Wednesday, March 29, 2023

What is an Orthosis?




3rd Edition of Orthopedic | 24-26 April 2023 | London, United Kingdom

More information:https://orthopedic-conferences.pencis.com/

#Arteries Of The Hand#Deep Palmar Arch
#Superficial Palmar Arch#Common Digital Arteries 
#Digital Arteries to the Thumb#Proper 
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Tuesday, March 28, 2023

What Is Lordosis?




3rd Edition of Orthopedic | 24-26 April 2023 | London, United Kingdom


#Lordosis#Arteries Of The Hand#Deep Palmar Arch #Superficial Palmar Arch#Common Digital Arteries #Digital Arteries to the Thumb#Proper Digital Arteries to the Fingers #orthopedicdoctor #conference #medicine #medical #pencis#ortho

Thursday, March 23, 2023

Adding Gli1+ cells could regenerate the enthesis after rotator cuff surgery

In the annals of shoulder surgery, NFL quarterback Drew Brees is an anomaly. In 2005, Brees was tackled and the rotator cuff tendon in his throwing shoulder was severely torn, a potentially career-ending injury. But after surgery and rehab, Brees returned the next season, led his team to the playoffs, and went on to win the 2010 Super Bowl.

Unfortunately, rotator cuff repairs don't always go so well, especially among seniors, the age group most susceptible to these injuries. The failure rate of this surgery ranges from 20% in younger patients with minor tears to 94% in older patients with major tears.

"The Egyptians came up with suturing to repair torn tissues. That's fundamentally what we're still doing today," Thomopoulos says. "We attach the torn tendon to bone, wait for the body's natural healing mechanisms to kick in, and hope for the best. Sometimes it works and sometimes it doesn't."

The reason why rotator cuff surgery fails so often has to do with a structure called the enthesis, a strong but paper-thin layer of tissue that connects tendon to bone. Once a torn tendon is grasped with sutures and anchored to the bone, the enthesis doesn't regenerate itself.




Without a functional enthesis, the surgical repair is mechanically weaker than the original and prone to a second tear.

"I thought, why not go back to developmental biology and learn how the body builds the enthesis from scratch? Once we know that, we can apply the lessons to regenerate the enthesis after injury," Thomopoulos says.

Thomopoulos previously discovered that enthesis cells arise from a common ancestor: Gli1+ cells. In theory, adding Gli1+ cells to the repair could regenerate the enthesis after rotator cuff surgery and make the connection stronger.

In a first step toward such a therapy, Thomopoulos' latest work, published this month, shows that transplantation of Gli1+ cells into mice with rotator cuff injuries promotes enthesis healing. "So far, we have only shown this in an idealized mouse model, but it's a promising start," he says.Turning Gli1+ cells into a therapy will require knowledge of the environmental conditions and molecular signals that the cells need to create all parts of the enthesis.

In the study, Thomopoulos has started to uncover those requirements, using single-cell RNA sequencing to determine how Gli1+ progenitor cells give rise to the different cells in the enthesis and the regulatory molecules that orchestrate the development of each type.

"There's a lot more work to do before we can move to clinical trials," Thomopoulos adds. "For instance, we'll need to find a good source of Gli1+ cells. Older people don't have many of these cells left, so we'll need to find a way to generate them in the laboratory. We'll also need to refine our delivery methods to get the cells to the right place."

If successful, this biologic approach could also be used to strengthen other repairs that require healing of tendon to bone, including ACL reconstructions, and to prevent weakened tendons from rupturing in the first place.

"I think biologics are the future of orthopedic surgery," Thomopoulos says, "but we still need years of basic research to fully realize the potential."

3rd Edition of Orthopedic | 24-26 April 2023 | London, United Kingdom

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#rotator cuff surgery#stem cells#Back Surgery#conference #spine diseases #sports #injuries#degenerative diseases#congenital disorders#Lancet #Arthroplasty#Injury#Shoulder surgery#Elbow Surgery#Spine #bone #Knee#Physiotherapy#Foot Surgery#Ankle SurgeryA#Posture#orthopedicdoctor #Gait#Cartilage#Osteoarthritis #long bones# orthopedic #medicine #sports

Hox genes control stem cells involved in forming and repairing bone

Genes long known to control the formation of bones before birth also control bone healing later in life, a new study found.

Led by researchers at NYU Langone Health, a new study pinpointed key Hox genes, specific to each location in the body, as the controllers of stem cells involved in both forming and repairing bone. HOX proteins act like the body's "zip code," specifying the position of limbs in the fetus by encoding instructions for transcription factors, which attach to DNA and influence the action of genes.

Such adjustments guide immature stem cells as they multiply and mature in the womb, say the study authors, to become heart muscle, nerves, bones, etc., and in the right places. Bone is among the tissues that keep pools of stem cells on hand into adulthood, ready to mature into needed replacement cells that maintain healthy tissue and heal broken bones.

Published online recently in the journal Development, the new work found that Hox genetic programs in adulthood control a bone stem cell type called periosteal stem and progenitors cells, or PSCPs. These cells play a central role in healing bones according to the womb-determined positions in which they first formed. Already known to encode the spatial code that sets the body's formation plan, HOX genes were shown in the study to give adult stem cells from different locations the properties needed to regenerate the particular bone in which they reside.

During aging, such stem cells become depleted, the researchers say, resulting in weaker bones that are more likely to fracture and slower to heal. In an effort to counter this loss in healing, the research team demonstrated that increasing the activity of the gene that directs the building of the Hoxa10 transcription factor in the tibia, the larger of the two "shin bones," in aging mice caused a 32.5 percent restoration of fracture repair capacity.



Bone requires attention

A fundamental question in the field has been whether bone healing is driven more by stem cells in the marrow in a bone's center, or by those known to pool in the nearby periosteum, the outer bone layer made of up tough connective tissue and cell-filled areas. Both stem cell types have the capacity to mature into osteoblasts, the cells that lay down new bone in response to a fracture, but the current study argues that stem cells in the periosteum, the PSPCs, are the important contributors to bone repair.

The study result builds on the understanding that, to keep stem cells pools on hand, they must get signals to continually divide and multiply without maturing, maintaining their "stemness" until needed. The body regulates bone repair by controlling the degree to which stem cells stay immature, with the most primitive cells playing the largest role in healing due to their flexibility and ability to quickly multiply.

In the current study, the researchers found that Hox deficiency leads to an increase in the stem cells' propensity to differentiate into mature bone cell types. Conversely, when the team increased Hoxa10 expression in tibia stem and progenitor cells, it reprogrammed them into a more stem cell-like state, a needed step if they are to become new bone-making cells as part of healing.

Specifically, say the authors, PSPCs exist as a mixed stem cell population that includes those with the most stemness, naive periosteal stem cells (PSCs), alongside more mature periosteal progenitor 1 and 2 (PP1 and PP2) cells. The current study authors found that Hoxa10 expression was most abundant in PSCs and was significantly reduced as cells progressed along the lineage hierarchy to PP1 and PP2. Experiments that increased the activity of the Hox genes in these more mature progenitors brought about a threefold increase of PSCs as cells were reprogrammed into a more primitive stem cell identity.

"PSPCs have distinguishing characteristics that form the basis for future cell-based therapies, including their greater tendency to naturally regenerate bone than many related stem cell groups," said co-corresponding lead author Kevin Leclerc, a postdoctoral scholar in Dr. Leucht's lab. "By modifying Hox activity in these cells, we can help them regenerate bone more effectively in individuals with deficient bone-healing capacity."

3rd Edition of Orthopedic | 24-26 April 2023 | London, United Kingdom

More information: https://orthopedic-conferences.pencis.com/


#stem cells#Back Surgery#conference #spine diseases #sports #injuries#degenerative diseases#congenital disorders#Lancet #Arthroplasty#Injury#Shoulder surgery#Elbow Surgery#Spine #bone #Knee#Physiotherapy#Foot Surgery#Ankle SurgeryA#Posture#orthopedicdoctor #Gait#Cartilage#Osteoarthritis #long bones# orthopedic #medicine #sports

Back Surgery

Most pain in the lower back can be treated without surgery. In fact, surgery often does not relieve the pain; research suggests that 20 to 40 percent of back surgeries are not successful. This lack of success is so common that there is a medical term for it: failed back surgery syndrome.

Nonetheless, there are times when back surgery is a viable or necessary option to treat serious musculoskeletal injuries or nerve compression. A pain management specialist can help you decide whether surgery is an appropriate choice after making sure you have exhausted all other options.

When should I consider back surgery?

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), part of the National Institutes of Health (NIH), the following conditions may be candidates for surgical treatment:
          * Herniated or ruptured disks, in which one or more of the disks that cushion the bones of the                    spine are damaged
  • * Spinal stenosis, a narrowing of the spinal column that puts pressure on the spinal cord an
    nerves
      * Spondylolisthesis, in which one or more bones in the spine slip out of place
      * Vertebral fractures caused by injury to the bones in the spine or by osteoporosis
      * Degenerative disk disease, or damage to spinal disks as a person gets older

    In rare cases, back pain is caused by a tumor, an infection, or a nerve root problem called cauda equina syndrome. In these cases, NIAMS advises surgery right away to ease the pain and prevent more problems.



What are some types of back surgery?

NIH’s National Institute of Neurological Disorders and Stroke (NINDS) lists the following as some of the surgical options for low back pain. But NINDS also cautions that “there is little evidence to show which procedures work best for their particular indications.”

    Vertebroplasty and kyphoplasty. These procedures are used to repair compression fractures of the vertebrae caused by osteoporosis. Both procedures include the injection of a glue-like bone cement that hardens and strengthens the bone.
    Spinal laminectomy/spinal decompression. This is performed when spinal stenosis causes a narrowing of the spinal canal that results in pain, numbness, or weakness. The surgeon removes the bony walls of the vertebrae and any bone spurs, aiming to open up the spinal column to remove pressure on the nerves.
    Discectomy. This procedure is used to remove a disk when it has herniated and presses on a nerve root or the spinal cord. Laminectomy and discectomy are frequently performed together.
    Foraminotomy. In this procedure, the surgeon enlarges the bony hole where a nerve root exits the spinal canal to prevent bulging disks or joints thickened with age from pressing on the nerve.
    Nucleoplasty, also called plasma disk decompression. This laser surgery uses radiofrequency energy to treat people with low back pain associated with a mildly herniated disk. The surgeon inserts a needle into the disk. A plasma laser device is then inserted into the needle and the tip is heated, creating a field that vaporizes the tissue in the disk, reducing its size and relieving pressure on the nerves.
    Spinal fusion. The surgeon removes the spinal disk between two or more vertebrae, then fuses the adjacent vertebrae using bone grafts or metal devices secured by screws. Spinal fusion may result in some loss of flexibility in the spine and requires a long recovery period to allow the bone grafts to grow and fuse the vertebrae together.
    Artificial disk replacement. This is considered an alternative to spinal fusion for the treatment of people with severely damaged disks. The procedure involves removal of the disk and its replacement by a synthetic disk that helps restore height and movement between the vertebrae.
Some surgical treatments are not recommended by NINDS, which cautions, for example, that intradiscal electrothermal therapy is “of questionable benefit.” NINDS notes that radiofrequency denervation provides only temporary pain relief and that “evidence supporting this technique is limited.”

What are the risks of back surgery?


Back surgery can carry higher risks than some other types of surgery because it is done closer to the nervous system. The most serious of these risks include paralysis and infections.

Even with a successful surgery, the recovery time can be long. Depending on the type of surgery and your condition before the surgery, healing may take months. And you may lose some flexibility permanently.

What are the considerations for anesthesia during surgery?

Back surgery will almost always be performed under general anesthesia. In addition to the usual risks associated with anesthesia, there are risks associated with the patient lying face down on the surgical table.


This position changes the body’s hemodynamics — that is, how blood flows through the body. The position also limits the surgical team’s access to the patient’s airway. This requires extra care in the positioning of equipment, monitors, patient, and anesthesiologist. It is extremely important to have an anesthesiologist in the operating room to make sure everything is set up correctly and to be able to take immediate action in case anything goes wrong. An anesthesiologist is a medical doctor who specializes in anesthesia, pain management, and critical care medicine.

How do I manage pain during my recovery?

Back surgery can cause a high degree of post-operative pain. You should consider a number of options for pain relief in the days and weeks after surgery. These options should be discussed with a pain management specialist who can explain the pros and cons of each option or combination of options, including their effectiveness, potential side effects, potential for addiction, and impact on the recovery process.

Some factors to consider:
Many of your options will involve medications such as opioids, nonsteroidal anti-inflammatory drugs, corticosteroids, and local anesthetics. Sometimes more than one drug will be taken. This multimodal therapy can improve pain control while limiting opioid use.

Opioids should be used with care to avoid addiction and manage side effects, some of which can be life-threatening.

Alternative or complementary methods of pain relief that do not involve medicines should also be discussed.

Anesthesiologists who specialize in pain management can work with you before and after surgery to develop a plan tailored to your condition, personal history, and preferences. They will consult with you after surgery to determine what is working and what is not, and they will adjust your pain management treatment based on the level of pain you are experiencing.

Anesthesiologists work with your surgical team to evaluate, monitor, and supervise your care before, during, and after surgery—delivering anesthesia, leading the Anesthesia Care Team, and ensuring your optimal safety.

3rd Edition of Orthopedic | 24-26 April 2023 | London, United Kingdom

More information: https://orthopedic-conferences.pencis.com/

#Back Surgery#conference #spine diseases #sports #injuries#degenerative diseases#congenital disorders#Lancet #Arthroplasty#Injury#Shoulder surgery#Elbow Surgery#Spine #bone #Knee#Physiotherapy#Foot Surgery#Ankle SurgeryA#Posture#orthopedicdoctor #Gait#Cartilage#Osteoarthritis #long bones# orthopedic #medicine #sports


Tuesday, March 21, 2023

What is a Shoulder Dislocation.



3rd Edition of Orthopedic | 24-26 April 2023 | London, United Kingdom

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#shoulder # Dislocation#Arteries Of The Hand#Deep Palmar Arch #Superficial Palmar Arch#Common Digital Arteries #Digital Arteries to the Thumb#Proper Digital Arteries to the Fingers #orthopedicdoctor #conference #medicine #medical #pencis#ortho

Saturday, March 18, 2023

OTI to participate in new Extremity Trauma Clinical Research Consortium

The Orthopaedic Trauma Institute (OTI) at the San Francisco General Hospital and Trauma Center and University of California, San Francisco has been chosen to serve as one of 12 core clinical centers in a newly established Extremity Trauma Clinical Research Consortium.

Funded by the Orthopaedic Extremity Trauma Research Program (OETRP) of the Department of Defense for $18.4 million during the next five years, the Consortium will work closely with several major military treatment centers and the U.S. Army Institute of Surgical Research (USAISR) to conduct multi-center clinical research studies relevant to the treatment and outcomes of severe orthopaedic trauma sustained on the battlefield. These studies will help establish treatment guidelines and facilitate the translation of new and emerging technologies into clinical practice.

“Bringing together many of the best and the brightest experts in the field of orthopaedic trauma surgery, the Consortium represents the most significant orthopaedic study group ever created in the United States,” said Theodore Miclau, MD, Vice Chair of the Department of Orthopaedics and Director of Orthopaedic Trauma at the University of California, San Francisco (UCSF) and Chief of Orthopaedic Surgery at San Francisco General Hospital (SFGH). “We are pleased that the OTI will be one of a select few trauma centers to participate as a core center in this important program.”




The Orthopaedic Trauma Institute, which opened its doors in February 2009, is a state-of-the-art facility on the San Francisco General Hospital campus dedicated to a multidisciplinary approach to clinical care, research, education and outreach.

“Participating in this Consortium will help us continue to advance the field of orthopaedic trauma through translational research opportunities,” Dr. Miclau added. “Initial funding of the Consortium will support the study of critical needs in acute clinical care identified by the military, including bone reconstruction and the management of musculoskeletal infections. Over time, it will expand and leverage its infrastructure to address many other priority topics relevant to the long-term management of severe extremity trauma, including prevention.”

“The need for such a Consortium is evident,” said Ellen MacKenzie, PhD, Director of the Coordinating Center for the Consortium at the Johns Hopkins University Bloomberg School of Public Health. “Eighty-two percent of all service members injured in Operation Iraqi Freedom and Operation Enduring Freedom sustain significant extremity trauma. Many sustain injuries to multiple limbs. The research to be conducted by the Consortium will help us better understand what works and what doesn’t in treating these injuries and ensure that our service members are provided with the best care possible.”

“We are thrilled to be partnering with the Consortium and the incredible team of investigators they have assembled,” said Dr. Joseph Wenke of the USAISR. “Together we will develop the infrastructure critically needed to address some of the most pressing issues in orthopedic trauma care. Without a large multi-center effort such as this, many of these issues would never be solved.”

In addition to the OTI, the other centers currently participating in the Consortium include: Boston University Medical Center, The Florida Orthopedic Institute, Carolinas Medical Center, Denver Health and Hospital Authority, OrthoIndy and the Indiana Orthopedic Hospital, Orthopedic Associates of Michigan, The University of Maryland Medical Systems R Adams Cowley Shock Trauma Center, The University of Mississippi Medical Center, The University of Texas Southwestern Medical Center, The University of Washington Harborview Medical Center, and Vanderbilt University Medical Center.

#Orthopaedic Trauma Institute#orthopedic training#orthopedic training programs
#Orthopedics#Orthopedic surgery#Joints#Bone#Arthritis#Fracture#Dislocation#Sprain#Strain#Tendinitis
#Bursitis#Osteoporosis

Changes needed in orthopedic training programs.

Changes are needed in the programs that train orthopedic surgeons to ensure these doctors are adequately trained, according to a study by researchers at Hospital for Special Surgery (HSS) in New York City. The study, which analyzed feedback from heads of orthopedic programs around the country, appears in the January issue of the Journal of Bone and Joint Surgery.

"Before this study, we at Special Surgery thought that we were the only hospital dealing with these complicated challenges," said Laura Robbins, DSW, vice president of education and academic affairs at HSS. "As a result of this study, we have come to realize that as a nation, the prominent training programs around the country are grappling with these same issues."

Because the field of training surgeons in general, and particularly orthopedic surgeons, has changed dramatically, investigators at HSS set out to identify the challenges faced by programs. They invited input from heads of well-established orthopedic residency programs across the country including New York University School of Medicine, University of California at Los Angeles Medical Center, Duke University School of Medicine, Johns Hopkins University School of Medicine, and Case Western Reserve University. The study analyzed survey responses from 17 heads of orthopedic programs around the country and feedback from 12 of these individuals gathered during a two-day meeting held at HSS.

Participants were asked to evaluate whether the traditional residency model is appropriate for the training of future surgeons and to discuss current approaches that have been successfully implemented in orthopedic training programs. The group identified four basic areas of need: addressing compromises to the learning experience caused by work-hour restrictions, identifying a body of core orthopedic knowledge with specific goals and expectations, developing common benchmarks to measure and improve program effectiveness, and addressing the challenges caused by generational differences between faculty and residents.

"One of the biggest factors challenging the education of orthopedic surgeons is the work-hour restrictions which have severely affected what residents are able to learn and do within the five years of training," Dr. Robbins said. "The public has read a lot in the media about work-hour restrictions for trainees, particularly surgeons. The Institute of Medicine recommended back in July that they would not tolerate any violations to the work hour restrictions-being that residents work no more than 24 hours, have shift breaks and one day off in seven. While we are meeting that mandate, it is a big challenge, because the resident no longer treats the patient from pre-surgery to post-surgery, greatly compromising the learning of continuity of care."



Dr. Robbins pointed out that patients may suffer as well. While physician assistants and hospitalists step in, so the resident can go home, nobody truly knows the patient from beginning to end. "The resident traditionally used to be the one person who knew the patient from the beginning of care to the end of care, because they were here during the day and during the night on call," Dr. Robbins said. "The issue today gets to the heart of patient safety and quality." The Accreditation Council for Graduate Medical Education first instituted work-hour restrictions in 2003.

Dr. Robbins said a solution to this problem has not been identified yet. "Most programs are saying we really need to look at the curriculum and modify the residents' rotations, so that the resident gets the exact training and experience they need, but what that is specifically is unknown at this point," she said.

Another big issue identified was addressing generational and gender differences. "The residents of today are a very different generation than the current senior surgeons. They approach training very differently in that they have multiple priorities, becoming good surgeons while they juggle family and extra activities as a whole. The trainees and the surgeons of the past were more focused on their careers first," Dr. Robbins said. Residents today also want to learn via electronic technology, which is vastly different from the way older surgeons learned. Dr. Robbins reported that programs are lagging behind in providing educational modalities via electronic technology. On a gender front, more women are going into orthopedic surgery and there are more challenges like maternity leave affecting programs.

Dr. Robbins added that orthopedic programs need to accept more trainees into programs. The number of residents accepted into orthopedic programs has been capped for more than 20 years, but there is an increasing demand for orthopedic surgeons. "We know from projections in studies that there won't be enough orthopedic surgeons in the future for the baby boomers who will need joint replacements," Dr. Robbins said. "The groups that establish how many trainees you have and how many surgeons you need really need to be looking at this and making some very broad sweeping recommendations."

According to Dr. Robbins, there was a sense from the two-day meeting that the American Medical Association and the American Board of Orthopedic Surgeons are concerned that there is a problem. However, there have not been any solid recommendations. "The common theme is that we have a problem as a country in training the orthopaedic surgeons of tomorrow yet there are no specific solutions," said Dr. Robbins. "Our goal is to bring back this group in the Spring to focus on coming up with specific recommendations."

#orthopedic training#orthopedic training programs
#Orthopedics#Orthopedic surgery#Joints#Bone#Arthritis#Fracture#Dislocation#Sprain#Strain#Tendinitis
#Bursitis#Osteoporosis

American Academy takes measures to attract women to become orthopaedic surgeons



Only 3.9 percent of orthopaedic surgeons and 13.8 percent of orthopaedic residents are women, according to the American Academy of Orthopaedic Surgeons.

The academy is working to attract more women to the specialty by placing advertisements in medical student publications and sponsoring booths at medical student meetings.

Loyola University Health System is helping lead the effort. At Loyola, 20 percent of orthopaedic faculty and 16 percent of orthopaedic residents are women. And at Loyola's Stritch School of Medicine, six of the 11 fourth-year students applying for orthopaedic residencies are women. Among podiatrists, two of the five attending and two of the seven residents are women.

"Having more women on our faculty and in our residency allows us to attract the most talented individuals to our specialty, regardless of gender," said Terry Light, MD, chair of the Department of Orthopaedic Surgery and Rehabilitation. "Having different perspectives among our faculty, residents and students enriches all of us."

Loyola orthopaedic surgeon Karen Wu, MD, specializes in adult hip and knee reconstructions, which are among the most physically demanding surgeries.
But in contrast to the stereotype of the big, brawny orthopaedic surgeon, Wu is just five-feet-four and weighs 120 pounds.

"I don't have huge muscles," Dr. Wu said. "But it's not really about brute strength. It's knowing how to work smart. I have never been in a situation where, physically, I couldn't do something."

Dr. Wu recalls that during her fellowship, she was asked to reduce a dislocated hip in a large woman. Dr. Wu was the first woman to do the Aufranc fellowship in hip and knee reconstruction at New England Baptist Hospital, and her colleagues were curious to see whether a woman was up to the task.

Dr. Wu accomplished the reduction on her first attempt.

The notion that women lack the strength for orthopaedic surgery is among the reasons why the field traditionally has attracted so few females. But orthopaedic surgeons such as Dr. Wu and her colleague, Teresa Cappello, MD, say they don't have to rely on their muscles. They work with power tools, utilize assistants when needed and focus on proper technique.

"If you have to use brute force, you're not doing it the right way," Dr. Cappello said.

Drs. Wu and Cappello are assistant professors in the Department of Orthopaedic Surgery and Rehabilitation, Loyola University Chicago Stritch School of Medicine. A third female orthopaedic surgeon, Erika Mitchell, MD, will join the faculty in November. Dr. Mitchell was recruited from Vanderbilt University Medical Center.

Her special interests include pelvic acetabular trauma and polytrauma. Dr. Cappello is a pediatric orthopaedic surgeon, and her special interests include lower extremity deformities, including clubfeet, leg length discrepancy and hip dysplasia.

Dr. Wu decided to become a surgeon because she likes to work with her hands, and her interest in sports led her to orthopaedics. She has participated in multiple team and individual sports since early childhood, including sailing team at the University of Michigan. Dr. Wu was first exposed to orthopaedics at age 13, when she suffered a distal radius fracture while skiing. Many of her friends also had athletic injuries.

Dr. Wu said orthopaedics appealed to her "because the goal of the field is to keep people active."

Dr. Wu said her gender never made her feel less-welcomed at Loyola. She recalled that when she had her first interview with Department Chair Terry Light, MD, she was six months pregnant. Dr. Light said she could delay her start time to take a maternity leave.

Dr. Cappello said that from an early age, her father strongly encouraged her to become a physician. She did not hesitate to enter a traditionally male-dominated specialty.

"My dad told me I could do anything a boy could do," Dr. Cappello said. "It never occurred to me that any door would be closed to me because I'm a woman."


#women#American Academy#Orthopedics#Orthopedic surgery#Joints#Bone#Arthritis#Fracture#Dislocation#Sprain#Strain#Tendinitis
#Bursitis#Osteoporosis

New guideline focuses on the timing of hip and knee arthroplasty

The American College of Rheumatology (ACR) and the American Association of Hip and Knee Surgeons (AAHKS) released a summary of its new guideline titled "the Optimal Timing of Elective Hip or Knee Arthroplasty for Patients with Symptomatic Moderate to Severe Osteoarthritis or Osteonecrosis Who Have Failed Nonoperative Therapy." The ACR and AAHKS have worked together before, creating guidelines for Perioperative Management of Antirheumatic Medication in Patients with Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty in 2017 and 2022. While those guidelines focus on which medications to take during and withhold prior to hip or knee arthroplasty for patients with rheumatic diseases such as systemic lupus erythematosus (SLE), spondyloarthritis (SpA), and rheumatoid arthritis (RA), this guideline focuses on the timing of hip and knee arthroplasty, and when additional nonoperative treatment or delays for medical optimization are appropriate for patients with advanced osteoarthritis and osteonecrosis who have failed nonoperative therapy.

"For patients with symptomatic moderate to severe osteoarthritis or osteonecrosis of the hip or knee who have been indicated for total hip or total knee arthroplasty, the efficacy of additional nonoperative treatments, such as physical therapy, anti-inflammatories, and injections is unknown," said Charles P. Hannon, MD, MBA, Assistant Professor of Orthopedic Surgery at Washington University in St. Louis and co-literature review leader of the guideline. "In addition, for patients with certain risk factors, such as obesity, which are linked to increased risk and poorer outcomes, the benefit of delaying surgery to modify these risk factors is not well established. For these reasons, a guideline needed to be created."




All the recommendations in the guideline are conditional. While there are no strong recommendations, there was high consensus for all recommendations.

One key recommendation is that patients with moderate to severe symptomatic osteoarthritis or osteonecrosis who are indicated for joint replacement and have failed nonoperative therapy should proceed directly to surgery without delay for additional nonoperative treatment of the joint problem.

Another key recommendation is that patients with nicotine dependence or diabetes should delay surgery to achieve either nicotine cessation or decreased use of nicotine products, as well as to allow for improved glycemic control.

"For patients presenting with nicotine dependence, there is a potential benefit of delaying total joint arthroplasty for nicotine use reduction or cessation," said Dr. Hannon. "The patient should be educated about the increased surgical risks associated with nicotine use and ideally engage in nicotine reduction strategies."

Like many ACR guidelines, a Patient Panel was consulted in the development of this guideline. The panel stressed the importance of shared decision-making between a patient and their physician when indicating a patient for total joint arthroplasty.

"This shared decision-making process should comprehensively discuss the unique risks and benefits of the procedure for the individual patient," said Dr. Goodman. "Patients with medical or surgical risk factors as described in this guideline should be counseled as to their increased risks, and preoperative attempts to modify these risk factors through efforts such as weight loss, glycemic control, or smoking cessation should be encouraged."

A full manuscript of the guideline has been submitted for journal peer review and is anticipated to be jointly published in ACR and AAHKS journals in 2023. The summary of the guideline recommendations can be viewed in full on the ACR and AAHKS websites.



#hip#knee arthroplasty#Orthopedics#Orthopedic surgery#Joints#Bone#Arthritis#Fracture#Dislocation#Sprain#Strain#Tendinitis
#Bursitis#Osteoporosis

Tuesday, March 14, 2023

Age-related accumulation of abdominal fat associated with lower muscle density

A new study published in the Journal of Clinical Endocrinology and Metabolism found that age-related accumulation of abdominal fat is associated with lower muscle density. Low muscle density means the muscle has more fat in it, which can lead to less effective muscle function that in turn may lead to more falls. According to the study, individuals with the greatest 6-year accumulation of visceral adipose tissue (VAT), found in the abdomen, had significantly lower muscle density. Since VAT accumulation is a preventable risk factor for poor musculoskeletal outcomes associated with aging, these findings add to the growing dangers of accumulating fat in the body.

Entitled "Accumulation in Visceral Adipose Tissue Over 6 Years Is Associated With Lower Paraspinal Muscle Density," it is the first large, longitudinal study of the association between changes in VAT and muscle density.







The study found that VAT may represent a modifiable risk factor for poor musculoskeletal outcomes with aging.

"The study adds important new information to public health efforts to reverse the trend of the growing obesity problem in the United States and worldwide," the authors said. "Fat that accumulates in the abdomen sometimes referred to as the 'male pattern,' was shown to produce less dense muscle surrounding the spine, resulting in less-effective muscle function."

The other researchers on the study were Timothy Tsai, M.P.H., Research Software Engineer II at the Hinda and Arthur Marcus Institute for Aging Research; Brett T. Allaire, Research Assistant III at the Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center; Mary L. Bouxsein, Ph.D., Professor of Orthopedic Surgery, Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center; Marian T. Hannan, D.Sc., M.P.H., Senior Scientist, Hinda and Arthur Marcus Institute for Aging Research; and Thomas G. Travison, Ph.D., Director of Biostatistics and Data Sciences, Co-Director of the Interventional Studies in Aging Center, Senior Scientist, Hinda and Arthur Marcus Institute for Aging Research.

The study was approved by Boston University Medical Campus and the Hebrew SeniorLife institutional review boards.

Funding came from a National Institutes of Health's National Institute of Arthritis and Musculoskeletal and Skin Diseases .
3rd Edition of Orthopedic | 24-26 April 2023 | London, United Kingdom

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Monday, March 13, 2023

Artificial intelligence as good as other methods for documenting hand surgery cases



Automatic-populated clinical notes that are artificial intelligence-based may decrease documentation burden for hand surgery cases in the future vs. transcription services or voice recognition systems, according to a presenter.

In research presented at the American Academy of Orthopaedic Surgeons Annual Meeting, Michael Rivlin, MD, FAAOS, discussed results of a prospective study he and his colleagues conducted to compare the quality of documentation of common orthopedic encounters for patients who undergo hand surgery with an artificial intelligence (AI)-based virtual scribe service, a transcription service and a voice recognition mobile (VRM) application.

Provider time is a critical resource that needs to be conserved, particularly with the high rates of physician mental health issue and burnout today, Rivlin told Healio in an interview.

“The more provider time you can give back to the provider, the more they can spend on caring for patients, so modalities, such as AI scribe or an in-person scribe, are helpful, but over time we expect the AI scribe to replace the human factor,” Rivlin said.

Because the quality of AI-generated documentation had not been analyzed previously, Rivlin and colleagues compared the quality and time spent documenting common orthopedic encounters in hand surgery, according to a press release. They used the following modalities during a patient visit:

AI-based virtual scribe service, which is an AI program that runs on a tablet and a machine extracts everything said in the room;

medical scribe, which a person either physically in the office visit or who participates virtually and transcribes the entire patient encounter;

transcription service, in which the physician uses a Dictaphone device to record an audio file about the patient visit and sends it to a third-party company so that what has been dictated can be transcribed; and

VRM application, which is a program available on electronic medical record platforms that types the words said based on voice recognition.




According to a press release for the study, three fellowship-trained orthopedic hand surgeons evaluated 10 standardized patients with pre-written clinical vignettes. Physicians not involved in the study acted out the clinical vignettes, which were documented by the different systems being analyzed, according to the press release.

Clinical documentation was performed during the clinical encounter using the AI-based scribe and medical scribe, and then afterward using a VRM and transcription service.

According to the press release, a total of 118 clinical encounters were documented. This included 30 AI scribe, 30 VRM, 28 transcription service and 30 medical scribe notes. Clinical notes were deemed as either acceptable or unacceptable and assigned a letter grade of A, B, C or F using an eight-point scoring system. In addition, an attorney reviewed all notes for medical legal risk.

Overall, all modalities performed well with similar documentation outputs between the modalities. According to the abstract, there were no significant differences in note quality for each hand surgeon who participated in the study, as well as for the entire cohort.

3rd Edition of Orthopedic | 24-26 April 2023 | London, United Kingdom

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#Orthopedics#Orthopedic surgery#Joints#Bone#Arthritis#Fracture#Dislocation#Sprain#Strain#Tendinitis
#Bursitis#Osteoporosis

Intraoperative 3D imaging more effective in confirming the accuracy of pedicle screw placement during spine surgery

A study at Hospital for Special Surgery (HSS) found that intraoperative three-dimensional (3D) imaging was superior to two-dimensional radiographs in confirming the accuracy of pedicle screw placement during spine surgery. The research was presented today at the American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting in Las Vegas.

Many spinal surgeries require the use of implants called pedicle screws to stabilize the spine. Precise positioning of these screws is critical for a successful outcome.

Dr. Lebl and colleagues set out to compare the accuracy of BPR versus 3D imaging when assessing intraoperative pedicle screw placement. "Our study is the first to compare the differences in intraoperative biplanar radiography and 3D imaging for pedicle screw accuracy in thoracic and lumbar cases using robotic technology," Dr. Lebl noted.

Investigators analyzed data from 103 patients who underwent spinal fusion by a single surgeon from 2019 to 2022. Pedicle screw placement was assessed with both intraoperative BPR and 3D imaging in each case.

"CT scans taken after surgery were compared to the findings of intraoperative BPR and 3D imaging to detect either false-positive or false-negative readings," explained Fedan Avrumova, BS, an HSS clinical research coordinator who presented the study at the AAOS meeting. "False positive findings are instances when BPR imaging suggests the screw was not in an acceptable position, while in fact a more advanced 3D image (intraoperative 3D scan or postoperative CT scan) showed the screw to be in an acceptable position. Conversely, a false negative instance was when a BPR image led one to believe or looked as though the screw was in an acceptable position, when in fact a more advanced 3D image or post-operative CT scan showed that it was in fact not acceptable."






Postoperative CT imaging revealed a clinically significant number of patients who had false-negative and false-positive screw placement readings on BPR. However, screw position shown on intraoperative 3D imaging was found to be much more accurate, Avrumova added.

"Based on our study, BPR imaging may lead one to think a screw is acceptable when in fact it is not, and also may miss many screws that are not in fact acceptable. In our study, it was approximately one percent of cases where this occurred. However, for surgeons and centers that implant hundreds and thousands of screws per year, this is going to result in a significant clinical impact for many people," Dr. Lebl noted. "Even one misplaced screw can have a significant impact for a patient, a surgeon, and a hospital system. Therefore, based on these findings, we suggest that for intraoperative confirmation of screw position 3D imaging may soon represent a new standard of care.


International Conference on Orthopedics and Sports Medicine



Speaker: Lidocaine has more favorable complication profile for neuraxial anesthesia in THA



Compared with bupivacaine, lidocaine had a more favorable complication profile when used for neuraxial anesthesia in patients undergoing total hip arthroplasty, according to presented results.

“Many people are moving toward regional anesthesia, such as neuraxial anesthesia (NA) [for THA],” Robert Scott Roundy, BS, said in his presentation at the American Academy of Orthopaedic Surgeons Annual Meeting. “However, what type of anesthetic to use in NA is still being debated. One of the worst complications of NA is transient neurological symptoms (TNS) or postoperative pain in the buttocks or extremities






Roundy and colleagues from Emory University performed a prospective, double-blinded randomized controlled trial that compared outcomes of 54 patients who received bupivacaine and 51 patients who received lidocaine for NA during THA. According to the study abstract, outcomes included TNS, time to normal sensation, urinary retention, ambulation and length of stay.

Overall, Roundy and colleagues found no differences in time to normal sensation, urinary retention, ambulation or length of stay between the groups. They noted patients in 13 patients (24%) in the bupivacaine group had urinary incontinence compared with no patients in the lidocaine group. Additionally, seven patients (13%) in the bupivacaine group reported having difficulty with urination or defecation compared with no patients in the lidocaine group.

“These data support the use of lidocaine as part of NA in total hips.

He noted that with increasing rates of outpatient surgery, as well as decreasing OR times and costs of lidocaine, this treatment may have further benefits that were not captured in this study.

3rd Edition of Orthopedic | 24-26 April 2023 | London, United Kingdom

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Arthroplasty surgeons showed more physiological stress, strain in revision vs. primary TJA

Results presented at the American Academy of Orthopaedic Surgeons Annual Meeting showed arthroplasty surgeons experienced significantly greater physiological stress and strain when performing revision total joint arthroplasty.

“When scheduling revision and primary total joint arthroplasty, surgeons should consider the higher physiological demand associated with revision total joint arthroplasty and ensure adequate personal preparation,” Irfan A. Khan, ATC, said in his presentation here. “Further study is needed to determine the generalizability of these results and to identify modifiable risk factors for stress and strain during arthroplasty.”

Khan and colleagues collected cardiorespiratory data using a smart vest among two high-volume fellowship-trained arthroplasty surgeons during primary (n=35) and revision (n=35) TJA.



Researchers collected patient BMI, surgical limb laterality and operative time, along with surgeon heart rate, surgeon stress index and surgeon heart rate variability.




Khan noted revision TJA cases had significantly lower BMI, significantly longer operative time and were more often performed using the posterolateral approach.

“When looking at differences between primary and revision total joint arthroplasty, there was a significantly higher energy expenditure and calories per hour, as well as significantly higher heart rate when performing revision total joint arthroplasty.

He added surgeons experienced a significantly higher rate of stress when performing revision TJA.

In subgroup analysis, revision TKA was associated with a significantly higher energy expenditure, heart rate and stress index, according to Khan. He added revision TKA was linked with a significantly lower heart rate variability, indicating increased stress and strain compared with primary TKA.

“When doing a subgroup analysis for hip cases, there were no significant differences for patient BMI or operative time; however, there was a significantly higher rate of energy expenditure when performing revision total hip arthroplasty and, although it was not significant, there does appear to be a higher stress index as well when performing a revision total hip arthroplasty.

3rd Edition of Orthopedic | 24-26 April 2023 | London, United Kingdom


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#Arthroplasty surgeons#Orthopedics#Orthopedic surgery#Joints#Bone#Arthritis#Fracture#Dislocation#Sprain#Strain#Tendinitis
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Sling immobilization may be optional after open Latarjet surgery for shoulder instability

LAS VEGAS — Presented results found similar functional and pain outcomes between patients with and those without sling immobilization after open Latarjet surgery for shoulder instability.

“In [patients who undergo open Latarjet surgery], you want to avoid stiffness, especially in external rotation. You want to avoid muscular atrophy, [and] you want to return them to their daily activities as early as possible,” Patrick Goetti Sr., MD, said in his presentation at the American Academy of Orthopaedic Surgeons Annual Meeting. “But we do not know if there is a predictive effect of immobilization on complication rates,” he said.





Goetti and colleagues performed a randomized controlled trial that analyzed functional and pain outcomes of 72 patients with anterior shoulder instability who underwent an open Latarjet procedure either with or without sling immobilization. Outcome measures included Rowe, single assessment numeric evaluation (SANE) and VAS pain scores at baseline, 1.5-, 3- and 6-month postoperative timepoints. Goetti noted grafts were secured with two, threaded 4-mm cancellous screws, which were 1 cm apart from each other.

At 6 months, both groups had showed significant improvements in all outcomes. Mean Rowe scores improved from 38.8 to 81.6; mean SANE scores improved from 42.5 to 84.7; and mean VAS scores improved from 27.7 to 13.9.

Researchers found no significant differences in outcomes between the groups. Mean Rowe scores were 80.7 in the sling group and 82.6 in the no-sling group; mean SANE scores were 83.7 in the sling group and 85.7 in no-sling group; and mean VAS scores were 15.6 in the sling group and 12.2 in the no-sling group. Goetti also noted CT evaluation revealed no differences in graft healing between the groups.

“The absence of postoperative immobilization did not increase complications rates,” Goetti said. “We therefore modified our practice and stopped using sling immobilization after open Latarjet,” he concluded.

#Orthopedics#Orthopedic surgery#Joints#Bone#Arthritis#Fracture#Dislocation#Sprain#Strain#Tendinitis
#Bursitis#Osteoporosis#Scoliosis#Kyphosis#Lordosis

Saturday, March 11, 2023

Trauma surgery

Trauma surgery is the specialization in surgery that focuses on the treatment and care of injuries, often life-threatening, that are caused by impact forces. The causes of impact forces are many, but some of the more common ones include traffic accidents, falls, sports and crush injuries, as well as gunshot or stabbing wounds.

In catastrophic incidents, trauma surgeons often form part of a larger team of specialized surgeons such as orthopedic (i.e. specialist for musculoskeletal injuries), vascular (i.e. specialist for the arteries, veins and other vessels), maxillofacial (i.e. specialist for facial injuries), cardiothoracic (i.e. specialist for the heart and thoracic organs), plastic (i.e. special for the reconstruction of body areas following) and neurosurgeons (i.e. specialists for injuries to the brain and nervous system).

Trauma surgery is a fast-paced and demanding practice that has very little time for the lengthy discussions that may otherwise be seen in some medical consultations. The trauma surgeon generally undergoes training after completion of a basic medical degree.

This training together with the medical degree may take up to a decade or more in most countries. Moreover, in some jurisdictions, trauma surgeons may also conduct the duties that would otherwise be done by general surgeons. This discipline, when combined with urgent general surgery may be referred to as acute surgery care.Trauma surgery is the specialization in surgery that focuses on the treatment and care of injuries, often life-threatening, that are caused by impact forces. The causes of impact forces are many, but some of the more common ones include traffic accidents, falls, sports and crush injuries, as well as gunshot or stabbing wounds.

In catastrophic incidents, trauma surgeons often form part of a larger team of specialized surgeons such as orthopedic (i.e. specialist for musculoskeletal injuries), vascular (i.e. specialist for the arteries, veins and other vessels), maxillofacial (i.e. specialist for facial injuries), cardiothoracic (i.e. specialist for the heart and thoracic organs), plastic (i.e. special for the reconstruction of body areas following) and neurosurgeons (i.e. specialists for injuries to the brain and nervous system).

Trauma surgery is a fast-paced and demanding practice that has very little time for the lengthy discussions that may otherwise be seen in some medical consultations. The trauma surgeon generally undergoes training after completion of a basic medical degree.




This training together with the medical degree may take up to a decade or more in most countries. Moreover, in some jurisdictions, trauma surgeons may also conduct the duties that would otherwise be done by general surgeons. This discipline, when combined with urgent general surgery may be referred to as acute surgery care.

Procedures involved in trauma surgery

In most jurisdictions, trauma surgeons are adequately trained and equipped to identify and handle injuries to the head and neck, abdominal area, chest, legs, feet, arms and hands. Any patient that has experienced traumatic physical injury may be seen by a trauma specialist.

Upon arrival to the emergency room, patients are quickly assessed to identify the extent of the injuries and which are the most threatening to function and life. Resuscitation and stabilization are key priorities prior to surgical operations if urgent surgery is not necessary to save the patient’s life. This is then followed by definitive surgical therapy.

Methods used to assess the extent of injury include radiographic X-rays and CT-scans as well as MRI’s. With these tools the surgeon is able to identify damage to internal organs and hemorrhaging. Trauma surgeons work closely with emergency staff in the resuscitative and stabilization efforts of the patient.

Airway patency, breathing, circulation and necessary drugs are the key parameters controlled. Triage care at admission checks typical details, such as the patient’s vital signs, age and history or pre-existing conditions, like cardiopulmonary diseases. Laboratory tests, like blood tests, may be necessary, as well as intravenous access lines and equipment for monitoring vital signs.

3rd Edition of Orthopedic | 24-26 April 2023 | London, United Kingdom


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#Orthopedics#Orthopedic surgery#Joints#Bone#Arthritis#Fracture#Dislocation#Sprain#Strain#Tendinitis
#Bursitis#Osteoporosis#Scoliosis#Kyphosis#Lordosis
#Spine#Back pain#Neck pain
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Thursday, March 9, 2023

how many bones in face

The facial skeleton consists of 14 bones with different anatomic structures and embryological formations (2 unpaired and 6 paired). These bones comprise the paired nasal bones, inferior nasal conchae, palatine bones, maxillae, zygomatic bones, lacrimal bones, and the unpaired mandible and vomer.




Skull bones – Facial and Cranial Bones

The skull comprises numerous, separate bones fused at the immobile joints, referred to as sutures, except for the mandible, which is fused to the skull by the mobile, synovial Temporomandibular joints (TMJ).

Normally, the human skull has twenty-two bones – fourteen facial skeleton bones and eight cranial bones.

The space containing the brain is the cranial cavity. The calvarium or the skull vault is the upper part of the cranium, forming the roof and the sidewalls of the cranial cavity. The foundation of the skull is the lower part of the cranium, constituting the floor of the cranial cavity.

What are the 22 Bones of the Skull?
The skull bones can be broadly divided into two main sections –

       Facial skeleton bones (14)

       Cranial bones (8)

Human Skeletal System

The skeletal system functions as the basic framework of a body and the entire body are built around the hard framework of Skeleton. It is the combination of all the bones and tissues associated with cartilages and joints. Almost all the rigid or solid parts of the body are the main components of the skeletal system. Joints play an important role in the skeletal system as it helps in permitting the different types of movements at different locations. If the skeleton were without joints, then there would be no sign of the movements in the human body.

3rd Edition of Orthopedic | 24-26 April 2023 | London, United Kingdom

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#Orthopedics#Orthopedic surgery#Joints#Bone#Arthritis#Fracture#Dislocation#Sprain#Strain#Tendinitis
#Bursitis#Osteoporosis#Scoliosis#Kyphosis#Lordosis
#Spine#Back pain#Neck pain
#Hip#Knee#Shoulder
#Elbow#Wrist#Hand#Foot#Ankle#Joint replacement

                                       
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Impingement

Impingement refers to a medical condition characterized by the compression or pinching of soft tissues, such as tendons or bursae, between ...