We analysed the effects of commonly used medications
on human osteoblastic cell activity in vitro, specifically proliferation
and tissue mineralisation. A list of medications was retrieved from
the records of patients aged >
65 years filed in the database of
the largest health maintenance organisation in our country (>
two
million members). Proliferation and mineralisation assays were performed
on the following drugs: rosuvastatin (statin), metformin (antidiabetic),
metoprolol (β-blocker), citalopram (selective serotonin reuptake
inhibitor [SSRI]), and omeprazole (proton pump inhibitor (PPI)).
All tested drugs significantly stimulated DNA synthesis to varying
degrees, with rosuvastatin 5 µg/ml being the most effective among
them (mean 225% ( Cite this article:
A combined anterior and posterior surgical approach
is generally recommended in the treatment of severe congenital kyphosis,
despite the fact that the anterior vascular supply of the spine
and viscera are at risk during exposure. The aim of this study was
to determine whether the surgical treatment of severe congenital thoracolumbar
kyphosis through a single posterior approach is feasible, safe and
effective. We reviewed the records of ten patients with a mean age of 11.1
years (5.4 to 14.1) who underwent surgery either by pedicle subtraction
osteotomy or by vertebral column resection with instrumented fusion
through a single posterior approach. The mean kyphotic deformity improved from 59.9° (45° to 110°)
pre-operatively to 17.5° (3° to 40°) at a mean follow-up of 47.0
months (29 to 85). Spinal cord monitoring was used in all patients
and there were no complications during surgery. These promising
results indicate the possible advantages of the described technique
over the established procedures. We believe that surgery should
be performed in case of documented progression and before structural
secondary curves develop. Our current strategy after documented
progression is to recommend surgery at the age of five years and
when 90% of the diameter of the spinal canal has already developed. Cite this article:
We investigated the effect of mitomycin-C on the reduction of the formation of peritendinous fibrous adhesions after tendon repair. In 20 Wistar albino rats the tendo Achillis was cut and repaired using a modified Kessler technique. The rats were divided into two equal groups. In group 1, an injection of mitomycin-C was placed between the tendon and skin of the right leg. In group 2, an identical volume of sterile normal saline was injected on the left side in a similar fashion. All the rats received mitomycin-C or saline for four weeks starting from the day of operation. The animals were killed after 30 days. The formation of peritendinous fibrous tissue, the inflammatory reaction and tendon healing were evaluated. The tensile strength of the repaired tendons was measured biomechanically. Microscopic evidence of the formation of adhesions and inflammation was less in group 1. There was no significant difference in the tensile load required to rupture the repaired tendons in the two groups. Mitomycin-C may therefore provide a simple and inexpensive means of preventing of post-operative adhesions.
Blast and ballistic weapons used on the battlefield cause devastating injuries rarely seen outside armed conflict. These extremely high-energy injuries predominantly affect the limbs and are usually heavily contaminated with soil, foliage, clothing and even tissue from other casualties. Once life-threatening haemorrhage has been addressed, the military surgeon’s priority is to control infection. Combining historical knowledge from previous conflicts with more recent experience has resulted in a systematic approach to these injuries. Urgent debridement of necrotic and severely contaminated tissue, irrigation and local and systemic antibiotics are the basis of management. These principles have resulted in successful healing of previously unsurvivable wounds. Healthy tissue must be retained for future reconstruction, vulnerable but viable tissue protected to allow survival and avascular tissue removed with all contamination. While recent technological and scientific advances have offered some advantages, they must be judged in the context of a hard-won historical knowledge of these wounds. This approach is applicable to comparable civilian injury patterns. One of the few potential benefits of war is the associated improvement in our understanding of treating the severely injured; for this positive effect to be realised these experiences must be shared.
Fracture repair occurs by two broad mechanisms:
direct healing, and indirect healing with callus formation. The effects
of bisphosphonates on fracture repair have been assessed only in
models of indirect fracture healing. A rodent model of rigid compression plate fixation of a standardised
tibial osteotomy was used. Ten skeletally mature Sprague–Dawley
rats received daily subcutaneous injections of 1 µg/kg ibandronate
(IBAN) and ten control rats received saline (control). Three weeks
later a tibial osteotomy was rigidly fixed with compression plating.
Six weeks later the animals were killed. Fracture repair was assessed
with mechanical testing, radiographs and histology. The mean stress at failure in a four-point bending test was significantly
lower in the IBAN group compared with controls (8.69 Nmm-2 ( Bisphosphonate treatment in a therapeutic dose, as used for risk
reduction in fragility fractures, had an inhibitory effect on direct
fracture healing. We propose that bisphosphonate therapy not be
commenced until after the fracture has united if the fracture has
been rigidly fixed and is undergoing direct osteonal healing. Cite this article:
Recent reports have suggested an increase in
the number of anterior cruciate ligament (ACL) injuries in children, although
their true incidence is unknown. The prognosis of the ACL-deficient knee in young active individuals
is poor because of secondary meniscal tears, persistent instability
and early-onset osteoarthritis. The aim of surgical reconstruction
is to provide stability while avoiding physeal injury. Techniques
of reconstruction include transphyseal, extraphyseal or partial
physeal sparing procedures. In this paper we review the management of ACL tears in skeletally
immature patients. Cite this article:
The June 2013 Oncology Roundup360 looks at: whether allograft composite is superior to megaprosthesis in massive reconstruction; pain from glomus tumours; thromboembolism and orthopaedic malignancy; bone marrow aspirate and cavity lesions; metastasectomy in osteosarcoma; spinal giant cell tumour; post-atomic strike sarcoma; and superficial sarcomas and post-operative infection rates.
There have been recent reports linking alendronate and a specific pattern of subtrochanteric insufficiency fracture. We performed a retrospective review of all subtrochanteric fractures admitted to our institution between 2001 and 2007. There were 20 patients who met the inclusion criteria, 12 of whom were on long-term alendronate. Alendronate-associated fractures tend to be bilateral (Fisher’s exact test, p = 0.018), have unique radiological features (p <
0.0005), be associated radiologically with a pre-existing ellipsoid thickening of the lateral femoral cortex and are likely to be preceded by prodromal pain. Biomechanical investigations did not suggest overt metabolic bone disease. Only one patient on alendronate had osteoporosis prior to the start of therapy. We used these findings to develop a management protocol to optimise fracture healing. We also advocate careful surveillance in individuals at-risk, and present our experience with screening and prophylactic fixation in selected patients.
Interest in football continues to increase, with ever younger age groups participating at a competitive level. Football academies have sprung up under the umbrella of professional clubs in an attempt to nurture and develop such talent in a safe manner. However, increased participation predisposes the immature skeleton to injury. Over a five-year period we have prospectively collected data concerning all injuries presenting to the medical team at Newcastle United football academy. We identified 685 injuries in our cohort of 210 players with a mean age of 13.5 years (9 to 18). The majority of injuries (542;79%) were to the lower limb. A total of 20 surgical procedures were performed. Contact injuries accounted for 31% (210) of all injuries and non-contact for 69% (475).The peaks of injury occurred in early September and March. The 15- and 16-year-old age group appeared most at risk, independent of hours of participation. Strategies to minimise injury may be applicable in both the academy setting and the wider general community.
We aimed to examine the characteristics of deep venous flow in
the leg in a cast and the effects of a wearable neuromuscular stimulator
(geko; FirstKind Ltd) and also to explore the participants’ tolerance
of the stimulator. This is an open-label physiological study on ten healthy volunteers.
Duplex ultrasonography of the superficial femoral vein measured
normal flow and cross-sectional area in the standing and supine
positions (with the lower limb initially horizontal and then elevated).
Flow measurements were repeated during activation of the geko stimulator
placed over the peroneal nerve. The process was repeated after the
application of a below-knee cast. Participants evaluated discomfort
using a questionnaire (verbal rating score) and a scoring index
(visual analogue scale).Objectives
Methods
Over recent years hip arthroscopic surgery has
evolved into one of the most rapidly expanding fields in orthopaedic surgery.
Complications are largely transient and incidences between 0.5%
and 6.4% have been reported. However, major complications can and
do occur. This article analyses the reported complications and makes recommendations
based on the literature review and personal experience on how to
minimise them.
This study evaluates the long-term survival of
spinal implants after surgical site infection (SSI) and the risk
factors associated with treatment failure. A Kaplan-Meier survival analysis was carried out on 43 patients
who had undergone a posterior spinal fusion with instrumentation
between January 2006 and December 2008, and who consecutively developed
an acute deep surgical site infection. All were appropriately treated
by surgical debridement with a tailored antibiotic program based
on culture results for a minimum of eight weeks. A ‘terminal event’ or failure of treatment was defined as implant
removal or death related to the SSI. The mean follow-up was 26 months
(1.03 to 50.9). A total of ten patients (23.3%) had a terminal event.
The rate of survival after the first debridement was 90.7% (95%
confidence interval (CI) 82.95 to 98.24) at six months, 85.4% (95%
CI 74.64 to 96.18) at one year, and 73.2% (95% CI 58.70 to 87.78)
at two, three and four years. Four of nine patients required re-instrumentation
after implant removal, and two of the four had a recurrent infection
at the surgical site. There was one recurrence after implant removal
without re-instrumentation. Multivariate analysis revealed a significant risk of treatment
failure in patients who developed sepsis (hazard ratio (HR) 12.5
(95% confidence interval (CI) 2.6 to 59.9); p <
0.001) or who
had >
three fused segments (HR 4.5 (95% CI 1.25 to 24.05); p = 0.03).
Implant survival is seriously compromised even after properly treated
surgical site infection, but progressively decreases over the first
24 months. Cite this article:
The aim of this study was to evaluate whether
coating titanium discs with selenium in the form of sodium selenite decreased
bacterial adhesion of In order to evaluate bacterial adhesion, sterile titanium discs
were coated with increasing concentrations of selenium and incubated
with bacterial solutions of The tested Selenium coating is a promising method to reduce bacterial attachment
on prosthetic material. Cite this article:
In patients with severe quadriplegic cerebral palsy and painful hip dislocation proximal femoral resection arthroplasty can reduce pain, but the risk of heterotopic ossification is significant. We present a surgical technique of autologous capping of the femoral stump in order to reduce this risk, using the resected femoral head as the graft. A retrospective study of 31 patients (43 hips) who had undergone proximal femoral resection arthroplasty with (29 hips) and without autologous capping (14 hips) was undertaken. Heterotopic ossification was less frequent in patients with autologous capping, and a more predictable pattern of bony overgrowth was found. For a selected group of non-ambulatory patients with long-standing painful dislocation of the hip, we recommend femoral resection arthroplasty over more complicated reconstructive operations. The risk of heterotopic ossification, which is a major disadvantage of this operation, is reduced by autologous capping.
This paper reports the cost of outpatient venous
thromboembolism (VTE) prophylaxis following 388 injuries of the lower
limb requiring immobilisation in our institution, from a total of
7408 new patients presenting between May and November 2011. Prophylaxis
was by either self-administered subcutaneous dalteparin (n = 128)
or oral dabigatran (n = 260). The mean duration of prophylaxis per
patient was 46 days (6 to 168). The total cost (pay and non-pay)
for prophylaxis with dalteparin was £107.54 and with dabigatran
was £143.99. However, five patients in the dalteparin group required
nurse administration (£23 per home visit), increasing the cost of
dalteparin to £1142.54 per patient. The annual cost of VTE prophylaxis
in a busy trauma clinic treating 12 700 new patients (2010/11), would
be
£92 526.33 in the context of an income for trauma of £1.82 million,
which represents 5.3% of the outpatient tariff. Outpatient prophylaxis in a busy trauma clinic is achievable
and affordable in the context of the clinical and financial risks
involved. Cite this article:
There is currently no consensus about the mean
volume of blood lost during spinal tumour surgery and surgery for metastatic
spinal disease. We conducted a systematic review of papers published
in the English language between 31 January 1992 and 31 January 2012.
Only papers that clearly presented blood loss data in spinal surgery
for metastatic disease were included. The random effects model was
used to obtain the pooled estimate of mean blood loss. We selected 18 papers, including six case series, ten retrospective
reviews and two prospective studies. Altogether, there were 760
patients who had undergone spinal tumour surgery and surgery for
metastatic spinal disease. The pooled estimate of peri-operative
blood loss was 2180 ml (95% confidence interval 1805 to 2554) with catastrophic
blood loss as high as 5000 ml, which is rare. Aside from two studies
that reported large amounts of mean blood loss (>
5500 ml), the
resulting funnel plot suggested an absence of publication bias.
This was confirmed by Egger’s test, which did not show any small-study
effects
(p = 0.119). However, there was strong evidence of heterogeneity
between studies (I2 = 90%; p <
0.001). Spinal surgery for metastatic disease is associated with significant
blood loss and the possibility of catastrophic blood loss. There
is a need to establish standardised methods of calculating and reporting
this blood loss. Analysis should include assessment by area of the
spine, primary pathology and nature of surgery so that the amount
of blood loss can be predicted. Consideration should be given to
autotransfusion in these patients. Cite this article: