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Orthopaedics Current Awareness

Newsletter

March 2015

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Contents Your Friendly Local Librarian… ........................................................................................................... 2

New Cochrane Library Systematic Reviews related to Orthopaedics .................................................. 3

New from NICE .................................................................................................................................. 3

New from Public Health England ....................................................................................................... 4

New Activity in UptoDate and DynaMed ............................................................................................ 5

Current Awareness Database Articles related to Orthopaedics .......................................................... 5

Medical ......................................................................................................................................... 5

Patient care and management ..................................................................................................... 12

Psychological ............................................................................................................................... 17

Other ........................................................................................................................................... 19

Journal Tables of Contents............................................................................................................... 20

Journal of Bone and Joint Surgery ................................................................................................ 20

Journal of Orthopaedic Trauma ................................................................................................... 22

Injury ........................................................................................................................................... 23

Strategies in Trauma and Limb Construction ................................................................................ 25

Clinical Orthopaedics and Related Research................................................................................. 26

Your Friendly Local Librarian… Whatever your information needs, the library is here to help. As your outreach librarian I offer

literature searching services as well as training and guidance in searching the evidence and critical

appraisal – just email me at bennet.jones@uhbristol.nhs.uk

Your Outreach Librarian can help facilitate evidence-based practise for all in the OUTREACH:

Orthopaedics team, as well as assisting with academic study and research. We can help with

literature searching, obtaining journal articles and books, and setting up individual current

awareness alerts. We also offer one-to-one or small group training in literature searching,

accessing electronic journals, and critical appraisal. Get in touch: bennet.jones@uhbristol.nhs.uk

We provide a literature searching service for any library member. For LITERATURE SEARCHING:

those embarking on their own research it is advisable to book some time with one of the librarians

for a 1 to 1 session where we can guide you through the process of creating a well-focused literature

research and introduce you to the health databases access via NHS Evidence. Please email requests

to bennet.jones@uhbristol.nhs.uk

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New Cochrane Library Systematic Reviews

related to Orthopaedics

Surgical versus non-surgical interventions for treating patellar dislocation

Toby O Smith; Simon Donell; Fujian Song; Caroline B Hing

First published: 26 February 2015

Patellar dislocation occurs when the patella disengages completely from the trochlear (femoral)

groove. Following reduction of the dislocation, conservative (non-surgical) rehabilitation with

physiotherapy may be used. Since recurrence of dislocation is common, some surgeons have

advocated surgical intervention rather than non-surgical interventions. This is an update of a

Cochrane review first published in 2011. Objectives: To assess the effects (benefits and harms) of

surgical versus non-surgical interventions for treating people with primary or recurrent patellar

dislocation.

Prosthetic rehabilitation for older dysvascular people following a unilateral transfemoral

amputation

Jane Cumming; Steve Barr; Tracey E Howe

First published: 25 January 2015

Dysvascularity accounts for 75% of all lower limb amputations in the UK. Around 37% of these are at

transfemoral level (mid-thigh), with the majority of people being over the age of 60 and having

existing co-morbidities. A significant number of these amputees will be prescribed a lower limb

prosthesis for walking. However, many amputees do not achieve a high level of function following

prosthetic rehabilitation. This is the second update of the review first published in 2005. Objectives:

We aimed to identify and summarise the evidence from randomised controlled trials evaluating

rehabilitation interventions for prosthetic ambulation following unilateral transfemoral amputation

in older dysvascular people, whether community dwelling or institutionalised.

New from NICE

Open reduction of slipped capital femoral epiphysis

NICE interventional procedure guidance [IPG511] Published date: January 2015

The capital femoral epiphysis forms part of the ball-and-socket joint of the hip. In children and

adolescents the ball and shaft of the femur are connected by a layer of soft cartilage, known as the

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growth plate, which allows for growth and hardens at adulthood. A slipped capital femoral epiphysis

(SCFE) results in the displacement of the femoral head, usually posteriorly and inferiorly in relation

to the femoral neck and within the confines of the acetabulum. This can cause knee and/or hip pain,

limping and considerable deformity.

Treatment options depend on the severity of the slip. Treatment of mild-to-moderate slips usually

involves percutaneous in situ fixation, with or without prophylactic pinning of the contralateral hip

using cannulated screws or Kirschner wires. For more severe acute slips, treatment options include

open fixation of the growth plate using a bone graft combined with early intertrochanteric

osteotomy to allow a full range of hip movement, or closed reduction and in situ fixation with

cannulated screws or Kirschner wires.

Implantation of a shock or load absorber for mild to moderate symptomatic medial knee

osteoarthritis

NICE interventional procedure guidance [IPG512] Published date: January 2015

Osteoarthritis of the medial compartment of the knee is the result of progressive deterioration of

the articular cartilage and menisci of the joint. This leads to exposure of the bone surface and

chronic excessive joint loading during movement. Symptoms include joint pain, stiffness, local

inflammation, limited movement and loss of knee function.

Treatment depends on the severity of the osteoarthritis. Conservative treatments include: analgesics

and corticosteroid injections to relieve pain and inflammation; physiotherapy and exercise to

improve function and mobility; and weight loss for people who are overweight or obese, as

recommended in NICE’s guideline on osteoarthritis. When symptoms are severe, surgery may be

indicated. Options include high tibial osteotomy and unicompartmental or total knee arthroplasty.

New from Public Health England

Surgical site infection surveillance service (SSISS)

This service allows hospitals to record incidents of infection after surgery, track patient results and

review or change practice to avoid further infections.

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New Activity in UptoDate and DynaMed

For full text to the following, log in with your Athens details.

Relative efficacy of pharmacologic interventions for knee osteoarthritis (February 2015)

Early mobilization after surgery may reduce length of hospital stay in patients with osteoarthritis

having knee or hip arthroplasty (Clin Rehabil 2014 Dec 1 early online)

Apixaban may decrease risk of bleeding compared to other anticoagulants in patients with mild

renal impairment, but not in patients with moderate to severe renal impairment (Am J Cardiol

2015 Feb 1)

Current Awareness Database Articles related to

Orthopaedics

Below is a selection of articles related to orthopaedics recently added to the healthcare databases,

grouped in the following categories:

Medical

Patient care and management

Psychological

Other

If you would like any of the following articles in full text, or if you would like a more focused

bennet.jones@uhbristol.nhs.uk search on your own topic, then get in touch:

Medical

Title: Acute compartment syndrome in orthopedics: causes, diagnosis, and management.

Citation: Advances in Orthopaedics, 2015, vol./is. 2015/(543412), 2090-3464;2090-3464 (2015)

Author(s): Raza H, Mahapatra A

Abstract: Almost all orthopaedic surgeons come across acute compartment syndrome (ACS) in their

clinical practice. Diagnosis of ACS mostly relies on clinical findings. If the diagnosis is missed and left

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untreated, it can lead to serious consequences which can endanger limb and life of the patient and

also risk the clinician to face lawsuits. This review article highlights the characteristic features of ACS

which will help an orthopaedic surgeon to understand the pathophysiology, natural history, high risk

patients, diagnosis, and surgical management of the condition.

Title: The promising application of graphene oxide as coating materials in orthopedic implants:

preparation, characterization and cell behavior.

Citation: Biomedical Materials, February 2015, vol./is. 10/1(015019), 1748-6041;1748-605X (2015

Feb)

Author(s): Zhao C, Lu X, Zanden C, Liu J

Abstract: To investigate the potential application of graphene oxide (GO) in bone repair, this study is

focused on the preparation, characterization and cell behavior of graphene oxide coatings on quartz

substrata. GO coatings were prepared on the substrata using a modified dip-coating procedure.

Atomic force microscopy (AFM), scanning electron microscopy (SEM) and Raman spectroscopy

results demonstrated that the as-prepared coatings in this study were homogeneous and had an

average thickness of ~67nm. The rapid formation of a hydroxyapatite (HA) layer in the simulated

body fluid (SBF) on GO coated substrata at day 14, as proved by SEM and x-ray diffraction (XRD),

strongly indicated the bioactivity of coated substrata. In addition, MC3T3-E1 cells were cultured on

the coated substrata to evaluate cellular activities. Compared with the non-coated substrata and

tissue culture plates, no significant difference was observed on the coated substrata in terms of

cytotoxicity, viability, proliferation and apoptosis. However, interestingly, higher levels of alkaline

phosphatase (ALP) activity and osteocalcin (OC) secretion were observed on the coated substrata,

indicating that GO coatings enhanced cell differentiation compared with non-coated substrata and

tissue culture plates. This study suggests that GO coatings had excellent biocompatibility and more

importantly promoted MC3T3-E1 cell differentiation and might be a good candidate as a coating

material for orthopedic implants.

Title: The use of early immobilization in the management of acute soft-tissue injuries of the knee:

results of a survey of emergency physicians, sports medicine physicians and orthopedic surgeons.

Citation: Canadian Journal of Surgery, February 2015, vol./is. 58/1(48-53), 0008-428X;1488-2310

(2015 Feb)

Author(s): Sommerfeldt M, Bouliane M, Otto D, Rowe BH, Beaupre L

Abstract: BACKGROUND: Evidence-based guidelines on the use of immobilization in the

management of common acute soft-tissue knee injuries do not exist. Our objective was to explore

the practice patterns of emergency physicians (EPs), sports medicine physicians (SMPs) and

orthopedic surgeons (OS) regarding the use of early immobilization in the management of these

injuries.METHODS: We developed a web-based survey and sent it to all EPs, SMPs and OS in a

Canadian urban centre. The survey was designed to assess the likelihood of prescribing

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immobilization and to evaluate factors associated with physicians from these 3 disciplines making

this decision.RESULTS: The overall response rate was 44 of 112 (39%): 17 of 58 (29%) EPs, 7 of 15

(47%) SMPs and 20 of 39 (51%) OS. In cases of suspected meniscus injuries, 9 (50%) EPs indicated

they would prescribe immobilization, whereas no SMPs and 1 (5%) OS would immobilize (p = 0.002).

For suspected anterior cruciate ligament injuries, 13 (77%) EPs, 2 (29%) SMPs and 5 (25%) OS said

they would immobilize (p = 0.005). For lateral collateral ligament injuries, 9 (53%) EPs, no SMPs and

6 (32%) OS would immobilize (p = 0.04). All respondents would prescribe immobilization for a grossly

unstable knee.CONCLUSION: We found that EPs were are more likely to prescribe immobilization for

certain acute soft-tissue knee injuries than SMPs and OS. The development of an evidenced- based

guideline for the use of knee immobilization after acute soft-tissue injury may reduce practice

variability.Publisher: Abstract available from the publisher.; Language: French

Title: Chemical functionalization of graphene to augment stem cell osteogenesis and inhibit

biofilm formation on polymer composites for orthopedic applications.

Citation: Acs Applied Materials & Interfaces, February 2015, vol./is. 7/5(3237-52), 1944-8244;1944-

8252 (2015 Feb 11)

Author(s): Kumar S, Raj S, Kolanthai E, Sood AK, Sampath S, Chatterjee K

Abstract: Toward designing the next generation of resorbable biomaterials for orthopedic

applications, we studied poly(-caprolactone) (PCL) composites containing graphene. The role, if any,

of the functionalization of graphene on mechanical properties, stem cell response, and biofilm

formation was systematically evaluated. PCL composites of graphene oxide (GO), reduced GO (RGO),

and amine-functionalized GO (AGO) were prepared at different filler contents (1%, 3%, and 5%).

Although the addition of the nanoparticles to PCL markedly increased the storage modulus, this

increase was largest for GO followed by AGO and RGO. In vitro cell studies revealed that the AGO

and GO particles significantly increased human mesenchymal stem cell proliferation. AGO was most

effective in augmenting stem cell osteogenesis leading to mineralization. Bacterial studies revealed

that interaction with functionalized GO induced bacterial cell death because of membrane damage,

which was further accentuated by amine groups in AGO. As a result, AGO composites were best at

inhibiting biofilm formation. The synergistic effect of oxygen containing functional groups and amine

groups on AGO imparts the optimal combination of improved modulus, favorable stem cell

response, and biofilm inhibition in AGO-reinforced composites desired for orthopedic applications.

This work elucidates the importance of chemical functionalization of graphene in polymer

composites for biomedical applications.

Title: Biofilm-based implant infections in orthopaedics.

Citation: Advances in Experimental Medicine & Biology, 2015, vol./is. 830/(29-46), 0065-2598;0065-

2598 (2015)

Author(s): Arciola CR, Campoccia D, Ehrlich GD, Montanaro L

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Abstract: The demand for joint replacement surgery is continuously increasing with rising costs for

hospitals and healthcare systems. Staphylococci are the most prevalent etiological agents of

orthopedic infections. After an initial adhesin-mediated implant colonization, Staphylococcus aureus

and Staphylococcus epidermidis produce biofilm. Biofilm formation proceeds as a four-step process:

(1) initial attachment of bacterial cells; (2) cell aggregation and accumulation in multiple cell layers;

(3) biofilm maturation and (4) detachment of cells from the biofilm into a planktonic state to initiate

a new cycle of biofilm formation elsewhere. The encasing of bacteria in biofilms gives rise to

insuperable difficulties not only in the treatment of the infection, but also in assessing the state and

the nature of the infection using traditional cultural methods. Therefore, DNA-based molecular

methods have been developed to provide rapid identification of all microbial pathogens. To combat

biofilm-centered implant infections, new strategies are being developed, among which anti-infective

or infective-resistant materials are at the forefront. Infection-resistant materials can be based on

different approaches: (i) modifying the biomaterial surface to give anti-adhesive properties, (ii)

doping the material with antimicrobial substances, (iii) combining anti-adhesive and antimicrobial

effects in the same coating, (iv) designing materials able to oppose biofilm formation and support

bone repair.

Title: A randomized, open-label trial of edoxaban in Japanese patients with severe renal

impairment undergoing lower-limb orthopedic surgery.

Citation: Thrombosis Journal [Electronic Resource], 2015, vol./is. 13/1(6), 1477-9560;1477-9560

(2015)

Author(s): Fuji T, Fujita S, Kawai Y, Abe Y, Kimura T, Fukuzawa M, Abe K, Tachibana S

Abstract: BACKGROUND: Edoxaban is an oral, direct, factor Xa inhibitor approved in Japan for

thromboembolic prophylaxis after lower-limb orthopedic surgery (LLOS), but contraindicated in

patients with severe renal impairment (SRI; creatinine clearance [CLCR] >15 to <30

mL/min).METHODS: This open-label study compared the safety of edoxaban 15 mg once daily in

Japanese patients with SRI to that of edoxaban 30 mg in patients with mild renal impairment (MiRI;

CLCR >50 to <80 mL/min; N=30) undergoing LLOS. Patients with CLCR >20 to <30 mL/min were

randomized to receive edoxaban 15 mg (N=22) or subcutaneous fondaparinux 1.5 mg once daily

(N=21). All patients with CLCR >15 to <20 mL/min received edoxaban 15 mg (N=7). Treatment was

administered for 11 to 14 days.RESULTS: Major or clinically relevant non-major bleeding occurred in

6.7%, 3.4%, and 5.0% of patients in the MiRI edoxaban 30-mg, SRI edoxaban 15-mg, and SRI

fondaparinux groups, respectively; there were no major bleeding events. No thromboembolic events

occurred. At all time points assessed, edoxaban plasma concentrations and changes in coagulation

biomarkers were similar between the SRI and MiRI groups.CONCLUSIONS: These results suggest

edoxaban 15 mg once daily is well tolerated in Japanese patients with SRI undergoing LLOS.TRIAL

REGISTRATION: Clinicaltrials.gov Identifier: NCT01857583.

Title: Microbial colonisation of orthopaedic tourniquets: A potential risk for surgical site infection.

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Citation: Indian Journal of Medical Microbiology, February 2015, vol./is. 33 Suppl/(S115-8), 0255-

0857;1998-3646 (2015 Feb)

Author(s): Sahu SK, Tudu B, Mall PK

Abstract: Pneumatic tourniquets have been used in orthopaedic surgery to get avascular fields.

Sixteen such tourniquets were analysed for microbial colonisation. Samples were taken from two

inner and two outer areas of each tourniquet and cultured on sheep blood agar. Eight of these were

wiped with Savlon and the rest with Sterillium solution. Post-treatment samples from the same sites

were again cultured. After incubation, colonies from each site were identified and counted. It was

observed that the tourniquets were colonised with coagulase-negative staphylococci,

Staphylococcus aureus, Bacillus, diphtheroids, Pseudomonas, Acinetobacter, enterococci,

enterobacteria, and Candida. On treating with Savlon and Sterillium, there was 92.18% and 95.70%

reduction in the colony count, respectively.

Title: Evidence against implant-derived cobalt toxicity: Case report and retrospective study of

serum cobalt concentrations in an orthopedic implant population.

Citation: Clinical Biochemistry, February 2015, vol./is. 48/3(130-4), 0009-9120;1873-2933 (2015 Feb)

Author(s): Tolan NV, Sierra RJ, Moyer TP

Abstract: OBJECTIVES: Cobalt (Co) exposure has been documented to result in increased

erythropoiesis. To evaluate the potential for implant-derived Co toxicity, we examined the

relationship between serum Co (sCo) and erythrocyte counts (ERY) in a metal-containing total-hip

arthroplasty implant population.METHODS: Retrospective review of sCo concentrations identified 77

patients with concomitant ERY. Statistical analysis was performed to determine if there was a

significant difference in ERY for patients divided into clinically relevant sCo ranges. A single detailed

case review of a patient with a loose mal-positioned acetabular component and significantly

elevated sCo was also performed for symptoms thought to arise from Co toxicity.RESULTS: Statistical

difference in ERY was not observed between patients with significantly elevated (>10ng/mL),

elevated (4-10ng/mL), modestly elevated (1.0-3.9ng/mL), or normal (<1.0ng/mL) sCo. While the

detailed case report was unremarkable for any of the clinical symptoms previously reported to be

associated with Co toxicity and no increase in ERY was observed, this patient's sCo was

84ng/mL.CONCLUSIONS: Increased erythropoiesis was not observed in patients with implant-derived

increased sCo. Even with a sCo 100x the upper-limit of normal, the patient presented did not have

increased ERY nor exhibit any symptoms ascribed with Co toxicity.Copyright &#xa9; 2014 The

Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Title: Usefulness of a Metal Artifact Reduction Algorithm for Orthopedic Implants in Abdominal

CT: Phantom and Clinical Study Results.

Citation: AJR. American Journal of Roentgenology, February 2015, vol./is. 204/2(307-17), 0361-

803X;1546-3141 (2015 Feb)

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Author(s): Jeong S, Kim SH, Hwang EJ, Shin CI, Han JK, Choi BI

Abstract: OBJECTIVE. The purpose of this study was to evaluate the usefulness of a metal artifact

reduction (MAR) algorithm for orthopedic prostheses in phantom and clinical CT. MATERIALS AND

METHODS. An agar phantom with two sets of spinal screws was scanned at various tube voltage (80-

140 kVp) and tube current-time (34-1032 mAs) settings. The orthopedic MAR algorithm was

combined with filtered back projection (FBP) or iterative reconstruction. The mean SDs in three ROIs

were compared among four datasets (FBP, iterative reconstruction, FBP with orthopedic MAR, and

iterative reconstruction with orthopedic MAR). For the clinical study, the mean SDs of three ROIs

and 4-point scaled image quality in 52 patients with metallic orthopedic prostheses were compared

between CT images acquired with and without orthopedic MAR. The presence and type of image

quality improvement with orthopedic MAR and the presence of orthopedic MAR-related new

artifacts were also analyzed. RESULTS. In the phantom study, the mean SD with orthopedic MAR was

significantly lower than that without orthopedic MAR regardless of dose settings and reconstruction

algorithms (FBP versus iterative reconstruction). The mean SD near the metallic prosthesis in 52

patients was significantly lower on CT images with orthopedic MAR (28.04 HU) than those without it

(49.21 HU). Image quality regarding metallic artifact was significantly improved with orthopedic MAR

(rating of 2.60 versus 1.04). Notable reduction of metallic artifacts and better depiction of abdominal

organs were observed in 45 patients. Diagnostic benefit was achieved in six patients, but orthopedic

MAR-related new artifacts were seen in 30 patients. CONCLUSION. Use of the orthopedic MAR

algorithm significantly reduces metal artifacts in CT of both phantoms and patients and has potential

for improving diagnostic performance in patients with severe metallic artifacts.

Title: Postural Orthostatic Tachycardia Syndrome (POTS): Association with Ehlers-Danlos

Syndrome and Orthopaedic Considerations.

Citation: Clinical Orthopaedics & Related Research, February 2015, vol./is. 473/2(722-8), 0009-

921X;1528-1132 (2015 Feb)

Author(s): Grigoriou E, Boris JR, Dormans JP

Abstract: BACKGROUND: Postural orthostatic tachycardia syndrome (POTS) is the most common of

several types of dysautonomia, characterized by dysfunction of the autonomic nervous system

manifesting with symptoms of orthostatic intolerance with or without associated orthostatic

hypotension and excessive autonomic excitation. Given the numerous presenting musculoskeletal

symptoms of POTS and its known associations with other clinical entities like Ehlers-Danlos

syndrome, POTS constitutes an unusual treatment challenge of which the orthopaedic surgeon and

other related healthcare providers should be aware.CASE DESCRIPTION: We describe two patients

with a diagnosis of POTS and musculoskeletal manifestations. The first is a 13-year-old boy with a

concurrent diagnosis of Ehlers-Danlos syndrome and worsening back pain. The patient had

resolution of his musculoskeletal symptoms after treatment with a Boston Overlap LSO brace and

physical therapy and resolution of his cardiovascular symptoms after pharmacologic treatment. The

second patient is a 17-year-old girl with an L1 vertebral hemangioma and pain of sudden onset

radiating to her lower extremities. Her symptoms were controlled with therapy and

gabapentin.LITERATURE REVIEW: POTS is a poorly understood and controversial clinical entity with

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lack of awareness and knowledge regarding the syndrome by the majority of medical specialists. Its

complex and wide range of clinical presentation has led to being commonly mistaken with

malingering, depression and anxiety disorders. Review of the literature did not yield any previous

studies addressing POTS and the special considerations for the orthopaedic surgeon caring for these

patients; previous studies of large patient series focus on investigating the pathologic substrate of

POTS and the efficacy of various treatment modalities on the cardiovascular dysregulation.CLINICAL

RELEVANCE: These two cases show that understanding and knowledge of this syndrome and its

comorbidities should guide any diagnostic approach or therapeutic intervention by the orthopaedic

surgeon caring for patients with this syndrome. It is important that the surgeon is aware of the

benefits of detailed patient education and physical conditioning, the increased perioperative

complications, and the need for specialized anesthesia.

Title: Incorporation of raloxifene-impregnated allograft around orthopedic titanium implants

impairs early fixation but improves new bone formation.

Citation: Acta Orthopaedica, February 2015, vol./is. 86/1(127-33), 1745-3674;1745-3682 (2015 Feb)

Author(s): Hermansen LL, Sorensen M, Barckman J, Bechtold JE, Soballe K, Baas J

Abstract: Background - The anti-osteoporotic drug raloxifene reduces the risk of vertebral fractures

by increasing bone mass density. We investigated whether raloxifene offers any benefits in

augmenting early fixation of orthopedic implants in the setting of impaction bone grafting. Methods

- 24 non-weight-bearing grafted gap implants were inserted bilaterally into the tibia of 12 dogs. The

2.5-mm peri-implant gap was filled with either raloxifene-impregnated or untreated bone allograft.

Implants were harvested after 28 days. Implant fixation was assessed by mechanical testing and

histomorphometric evaluation. Results - Raloxifene-treated allograft reduced early implant fixation

compared to untreated allograft, as measured by inferior maximum shear strength (p < 0.001) and

apparent shear stiffness (p = 0.001). We found that the raloxifene group had more newly formed

bone in the gap around the implant (p = 0.02), but also less allograft (p = 0.03). Interpretation - The

accelerated allograft resorption in the raloxifene group explained the impaired early fixation, despite

its stimulation of new bone formation. Our results with local and possible high-dose treatment are

not consistent with current theory regarding the mechanism of how systemic raloxifene

administration counteracts the decrease in BMD in postmenopausal women. Instead of being solely

anti-resorptive as generally held, our results indicate a possible anabolic side of raloxifene.

Title: Epidemiology and risk factors for surgical site infections in patients requiring orthopedic

surgery.

Citation: European journal of orthopaedic surgery & traumatologie, February 2015, vol./is.

25/2(251-4), 1633-8065;1633-8065 (2015 Feb)

Author(s): Jain RK, Shukla R, Singh P, Kumar R

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Abstract: INTRODUCTION: Surgical site infection (SSI) is the most common complication following

surgical procedures. The aim of this study was to determine the incidence and associated risk factors

of SSI in orthopedic patients admitted in a tertiary care center.MATERIALS AND METHODS: Data

were collected which focused on demographic details, lifestyle factors, diagnosis, surgical procedure,

duration of surgery, prophylactic antibiotics, postoperative antibiotics and comorbidity obtained

from the patients hospital records. Univariate analysis and multinomial logistic regression tests were

performed to identify independent risk factors for orthopedic incisional SSIs.RESULTS: The overall

rate of SSI was 2.1 %. Univariate analysis showed diabetes, smoking and duration of hospital stay to

be significantly associated with patients in whom SSI developed than in uninfected control patients.

Independent risk factors for SSI that were identified by multinomial logistic regression were diabetes

(OR 3.953) and smoking (OR 38.319).CONCLUSION: Diabetes and smoking were independent risk

factors for SSIs. Therefore, it is recommended to tightly regulate blood glucose levels and stop

smoking to reduce the SSIs.

Title: High-strength, surface-porous polyether-ether-ketone for load-bearing orthopedic implants.

Citation: Acta Biomaterialia, February 2015, vol./is. 13/(159-67), 1742-7061;1878-7568 (2015 Feb)

Author(s): Evans NT, Torstrick FB, Lee CS, Dupont KM, Safranski DL, Chang WA, Macedo AE, Lin AS,

Boothby JM, Whittingslow DC, Carson RA, Guldberg RE, Gall K

Abstract: Despite its widespread clinical use in load-bearing orthopedic implants, polyether-ether-

ketone (PEEK) is often associated with poor osseointegration. In this study, a surface-porous PEEK

material (PEEK-SP) was created using a melt extrusion technique. The porous layer was 399.6+/-

63.3mum thick and possessed a mean pore size of 279.9+/-31.6mum, strut spacing of 186.8+/-

55.5mum, porosity of 67.3+/-3.1% and interconnectivity of 99.9+/-0.1%. Monotonic tensile tests

showed that PEEK-SP preserved 73.9% of the strength (71.06+/-2.17MPa) and 73.4% of the elastic

modulus (2.45+/-0.31GPa) of as-received, injection-molded PEEK. PEEK-SP further demonstrated a

fatigue strength of 60.0MPa at one million cycles, preserving 73.4% of the fatigue resistance of

injection-molded PEEK. Interfacial shear testing showed the pore layer shear strength to be 23.96+/-

2.26MPa. An osseointegration model in the rat revealed substantial bone formation within the pore

layer at 6 and 12weeks via microcomputed tomography and histological evaluation. Ingrown bone

was more closely apposed to the pore wall and fibrous tissue growth was reduced in PEEK-SP when

compared to non-porous PEEK controls. These results indicate that PEEK-SP could provide improved

osseointegration while maintaining the structural integrity necessary for load-bearing orthopedic

applications. Copyright &#xa9; 2014 Acta Materialia Inc. Published by Elsevier Ltd. All rights

reserved.

Patient care and management

Title: The impact of a daily pre-operative surgical huddle on interruptions, delays, and surgeon

satisfaction in an orthopedic operating room: a prospective study.

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Citation: Patient Safety in Surgery [Electronic Resource], 2015, vol./is. 9/(8), 1754-9493;1754-9493

(2015)

Author(s): Jain AL, Jones KC, Simon J, Patterson MD

Abstract: BACKGROUND: The goal of this project was to implement a daily pre-operative huddle

(briefing) for orthopedic cases and evaluate the impact of the daily huddle on surgeons' perceptions

of interruptions and operative delays.METHODS: Baseline measurements on interruptions, delays,

and questions were obtained. Then the daily pre-operative huddle was introduced. Surgeons

completed a surgical outcomes worksheet for each day's cases. Outcomes evaluated were primarily

interruptions and delays starting cases before and following introduction of the huddle.RESULTS: 19

baseline observations and 19 huddle-implemented observations of surgeon's days were assessed.

Overall, surgeon satisfaction increased and fewer delays occurred after introduction of huddles.

Interruptions decreased in all categories including equipment, antibiotics, planned procedure and

side. Time required for a huddle was less than one minute per case.CONCLUSIONS: In this pilot

study, a daily pre-operative huddle improved the flow of a surgeon's day and satisfaction and

indirectly provided indications of safety benefits by decreasing the number of interruptions and

delays. Further studies in other surgical specialties should be conducted due to the promising

results. Data was collected from three orthopedic surgeons in this phase; however, as a next step,

data should be drawn from the rest of the orthopedic surgical team and other surgical subspecialties

as well.

Title: Physiotherapy triage assessment of patients referred for orthopaedic consultation - Long-

term follow-up of health-related quality of life, pain-related disability and sick leave.

Citation: Manual Therapy, February 2015, vol./is. 20/1(38-45), 1356-689X;1532-2769 (2015 Feb)

Author(s): Samsson KS, Larsson ME

Abstract: INTRODUCTION: The literature indicates that physiotherapy triage assessment can be

efficient for patients referred for orthopaedic consultation, however long-term follow up of patient

reported outcome measures are not available.AIM: To report a long-term evaluation of patient-

reported health-related quality of life, pain-related disability, and sick leave after a physiotherapy

triage assessment of patients referred for orthopaedic consultation compared with standard

practice.METHODS: Patients referred for orthopaedic consultation (n = 208) were randomised to

physiotherapy triage assessment or standard practice. The randomised cohort was analysed on an

intention-to-treat (ITT) basis. The patient reported outcome measures EuroQol VAS (self-reported

health-state), EuroQol 5D-3L (EQ-5D) and Pain Disability Index (PDI) were assessed at baseline and

after 3, 6 and 12 months. EQ VAS was analysed using a repeated measure ANOVA. PDI and EQ-5D

were analysed using a marginal logistic regression model. Sick leave was analysed for the 12 months

following consultation using a Mann-Whitney U-test.RESULTS: The patients rated a significantly

better health-state at 3 after physiotherapy triage assessment [mean difference -5.7 (95% CI -11.1; -

0.2); p = 0.04]. There were no other statistically significant differences in perceived health-related

quality of life or pain related disability between the groups at any of the follow-ups, or sick

leave.CONCLUSION: This study reports that the long-term follow up of the patient related outcome

14

measures health-related quality of life, pain-related disability and sick leave after physiotherapy

triage assessment did not differ from standard practice, indicating the possible benefits of

implementation of this model of care.Copyright &#xa9; 2014 Elsevier Ltd. All rights reserved.

Title: The influence of patient factors on patient-reported outcomes of orthopedic surgery

involving implantable devices: a systematic review.

Citation: Seminars in Arthritis & Rheumatism, February 2015, vol./is. 44/4(461-71), 0049-0172;1532-

866X (2015 Feb)

Author(s): Waheeb A, Zywiel MG, Palaganas M, Venkataramanan V, Davis AM

Abstract: OBJECTIVES: Recent evidence suggests that patient factors can influence response to

medical and surgical treatment and may play an under-recognized role in predicting treatment

outcomes. However, the current state of knowledge concerning potential associations following

orthopedic surgery in particular is unclear. The purpose of the present study was to systematically

review current literature to investigate the currently known associations between pre-operative

patient factors and patient-reported outcomes following orthopedic surgery.METHODS: A

systematic review was performed of the PubMed database to identify original studies that

investigated the relationships between one or more patient factors and patient-reported outcomes

of primary orthopedic surgical procedures involving implantation of a medical device. A total of

10,174 records were identified, with 83 studies included in the final review.RESULTS: The most

commonly assessed patient factors included age, sex, and body mass index (BMI), reported in 63%,

55%, and 48% of studies, respectively. The only other patient factors identified were socioeconomic

status and race, both of which were assessed in a single study. Considerable heterogeneity was

observed in the methods used to stratify subjects by patient factors, patient-reported outcome

constructs assessed, and follow-up intervals. Only 10% of studies performed appropriate sample size

or power calculations, only 51% used methodologies to control for potentially confounding factors,

and 6% assessed responder status. Overall, variable and conflicting findings were seen. While female

sex and increasing BMI did appear to be associated with worse absolute outcomes, these differences

did not appear to be maintained when differences in baseline status were considered. No clear

associations between age and outcomes were identified.CONCLUSIONS: The present understanding

of these relationships between patient factors and patient-reported outcomes following orthopedic

surgery is limited. There is a need for further studies using high-quality methodology, consistent

stratification of participants based on patient factors, accepted patient-reported outcome

constructs, and appropriate assessment of responder status.Copyright &#xa9; 2014 Elsevier Inc. All

rights reserved.

Title: The effect of a non-surgical orthopaedic physician on wait times to see a paediatric

orthopaedic surgeon.

Citation: Journal of Paediatrics & Child Health, February 2015, vol./is. 51/2(174-9), 1034-4810;1440-

1754 (2015 Feb)

15

Author(s): Bowman M, Mackey A, Wilson N, Stott NS

Abstract: AIMS: High referral volumes to paediatric orthopaedic surgeons create long clinic waiting

lists. The use of extended scope roles for doctors and health professionals is one strategy to address

these wait times. We completed a 6-month trial of a non-surgical paediatric orthopaedic physician

role (NSP) to help manage non-urgent referrals to our service from local general practitioners

(GPs).METHODS: For a 6-month period, the majority of non-urgent GP referrals were assessed by a

US-trained NSP. Wait times were compared between this period and the same time period in the

previous year. Family and referrer satisfaction was determined through postal surveys.RESULTS:

Over the trial period, the NSP saw a total of 155 new patient referrals, which represented 49% of all

non-urgent GP referrals for the period. Before the trial, only 75% of non-urgent referrals were seen

within 131 days (19 weeks) with 10% waiting more than 215 days (31 weeks). By the end of the trial,

75% of referrals were seen within 55 days (8 weeks) and 90% within 61 days (9 weeks). The most

common outcome was discharge with management advice. 12% of patients were referred on to an

orthopaedic surgeon but only 1% went on to a surgical wait list. Families and referrers reported high

levels of satisfaction and only three patients discharged by the NSP were referred back for

orthopaedic surgeon review.CONCLUSION: The NSP role was effective at reducing clinic wait times

for patients with non-urgent paediatric orthopaedic conditions, while maintaining family and

referrer satisfaction.Copyright &#xa9; 2014 The Authors. Journal of Paediatrics and Child Health

&#xa9; 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Title: Healthcare reimbursement models and orthopaedic trauma: will there be change in patient

management? A survey of orthopaedic surgeons.

Citation: Journal of Orthopaedic Trauma, February 2015, vol./is. 29/2(e79-84), 0890-5339;1531-

2291 (2015 Feb)

Author(s): Ihejirika RC, Sathiyakumar V, Thakore RV, Jahangir AA, Obremskey WT, Mir HR, Sethi MK

Abstract: OBJECTIVES: Healthcare reimbursement models are changing. Fee-for-service may be

replaced by pay-for-performance or capitated care. The purpose of this study was to examine the

potential changes in orthopaedic trauma surgery patient management based on potential shifts in

policy surrounding readmission and reimbursement.METHODS: An e-mail survey consisting of 3

case-based scenarios was delivered to 375 orthopaedic surgeons. Five options for management of

each case were provided. Each of the 3 cases was presented in 3 different healthcare settings:

scenario A, our current healthcare setting; scenario B, in which 90-day reoperation or readmission

would not be reimbursed; and scenario C, in which a capitated healthcare structure paid a fixed

amount per patient.RESULTS: The response rate was 40.3% with 151 surgeons completing the

survey. A 71.1% of the respondents were in private practice settings, whereas 28.3% were in

academic centers. In each case, there was significant increase in the respondents' choice to transfer

patients to tertiary care centers under both the capitated and penalization systems as compared

with the current fee-for-service model.CONCLUSIONS: This survey is the first of its kind to

demonstrate through case-based scenarios that a healthcare system with readmission penalties and

capitated reimbursement models may lead to a significant increase in transfer of complex

orthopaedic trauma patients to tertiary care centers. Physicians should be encouraged to continue

16

evidence-based medicine instead of making decisions due to finances, and other avenues of

healthcare savings should be explored to decrease patient transfer rates with healthcare changes.

Title: Do previsit expectations correlate with satisfaction of new patients presenting for evaluation

with an orthopaedic surgical practice?.

Citation: Clinical Orthopaedics & Related Research, February 2015, vol./is. 473/2(716-21), 0009-

921X;1528-1132 (2015 Feb)

Author(s): Hageman MG, Briet JP, Bossen JK, Blok RD, Ring DC, Vranceanu AM

Abstract: BACKGROUND: Patient satisfaction is associated with increased compliance, improved

treatment outcomes, and decreased risk of litigation. Factors such as patient understanding and

psychological well-being are recognized influences on satisfaction. Less is known about the

relationship between previsit expectations and satisfaction.QUESTIONS/PURPOSES: (1) Are there

correlations among previsit expectations, met expectations, and patient satisfaction? (2) What are

the categories of expectations, and which one(s) correlate with satisfaction?METHODS: Eighty-six

new patients presenting to a hand surgery practice of a tertiary referral hospital with 70% direct

primary care referrals, mostly with elective concerns, indicated their previsit expectations (Patient

Intention Questionnaire [PIQ]). Immediately after the visit, the same patients rated the degree to

which their previsit expectations were met (Expectation Met Questionnaire [EMQ]) and their

satisfaction level (Medical Interview Satisfaction Scale). These tools have been used in primary care

office settings and claim good psychometric properties, and although they have not been strictly

validated for responsiveness and other test parameters, they have good face validity. We then

conducted a multivariable backward linear regression to determine whether (1) scores on the PIQ;

and (2) scores on the EMQ are associated with satisfaction.RESULTS: Satisfaction correlated with

met expectations (r = 0.36; p < 0.001) but not with previsit expectations (r = -0.01, p = 0.94). We

identified five primary categories of previsit expectations that accounted for 50% of the variance in

PIQ: (1) "Information and Explanation"; (2) "Emotional and Understanding"; (3) "Emotional

Problems"; (4) "Diagnostics"; and (5) "Comforting". The only category of met expectations that

correlated with satisfaction was Information and Explanation (r = 0.43; p < 0.001).CONCLUSIONS:

Among patients seeing a hand surgeon, met expectations correlate with satisfaction. In particular,

patients with met expectations regarding information and explanation were more satisfied with

their visit. Efforts to determine the most effective methods for conveying unexpected information

warrant investigation.LEVEL OF EVIDENCE: Level II, prognostic study.

Title: How Much Tumor Surgery Do Early-career Orthopaedic Oncologists Perform?.

Citation: Clinical Orthopaedics & Related Research, February 2015, vol./is. 473/2(695-702), 0009-

921X;1528-1132 (2015 Feb)

Author(s): Miller BJ, Rajani R, Leddy L, Carmody Soni EE, White JR, Musculoskeletal Oncology

Research Initiative

17

Abstract: BACKGROUND: There are few data on the types of procedures orthopaedic oncologists

perform in their first years of practice. Because fellowships are graduating fellows each year and the

number of tumor patients is limited, defining the practice patterns of early-career orthopaedic

oncologists may help diminish early employment discontent and enhance workforce

discussions.QUESTIONS/PURPOSES: The aim of the study was to use the objective case log volumes

of a cross-section of early career orthopaedic oncologists to describe (1) the number of operations

performed annually; (2) the proportion of tumor, trauma, adult reconstruction, and other operations

for individual participants, (3) individual practice characteristics that were associated with the

number of tumor procedures; and (4) the sources of satisfaction and challenges in each individual's

career and surgical practice.METHODS: Fifteen fellowship-trained orthopaedic oncologists out of a

potential pool of 33 (45%) in their first 4 years of practice responded to a survey by submitting

complete operative case lists for a 2-year period. We recorded the type of procedure and

determined associations between the annual number of tumor operations and total operative

caseload, years in practice, and some details of individual practice patterns. Each participant

completed a survey regarding practice-related sources of stress and satisfaction. A total of 5611

surgical cases were available for review. For the entire cohort, there were 3303 (59%) tumor

procedures, 973 (17%) trauma, 890 (16%) adult reconstruction, and 445 (8%) other.RESULTS: The

median annual number of total operations was 214 (range, 63-356) and median annual number of

tumor operations was 135 (range, 47-216). The median proportion of tumor operations in an

individual practice was 56% (range, 43%-94%). The annual number of tumor operations correlated

with the total annual number of operations (r = 0.73, p < 0.001). Sources of stress and satisfaction

were similar to the general membership of the Musculoskeletal Tumor Society (MSTS), apart from

more early-career surgeons regarding case volume as important (29 of 104 [28%] of MSTS versus 11

of 15 [73%] of early-career, p < 0.001).CONCLUSIONS: The typical early-career orthopaedic tumor

surgeon had fewer than 60% of his or her operative procedures directly related to the subject of his

or her fellowship training in orthopaedic oncology. Overall, the challenges and rewards of clinical

practice are similar to oncologic surgeons later in their career. This study is a first step in assessing

early practice characteristics and may be of value to the prospective orthopaedic oncologist,

fellowship educators, and the society in workforce discussions. Early-career practice patterns have

not been previously presented, to our knowledge, for any subspecialty of orthopaedic surgery, and

we hope that this study will stimulate similar efforts throughout the field.LEVEL OF EVIDENCE: Level

IV, economic and decision analyses. See Guidelines for Authors for a complete description of levels

of evidence.

Psychological

Title: Societal impacts of regenerative medicine: reflections on the views of orthopedic

professionals.

Citation: Regenerative Medicine, 2015, vol./is. 10/1(17-24), 1746-0751;1746-076X (2015)

Author(s): Niemansburg SL, Tempels TH, Dhert WJ, van Delden JJ, Bredenoord AL

18

Abstract: As the amount of clinical studies in orthopedic regenerative medicine (RM) is increasing, it

is time to take into account its impact on society. A total of 36 biomedical professionals working at

the front row of orthopedic RM were interviewed to explore their attitudes, opinions and

expectations regarding the societal impacts of RM. Professionals mainly recognized the societal

impacts of counteraction of aging, prevention of disease and social justice. The 'soft' sides of these

impacts were hardly mentioned. Whereas they did not perceive themselves in the position to

mitigate these impacts, professionals should take up their role as actor and become involved in the

societal debate. This is important as they can co-shape the societal impacts during the

developmental process of technologies and thereby stimulate responsible innovation.

Title: Disability and depression after orthopaedic trauma.

Citation: Injury, February 2015, vol./is. 46/2(207-12), 0020-1383;1879-0267 (2015 Feb)

Author(s): Nota SP, Bot AG, Ring D, Kloen P

Abstract: INTRODUCTION: Musculoskeletal injury is a common cause of impairment

(pathophysiology), but the correlation of impairment with pain intensity and magnitude of disability

is limited. Psychosocial factors explain a large proportion of the variance in disability for various

orthopaedic pathologies. The aim of this study is to prospectively assess the relationship between

psychological factors and magnitude of disability in a sample of orthopaedic trauma patients in The

Netherlands.MATERIAL AND METHODS: One hundred and one adult patients between 1 and 2

months after one or more fractures, tendon or ligament injuries were enrolled. Four eligible patients

refused to participate. Thirty-five women and 30 men with an average age of 50 years (range, 22-92

years) completed the follow-up evaluation between 5 and 8 months after their injury and their data

was analyzed. The patients completed a measure of disability (the Short Musculoskeletal Function

Assessment-Netherlands, SMFA-NL), the Dutch Centre for Epidemiologic Study of Depression-scale

(CES-D), the Dutch Impact of Event Scale (SVL), and the Dutch Pain Catastrophizing Scale (PCS) at the

time of enrollment and again 5-8 months after injury.RESULTS: There were moderate correlations

between symptoms of depression (CES-D, r=0.48, p<0.001) and symptoms of PTSD (SVL, r=0.35,

p=0.004) at enrollment and magnitude of disability 5-8 months after trauma. Catastrophic thinking

(PCS) at enrollment and magnitude of disability 5-8 months after trauma showed a small correlation

(PCS, r=0.26, p=0.034). The Pain Catastrophizing Scale (Beta=0.29; p=0.049), surgery (Beta=0.26;

p=0.034), additional surgery (Beta=0.26; p=0.019) and other pain conditions (Beta=0.31; p=0.009)

were the significant predictors in the final model (adjusted R-squared=0.35; p<0.001) for greater

disability 5-8 months after trauma.DISCUSSION AND CONCLUSIONS: In The Netherlands, symptoms

of depression measured 1-2 months after musculoskeletal trauma correlate with disability 5-8

months after this trauma. The psychological aspects of recovery from musculoskeletal injury merit

greater attention.LEVEL OF EVIDENCE: Level II, Prognostic study.Copyright &#xa9; 2014 Elsevier Ltd.

All rights reserved.

19

Title: Identifying and exploring physical and psychological morbidity and patient and family

caregiver resilience following acute wound development and/or wound blistering post

orthopaedic surgery: a systematic review.

Citation: International Wound Journal, February 2015, vol./is. 12/1(63-9), 1742-4801;1742-481X

(2015 Feb)

Author(s): Ousey K, Edward KL, Lui S

Abstract: The aim of this article was to identify the literature that examined and explored physical

and psychological morbidity and patient and family caregiver resilience following acute wound

development and/or wound blistering post orthopaedic surgery. A systematic review of the

literature using the databases MEDLINE, CINAHL and EMBASE was undertaken. The papers were

examined using title and abstract for relevance to the primary and secondary outcomes. The primary

outcome of interest was family caregiver resilience following acute wound development and/or

wound blistering post orthopaedic surgery. The search yielded 275 records after removing any

duplicates; eight studies were considered eligible and were reviewed as full text. Following full

review, none of the studies was included in this article. To conclude, there were no papers that

investigated or examined the concept of resilience in relation to the management of acute post-

surgical orthopaedic wounds. Four of the papers identified, following the review process, did discuss

quality of life outcomes and how these may be improved following wound development; most

papers focused on the management of chronic wounds. It is apparent from the review that there is

no evidence currently available that explores patient and family caregiver resilience following acute

wound development and/or wound blistering post orthopaedic surgery. Copyright &#xa9; 2013 The

Authors. International Wound Journal &#xa9; 2013 Medicalhelplines.com Inc and John Wiley & Sons

Ltd.

Other

Title: Arthroscopic training resources in orthopedic resident education.

Citation: The Journal of Knee Surgery, February 2015, vol./is. 28/1(67-74), 1538-8506;1938-2480

(2015 Feb)

Author(s): Koehler R, John T, Lawler J, Moorman C 3rd, Nicandri G

Abstract: The purpose of this study was to determine the frequency of use, perceived effectiveness,

and preference for arthroscopic surgical skill training resources. An electronic survey was sent to

orthopedics residents, residency program directors, and orthopedic sports medicine attending

physicians in the United States. The frequency and perceived effectiveness of 10 types of adjunctive

arthroscopic skills training was assessed. Residents and faculty members were asked to rate their

confidence in resident ability to perform common arthroscopic procedures. Surveys were completed

by 40 of 152 (26.3%) orthopedic residency program directors, 70 of 426 (16.4%) sports medicine

faculty, and 235 of 3,170 (7.4%) orthopedic residents. The use of adjunctive methods of training

varied from only 9.8% of programs with virtual reality training to 80.5% of programs that used

20

reading of published materials to develop arthroscopic skill. Practice on cadaveric specimens was

viewed as the most effective and preferred adjunctive method of training. Residents trained on

cadaveric specimens reported increased confidence in their ability to perform arthroscopic

procedures. The resources for developing arthroscopic surgical skill vary considerably across

orthopedic residency programs in the United States. Adjunctive training methods were perceived to

be effective at supplementing traditional training in the operating room. Copyright Thieme Medical

Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Journal Tables of Contents

The most recent issues of the following journals:

Journal of Bone and Joint Surgery

Journal of Orthopaedic Trauma

Injury

Strategies in Trauma and Limb Construction

Clinical Orthopaedics and Related Research

Click on the links for abstracts. If you would like any of these papers in full text then get in touch:

bennet.jones@uhbristol.nhs.uk

Journal of Bone and Joint Surgery Vol. 97, iss. 4, February 2015

A New Approach to Managing Patients with Problematic Metal Hip Implants: The Use of an

Internet-Enhanced Multidisciplinary Team MeetingAAOS Exhibit Selection

The Impact of Trauma-Center Care on Mortality and Function Following Pelvic Ring and Acetabular

Injuries

Effect of Tear Location on Propagation of Isolated Supraspinatus Tendon Tears During Increasing

Levels of Cyclic Loading

Extensor Mechanism Allograft Reconstruction for Extensor Mechanism Failure Following Total

Knee Arthroplasty

Uncemented Jumbo Cups for Revision Total Hip ArthroplastyA Concise Follow-up, at a Mean of

Twenty Years, of a Previous Report

21

Total Hip Arthroplasty After Operatively Treated Acetabular FractureA Concise Follow-up, at a

Mean of Twenty Years, of a Previous Report

Ilfeld Abduction Orthosis Is an Effective Second-Line Treatment After Failure of Pavlik Harness for

Infants with Developmental Dysplasia of the Hip

Unsatisfactory Outcome of Arthrodesis Performed After Septic Failure of Revision Total Knee

Arthroplasty

Local Delivery of the Cationic Steroid Antibiotic CSA-90 Enables Osseous Union in a Rat Open

Fracture Model of Staphylococcus aureus Infection

Prevalence of Radiographic Parameters Predisposing to Femoroacetabular Impingement in Young

Asymptomatic Chinese and White Subjects

Sandwich Allografts for Long-Bone Nonunions in Patients with Osteogenesis ImperfectaA

Retrospective Study

Morbid Obesity: A Significant Risk Factor for Failure of Two-Stage Revision Total Hip Arthroplasty

for Infection

Weight-Bearing-Line Analysis in Supramalleolar Osteotomy for Varus-Type Osteoarthritis of the

Ankle

Erratum

The AOA-JOA 2014 Exchange Traveling Fellowship: Banzai and Beyond

Caring for the Critically InjuredCommentary on an article by Saam Morshed, MD, PhD, MPH, et al.:

“The Impact of Trauma-Center Care on Mortality and Function Following Pelvic Ring and

Acetabular Injuries”

Are Anterior Supraspinatus Tendon Tears More Prone to Propagation?Commentary on an article

by Daisuke Araki, MD, PhD, et al., “Effect of Tear Location on Propagation of Isolated

Supraspinatus Tendon Tears During Increasing Levels of Cyclic Loading”

Extensor Allograft: The Consummate Treatment for Extensor Disruption After Total Knee

ArthroplastyCommentary on an article by Nicholas M. Brown, MD, et al.: “Extensor Mechanism

Allograft Reconstruction for Extensor Mechanism Failure Following Total Knee Arthroplasty”

Operative Care Did Not Benefit Closed, Displaced, Intra-Articular Calcaneal Fractures

Epidural Injections with Glucocorticoid and Lidocaine for Spinal Stenosis Did Not Confer Additional

Benefit Compared with Lidocaine Alone

Topical Tranexamic Acid Was Noninferior to Intravenous Tranexamic Acid in Controlling Blood Loss

During Total Knee Arthroplasty

What’s New in Pediatric Orthopaedics

22

Journal of Orthopaedic Trauma Vol. 29, iss. 3, March 2015

From Evidence to Application: AAOS Clinical Practice Guideline on Management of Hip Fractures in

the Elderly

Femoral Neck Fractures: Current Management

Periprosthetic Femur Fractures

Femoral Nerve Palsy After Pelvic Fracture Treated With INFIX: A Case Series

Biomechanical Analysis of Augmented Plate Fixation for the Treatment of Vertical Shear Femoral

Neck Fractures

Functional Outcomes After Total Hip Arthroplasty for the Acute Management of Acetabular

Fractures: 1- to 14-Year Follow-up

Can Geriatric Hip Fractures be Managed Effectively Within a Level 1 Trauma Center?

Comparative Study of the Second and Third Generation of Gamma Nail for Trochanteric Fractures:

Review of 218 Cases

Morbid Obesity Increases the Risk for Systemic Complications in Patients With Femoral Shaft

Fractures

Failure to Rescue After Proximal Femur Fracture Surgery

Complications and Institutionalization Are Almost Doubled After Second Hip Fracture Surgery in

the Elderly Patient

Factors Affecting Delay to Surgery and Length of Stay for Patients With Hip Fracture

Postoperative Length of Stay and 30-Day Readmission After Geriatric Hip Fracture: An Analysis of

8434 Patients

Adverse Events, Length of Stay, and Readmission After Surgery for Tibial Plateau Fractures

ASA Score as a Predictor of 30-Day Perioperative Readmission in Patients With Orthopaedic

Trauma Injuries: An NSQIP Analysis

Ultrasound Monitoring of Fracture Healing: Is This the End of Radiography in Fracture Follow-ups?

Prospective Randomized Controlled Trial Using Telemedicine for Follow-Ups in an Orthopedic

Trauma Population: A Pilot Study

Sleep Disturbance After Fracture is Related to Emotional Well-Being Rather Than Functional Result

23

Injury Vol. 46, iss. 2, February 2015

Editorial Board/Publication Information

Are the less common compartment syndromes less of a problem?

Major trauma centres and trauma networks – The potential impact on surgical training

Commercially available gaming systems as clinical assessment tools to improve value in the

orthopaedic setting: A systematic review

Evaluating the use of antibiotic prophylaxis during open reduction and internal fixation surgery in

patients at low risk of surgical site infection

Open fractures in the elderly. The importance of skin ageing

The effect of introducing a Trauma Network on patient flow, hospital finances and trainee

operating

Trauma registry methodology: A survey of trauma registry custodians to determine current

approaches

Disability and depression after orthopaedic trauma

The biomechanical effect of bone quality and fracture topography on locking plate fixation in

periprosthetic femoral fractures

Unique stability of femoral neck fractures treated with the novel biplane double-supported screw

fixation method: A biomechanical cadaver study

Immune responses in relation to the type and time of thermal injury: An experimental study

Hypothermia treatment preserves mitochondrial integrity and viability of cardiomyocytes after

ischaemic reperfusion injury

Neuroprotective effects of testosterone on ischemia/reperfusion injury of the rabbit spinal cord

Activity of bone cement loaded with daptomycin alone or in combination with gentamicin or

PEG600 against Staphylococcus epidermidis biofilms

Do minimally displaced, closed tibial fractures in children need monitoring for compartment

syndrome?

Modified tension band fixation and coracoclavicular stabilisation for unstable distal clavicle

fracture

24

The role of external fixation in the treatment of humeral shaft fractures: A retrospective case

study review on 85 humeral fractures

Association of perioperative blood transfusion and adverse events after operative treatment of

proximal humerus fractures

Long-term clinical outcomes of war-related bilateral lower extremities amputations

Predictability of salvage and outcome of Gustilo and Anderson type-IIIA and type-IIIB open tibial

fractures using Ganga Hospital Scoring system

Medium-term outcomes following limb salvage for severe open tibia fracture are similar to trans-

tibial amputation

Functional and radiological outcome of periprosthetic femoral fractures after hip arthroplasty

Estimation of tibial shaft defect volume using standard radiographs: Development and validation

of a novel technique

Measuring illness beliefs in patients with lower extremity injuries: Reliability and validity of the

Dutch version of the Somatic Pre-Occupation and Coping questionnaire (SPOC-NL)

Significance of clinical examination, CT and MRI scan in the diagnosis of posterior pelvic ring

fractures

Accuracy of reduction and early clinical outcome in acetabular fractures treated by the standard

ilio-inguinal versus the Stoppa/iliac approaches

Percutaneous iliosacral fixation in external rotational pelvic fractures. A biomechanical analysis

CT-guided sacroiliac percutaneous screw placement in unstable posterior pelvic ring injuries:

Accuracy of screw position, injury reduction and complications in 71 patients with 136 screws

A priority driven ABC approach to the emergency management of high energy pelvic trauma

improves decision making in simulated patient scenarios

Indirect reduction of posterior wall fragment using a suture anchor in acetabular posterior wall

fracture with posterior labral root tear

Mid-term results after treatment of intertrochanteric femoral fractures with percutaneous

compression plate (PCCP)

The risk of cardiorespiratory deaths persists beyond 30 days after proximal femoral fracture

surgery

Financial aspects of arthroplasty options for intra-capsular neck of femur fractures: A cost analysis

study to review the financial impacts of implementing NICE guidelines in the NHS organisations

The relationship between socioeconomic status and fracture in a fracture clinic setting: Data from

the Nottingham Fracture Liaison Service

25

Predicting 30-day mortality following hip fracture surgery: Evaluation of six risk prediction models

The effect of osteoporotic treatment on the functional outcome, re-fracture rate, quality of life

and mortality in patients with hip fractures: A prospective functional and clinical outcome study

on 520 patients

The effect of becoming a major trauma centre on outcomes for elderly hip fracture patients

Is it safe to use a kinetic therapy bed for care of patients with cervical spine injuries?

Relationships between posterior ligamentous complex injury and radiographic parameters in

patients with thoracolumbar burst fractures

Ankle fractures: When can I drive doctor? A simulation study

Pedicled fibular flap for reconstruction of composite defects in foot

Profunda femoris injury following lesser trochanter displacement: Complications following

intramedullary femoral nailing

The medial femoral condyle free osteocutaneous flap for osteomyelitis in pilon fractures

Hoffa's fracture – Lateral meniscus obstructing the fracture reduction – A case report

Combined lateral femoral epicondylar osteotomy and a submeniscal approach for the treatment

of a tibial plateau fracture involving the posterolateral quadrant

Correspondence to: “Factors affecting injury severity of vehicle occupants following road traffic

collisions”

Concerns about fibrosis development after scaffolded PRP therapy of muscle injuries:

Commentary on an article by Sanchez et al.: “Muscle repair: Platelet-rich plasma derivates as a

bridge from spontaneity to intervention.”

Strategies in Trauma and Limb Construction Vol. 9, iss. 3, November 2014

Repositioning of the humeral tuberosities can be guided by pectoralis major insertion

Internal fixation of shaft humerus fractures by dynamic compression plate or interlocking

intramedullary nail: a prospective, randomised study

Use of external fixation for perilunate dislocations and fracture dislocations

Midterm results of Ilizarov hip reconstruction for late sequelae of childhood septic arthritis

26

Adjuvant treatment of chronic osteomyelitis of the tibia following exogenous trauma using

OSTEOSET®-T: a review of 21 patients in a regional trauma centre

Surgical treatment of intra-articular calcaneal fractures: description of a technique using an

adjustable uniplanar external fixator

The effect of the timing of antibiotics and surgical treatment on infection rates in open long-bone

fractures: a 6-year prospective study after a change in policy

Pseudo-arthrosis of the spine of the scapula: a case report with a delayed diagnosis

Patient-specific distal radius locking plate for fixation and accurate 3D positioning in corrective

osteotomy

Proximal tibiofibular dislocation: a case report and review of literature

Clinical Orthopaedics and Related Research Vol. 473, iss. 3, March 2015

Editorial: Increased Manuscript Submissions Prompt Journals to Make Hard Choices

Editor’s Spotlight/Take 5: Natural Polyphenols Enhance Stability of Crosslinked UHMWPE for Joint

Implants

Natural Polyphenols Enhance Stability of Crosslinked UHMWPE for Joint Implants

Cochrane in CORR®: Intramedullary Nails for Extracapsular Hip Fractures in Adults (Review)

CORR® Curriculum — Orthopaedic Education: Operative Assessment and the ACGME Milestones:

Time for Change

On Patient Safety: Surgical Complications Do Not Always Produce Poor Outcomes (Just Bad

Feelings)

Art in Science: Giovanni Paolo Mascagni and the Art of Anatomy

2014 ABJS Earl McBride Lecture: Disruptive Innovation: Orthopaedics in the 21st Century

Editorial Comment: 2013 Meetings of the Musculoskeletal Tumor Society and the International

Society of Limb Salvage

Does Intraoperative Navigation Assistance Improve Bone Tumor Resection and Allograft

Reconstruction Results?

Should Fractures in Massive Intercalary Bone Allografts of the Lower Limb Be Treated With ORIF or

With a New Allograft?

27

What Are the Functional Outcomes of Endoprosthestic Reconstructions After Tumor Resection?

What Was the Survival of Megaprostheses in Lower Limb Reconstructions After Tumor Resections?

Frequent Complications and Severe Bone Loss Associated With the Repiphysis Expandable Distal

Femoral Prosthesis

Do Patients With Ewing’s Sarcoma Continue With Sports Activities After Limb Salvage Surgery of

the Lower Extremity?

What Sports Activity Levels Are Achieved in Patients With Modular Tumor Endoprostheses of

Osteosarcoma About the Knee?

CORR Insights®: What Sports Activity Levels Are Achieved in Patients With Modular Tumor

Endoprostheses of Osteosarcoma About the Knee?

Multilevel En Bloc Spondylectomy for Tumors of the Thoracic and Lumbar Spine Is Challenging But

Rewarding

What Is the Use of Imaging Before Referral to an Orthopaedic Oncologist? A Prospective,

Multicenter Investigation

CORR Insights®: What Is the Use of Imaging Before Referral to an Orthopaedic Oncologist? A

Prospective, Multicenter Investigation

Is Claviculo Pro Humeri of Value for Limb Salvage of Pediatric Proximal Humerus Sarcomas?

What Are the 5-year Survivorship Outcomes of Compressive Endoprosthetic Osseointegration

Fixation of the Femur?

Survival of Modern Knee Tumor Megaprostheses: Failures, Functional Results, and a Comparative

Statistical Analysis

Does Competing Risk Analysis Give Useful Information About Endoprosthetic Survival in Extremity

Osteosarcoma?

MicroRNA Regulates Vascular Endothelial Growth Factor Expression in Chondrosarcoma Cells

CORR Insights®: MicroRNA Regulates Vascular Endothelial Growth Factor Expression in

Chondrosarcoma Cells

Does Total Humeral Endoprosthetic Replacement Provide Reliable Reconstruction With

Preservation of a Useful Extremity?

Editorial Comment: Advances in UHMWPE Biomaterials

Does Vitamin E-blended UHMWPE Prevent Biofilm Formation?

A Comparison of the Efficacy of Various Antioxidants on the Oxidative Stability of Irradiated

Polyethylene

28

Multidirectional Wear and Impact-to-wear Tests of Phospholipid-polymer-grafted and Vitamin E-

blended Crosslinked Polyethylene: A Pilot Study

Spectroscopic and Chromatographic Quantification of an Antioxidant-stabilized Ultrahigh-

molecular-weight Polyethylene

CORR Insights®: Spectroscopic and Chromatographic Quantification of an Antioxidant-stabilized

Ultrahigh-molecular-weight Polyethylene

Retrieval Analysis of Sequentially Annealed Highly Crosslinked Polyethylene Used in Total Hip

Arthroplasty

CORR Insights®: Retrieval Analysis of Sequentially Annealed Highly Crosslinked Polyethylene Used

in Total Hip Arthroplasty

Do Crosslinking and Vitamin E Stabilization Influence Microbial Adhesions on UHMWPE-based

Biomaterials?

UHMWPE Wear Debris and Tissue Reactions Are Reduced for Contemporary Designs of Lumbar

Total Disc Replacements

Is There a Difference in Total Knee Arthroplasty Risk of Revision in Highly Crosslinked versus

Conventional Polyethylene?

CORR Insights®: Is There a Difference in TKA Risk of Revision in Highly Crosslinked versus

Conventional Polyethylene?

Metal-on-conventional Polyethylene Total Hip Arthroplasty Bearing Surfaces Have a Higher Risk of

Revision Than Metal-on-highly Crosslinked Polyethylene: Results From a US Registry

Does Cyclic Stress Play a Role in Highly Crosslinked Polyethylene Oxidation?

Injury Risk to Extraosseous Knee Vasculature During Osteotomies: A Cadaveric Study With CT and

Dissection Analysis

CORR Insights®: Injury Risk to Extraosseous Knee Vasculature During Osteotomies: A Cadaveric

Study With CT and Dissection Analysis

Diabetes Confers Little to No Increased Risk of Postoperative Complications After Hip Fracture

Surgery in Geriatric Patients

CORR Insights®: Diabetes Confers Little to No Increased Risk of Postoperative Complications After

Hip Fracture Surgery in Geriatric Patients

Hip Arthroscopy in the Setting of Hip Osteoarthritis: Systematic Review of Outcomes and

Progression to Hip Arthroplasty

Topical Tranexamic Acid Does Not Affect Electrophysiologic or Neurovascular Sciatic Nerve

Markers in an Animal Model

Are Younger Patients Undergoing THA Appropriately Characterized as Active?

29

Does Nonsurgical Treatment Improve Longitudinal Outcomes of Lateral Epicondylitis Over No

Treatment? A Meta-analysis

CORR Insights®: Does Nonsurgical Treatment Improve Longitudinal Outcomes of Lateral

Epicondylitis Over No Treatment? A Meta-analysis

Medical Services and Associated Costs Vary Widely Among Surgeons Treating Patients With Hand

Osteoarthritis

CORR Insights®: Medical Services and Associated Costs Vary Widely Among Surgeons Treating

Patients With Hand Osteoarthritis

Open versus Endoscopic Carpal Tunnel Release: A Meta-analysis of Randomized Controlled Trials

Morbidity and Readmission After Open Reduction and Internal Fixation of Ankle Fractures Are

Associated With Preoperative Patient Characteristics

Who Leaves the Hospital Against Medical Advice in the Orthopaedic Setting?

Can High-friction Intraannular Material Increase Screw Pullout Strength in Osteoporotic Bone?

Differential Cytotoxicity of Corticosteroids on Human Mesenchymal Stem Cells

Letter to the Editor: Editor’s Spotlight/Take 5: Is Single-stage Revision According to a Strict

Protocol Effective in Treatment of Chronic Knee Arthroplasty Infections

Erratum to: Residual Deformity Is the Most Common Reason for Revision Hip Arthroscopy: A

Three-dimensional CT Study

Classifications in Brief: Eichenholtz Classification of Charcot Arthropathy

30

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Level 5, Education and Research Centre

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Contact your outreach librarian:

Bennet Jones, outreach librarian

bennet.jones@uhbristol.nhs.uk

Ext. 20103