
Arthroscopic anterior cruciate ligament surgery: Results of autogenous patellar tendon graft versus the Leeds-Keio synthetic graft
This article conducted a prospective, randomised controlled trial comparing anterior cruciate ligament reconstruction using middle third patellar tendon graft (PT) to synthetic Leeds-Keio (LK) ligament. The patients were randomised (26 PT, 24 LK). Subjective knee function was classified (Lysholm, Tegner activity, IKDC scores), laxity was measured (Lachman test, Stryker laxometer), and functional ability was assessed (one-hop test). The use of the LK ligament has been largely abandoned due to reports of its insufficiency. These results demonstrate that it is not as inferior as one might expect. We conclude that the results of LK ligament ACL reconstruction are as acceptable as those using PT. It may provide an additional means of reconstruction where no suitable alternative is present.
Localized Development of Knee Osteoarthritis Can Be Predicted from MR Imaging Findings a Decade Earlier
MR imaging at 3 T helps identify risk factors in patients with subacute knee symptoms 10 years before the development of osteoarthritis. In a study of 326 patients with a mean 10-year follow-up, Huétink and co-workers found that patients who have had tears of the anterior cruciate ligament or one or both menisci have increased risk of developing features of osteoarthritis. Treatment of meniscal tears—in particular, partial meniscectomy—does not decrease the risk of developing osteoarthritic fractures, the researchers noted.
After ACL Injury, Lubricating The Knee Cartilage May Prevent Osteoarthritis
An injury to the anterior cruciate ligament (ACL) is fairly common, especially among young athletes. While it can often be corrected through surgery, the injury can lead to increased risk of developing degenerative joint diseases, including osteoarthritis (OA). The problem is that fluid in the knee joint, which lubricates the cartilage, is impacted by the trauma of the injury and begins to deteriorate. A new study from Rhode Island Hospital researchers identifies options for restoring that lubrication to potentially prevent development of OA. The study is published in the August 2010 edition of the journal Arthritis & Rheumatism and is now available online ahead of print.
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.
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