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<channel rdf:about="http://www.gourt.com/Health/Medicine/Surgery/Orthopedics/Organizations.html">
<title>Organizations RSS : Gourt</title>
<link>http://www.gourt.com/Health/Medicine/Surgery/Orthopedics/Organizations.html</link>
<description></description>
<dc:language>en-us</dc:language>
<dc:rights>Copyright 2007, Gourt.com</dc:rights>
<dc:date>2009-07-03T22:27+41:00
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<dc:publisher>rtruog@gourt.com</dc:publisher>
<dc:creator>rtruog@gourt.com</dc:creator>
<dc:subject>Organizations RSS : Gourt</dc:subject>
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<item rdf:about="http://www.josr-online.com/content/4/1/23">
<title>Salter-Harris II injury of the proximal tibial epiphysis with both vascular compromise and compartment syndrome: a case report </title>
<link>http://www.josr-online.com/content/4/1/23</link>
<description><![CDATA[We present a case of a Salter-Harris II injury to the proximal tibia associated with both vascular compromise and compartment syndrome. The potential complications of this injury are limb threatening and the neurovasular status of the limb should be continually monitored. Maintaining anatomic reduction is difficult and fixation may be needed to achieve optimal results.]]></description>
</item>

<item rdf:about="http://www.josr-online.com/content/4/1/22">
<title>Mechanically-induced osteogenesis in the cortical bone of pre- to peripubertal stage and peri- to postpubertal stage mice</title>
<link>http://www.josr-online.com/content/4/1/22</link>
<description><![CDATA[Background:
Exercise during postnatal development plays a key role in determining adult bone mass and reducing the risk of fracture and osteoporosis later in life.  However, the relationship between mechanically-induced osteogenesis and age is unclear.  Elevated levels of estrogen during puberty may inhibit periosteal bone formation.  Thus, magnitudes of mechanically-induced osteogenesis may be vary with pubertal state.
Methods:
The present study uses a murine model to examine age-related changes in bone formation at the femoral midshaft with voluntary exercise.  Pre- to peripubertal mice aged 3 weeks and peri- to postpubertal mice aged 7 weeks were randomly divided into sedentary and exercised groups and subjected to histomorphometric comparison after 4 weeks of treatment.
Results:
Results of the experiment indicate that exercise significantly increased osteogenesis on the periosteal and endocortical surface of the mice in the older age group (P < 0.05).  Exercise had no significant effect on bone formation of mice in the younger age group, although exercised mice exhibited more bone growth on average than controls.  Endocortical apposition was the primary method of bone formation for all mice in the experiment; however exercised mice in the older age group were able to add more bone on the periosteal surface than age-matched controls and exercised mice in the younger age group (P < 0.05).  Medullary area increased with age, but exercised mice in both age groups had smaller medullary cavities relative to overall bone area than controls.
Conclusion:
These findings suggest that the amount and location of mechanically-induced osteogenesis differs by age during skeletal development.  Late adolescence may be the optimal time to accrue bone mass and maximize bone strength.]]></description>
</item>

<item rdf:about="http://www.josr-online.com/content/4/1/21">
<title>Difficulty in diagnosing the pathological nature of an acute fracture of the clavicle: A case report.</title>
<link>http://www.josr-online.com/content/4/1/21</link>
<description><![CDATA[Fractures of the clavicle comprise between 5% to10% of all fractures. Medial clavicular fractures are uncommon and are normally caused by high-energy trauma. A low impact mechanism of injury should raise suspicion of a pathological fracture, but this case report highlights the difficulty in diagnosing the pathological nature of an acute fracture of the clavicle. We describe a patient who presented with a medial clavicular fracture after a simple fall but the fracture was diagnosed as pathological in retrospect four months after the initial presentation. We would also like to emphasise that the medial clavicle is the most frequent site of pathological fractures of the clavicle, and the possibility of an underlying pathological condition should be considered whenever a patient with a medial clavicular fracture is encountered.]]></description>
</item>

<item rdf:about="http://www.josr-online.com/content/4/1/20">
<title>Percutaneous endoscopic lumbar discectomy: clinical and quality of life outcomes with a minimum 2 year follow-up</title>
<link>http://www.josr-online.com/content/4/1/20</link>
<description><![CDATA[Background:
Percutaneous endoscopic lumbar discectomy is a relatively new technique. Very few studies have reported the clinical outcome of percutaneous endoscopic discectomy in terms of quality of life and return to work.Method55 patients with percutaneous endoscopic lumbar discectomy done from 2002 to 2006 had their clinical outcomes reviewed in terms of the North American Spine Score (NASS), Medical Outcomes Study Short Form-36 scores (SF-36) and Pain Visual Analogue Scale (VAS) and return to work.
Results:
The mean age was 35.6 years, the mean operative time was 55.8 minutes and the mean length of follow-up was 3.4 years. The mean hospital stay for endoscopic discectomy was 17.3 hours. There was significant reduction in the severity of back pain and lower limb symptoms (NASS and VAS, p<0.05) at 6 months and 2 years. There was significant improvement in all aspects of the Quality of Life (SF-36, p<0.05) scores except for general health at 6 months and 2 years postoperation. The recurrence rate was 5% (3 patients). 5% (3 patients) subsequently underwent lumbar fusion for persistent back pain. All patients returned to their previous occupation after surgery at a mean time of 24.3 days.
Conclusions:
Percutaneous endoscopic lumbar discectomy is associated with improvement in back pain and lower limb symptoms postoperation which translates to improvement in quality of life. It has the advantage that it can be performed on a day case basis with short length of hospitalization and early return to work thus improving quality of life earlier.]]></description>
</item>

<item rdf:about="http://www.josr-online.com/content/4/1/19">
<title>Vascular endothelial growth factor regulates osteoblast survival - evidence for an autocrine feedback mechanism</title>
<link>http://www.josr-online.com/content/4/1/19</link>
<description><![CDATA[Background:
Apoptosis of osteoblasts and osteoclasts regulates bone homeostasis. Skeletal injury in humans results in 'angiogenic' responses primarily mediated by vascular endothelial growth factor(VEGF), a protein essential for bone repair in animal models. Osteoblasts release VEGF in response to a number of stimuli and express receptors for VEGF in a differentiation dependent manner. This study investigates the putative role of VEGF in regulating the lifespan of primary human osteoblasts(PHOB) in vitro.
Methods:
PHOB were examined for VEGF receptors. Cultures were supplemented with VEGF(0–50 ng/mL), a neutralising antibody to VEGF, mAB VEGF(0.3 ug/mL) and Placental Growth Factor (PlGF), an Flt-1 receptor-specific VEGF ligand(0–100 ng/mL) to examine their effects on mineralised nodule assay, alkaline phosphatase assay and apoptosis.. The role of the VEGF specific antiapoptotic gene target BCl2 in apoptosis was determined.
Results:
PHOB expressed functional VEGF receptors. VEGF 10 and 25 ng/mL increased nodule formation 2.3- and 3.16-fold and alkaline phosphatase release 2.6 and 4.1-fold respectively while 0.3 ug/mL of mAB VEGF resulted in approx 40% reductions in both. PlGF 50 ng/mL had greater effects on alkaline phosphatase release (103% increase) than on nodule formation (57% increase). 10 ng/mL of VEGF inhibited spontaneous and pathological apoptosis by 83.6% and 71% respectively, while PlGF had no significant effect. Pretreatment with mAB VEGF, in the absence of exogenous VEGF resulted in a significant increase in apoptosis (14 vs 3%). VEGF 10 ng/mL increased BCl2 expression 4 fold while mAB VEGF decreased it by over 50%.
Conclusion:
VEGF is a potent regulator of osteoblast life-span in vitro. This autocrine feedback regulates survival of these cells, mediated via a non flt-1 receptor mechanism and expression of BCl2 antiapoptotic gene.]]></description>
</item>

<item rdf:about="http://www.josr-online.com/content/4/1/18">
<title>Interleukin-6 as an early marker for Fat Embolism</title>
<link>http://www.josr-online.com/content/4/1/18</link>
<description><![CDATA[Background:
Fat Embolism is a complication of long bone fractures, intramedullary fixation and joint arthroplasty. It may progress to fat embolism syndrome, which is rare but involves significant morbidity and can occasionally be fatal. Fat Embolism can be detected at the time of embolization by transoesophageal echocardiography or atrial blood sampling. Later, a combination of clinical signs and symptoms will point towards fat embolism but there is no specific test to confirm the diagnosis. We investigated serum Interleukin-6 (IL-6) as a possible early marker for fat embolism.
Methods:
An animal study was conducted to simulate a hip replacement in 31 adult male Sprague Dawley rats. The procedure was performed under general anesthesia and the animals divided into 3 groups: control, uncemented and cemented. Following surgery and recovery from anaesthesia, the rats allowed to freely mobilize in their cages. Blood was taken before surgery and at 6 hours, 12 hours and 24 hours to measure serum IL-6 levels. The rats were euthanized at 24 hours and lungs removed and stained for fat. The amount of fat seen was then correlated with serum IL-6 levels.
Results:
No rats in the control group had fat emboli. Numerous fat emboli were seen in both the uncemented and cemented implant groups. The interleukin levels were raised in all groups reaching a peak at 12 hours after surgery reaching 100 pg/ml in the control group and around 250 pg/ml in the uncemented and cemented implant groups. The IL-6 levels in the control group were significantly lower than any of the implant groups at 12 and 24 hours. At these time points, the serum IL-6 correlated with the amount of fat seen on lung histology.
Conclusion:
Serum IL-6 is a possible early marker of fat embolism.]]></description>
</item>

<item rdf:about="http://www.josr-online.com/content/4/1/17">
<title>The effect of  newer anti-rheumatic drugs on osteogenic cell proliferation : an in-vitro study.</title>
<link>http://www.josr-online.com/content/4/1/17</link>
<description><![CDATA[Background:
Disease modifying anti-rheumatic drugs (DMARDs) may interfere with bone healing. Previous studies give conflicting advice regarding discontinuation of these drugs in the peri-operative setting. No consensus exists in current practice especially with the newer DMARDs such as Leflunomide, Etanercept, and Infliximab. The aim of this study was to assess the in-vitro effect of these drugs alone and in relevant clinical combinations on Osteoblast activity.
Methods:
Osteoblasts were cultured from femoral heads obtained from five young otherwise healthy patients undergoing total hip replacement. The cells were cultured using techniques that have been previously described. A full factorial design was used to set up the experiment on samples obtained from the five donors. Normal therapeutic concentrations of the various DMARDs were added alone and in combination to the media. The cell proliferation was estimated after two weeks using spectrophotometric technique using Roche Cell proliferation Kit. Multilevel regression analysis was used to estimate which drugs or combination of drugs significantly affected cell proliferation.
Results:
Infliximab and Leflunomide had an overall significant inhibitory effect (p < 0.05). Dexamethasone had a small stimulatory effect that was however strongly donor-dependent. The cox-2 inhibitor Etoricoxib was found to negate or increase the action of two other drugs (Leflunomide and Dexamethasone). Methotrexate and Etanercept had no discernable donor-dependant or donor-independent effect on osteoblast proliferation.
Conclusion:
Our study indicates that in-vitro osteoblast proliferation can be inhibited by the presence of certain DMARDs. Combinations of drugs had an influence and could negate the action of a drug on osteoblast proliferation. The response to drugs may be donor-dependent.]]></description>
</item>

<item rdf:about="http://www.josr-online.com/content/4/1/16">
<title>Comparison of migration behavior between single and dual lag screw implants for intertrochanteric fracture fixation
</title>
<link>http://www.josr-online.com/content/4/1/16</link>
<description><![CDATA[Background:
Lag screw cut-out failure following fixation of unstable intertrochanteric fractures in osteoporotic bone remains an unsolved challenge. This study tested if resistance to cut-out failure can be improved by using a dual lag screw implant in place of a single lag screw implant. Migration behavior and cut-out resistance of a single and a dual lag screw implant were comparatively evaluated in surrogate specimens using an established laboratory model of hip screw cut-out failure.
Methods:
Five dual lag screw implants (Endovis, Citieffe) and five single lag screw implants (DHS, Synthes) were tested in the Hip Implant Performance Simulator (HIPS) of the Legacy Biomechanics Laboratory. This model simulated osteoporotic bone, an unstable fracture, and biaxial rocking motion representative of hip loading during normal gait. All constructs were loaded up to 20,000 cycles of 1.45 kN peak magnitude under biaxial rocking motion. The migration kinematics was continuously monitored with 6-degrees of freedom motion tracking system and the number of cycles to implant cut-out was recorded.
Results:
The dual lag screw implant exhibited significantly less migration and sustained more loading cycles in comparison to the DHS single lag screw. All DHS constructs failed before 20,000 cycles, on average at 6,638 ± 2,837 cycles either by cut-out or permanent screw bending. At failure, DHS constructs exhibited 10.8 ± 2.3° varus collapse and 15.5 ± 9.5° rotation around the lag screw axis. Four out of five dual screws constructs sustained 20,000 loading cycles. One dual screw specimens sustained cut-out by medial migration of the distal screw after 10,054 cycles. At test end, varus collapse and neck rotation in dual screws implants advanced to 3.7 ± 1.7° and 1.6 ± 1.0°, respectively.
Conclusion:
The single and double lag screw implants demonstrated a significantly different migration resistance in surrogate specimens under gait loading simulation with the HIPS model. In this model, the double screw construct provided significantly greater resistance against varus collapse and neck rotation in comparison to a standard DHS lag screw implant.]]></description>
</item>

<item rdf:about="http://www.josr-online.com/content/4/1/15">
<title>Varus distal femoral osteotomy in young adults with valgus knee</title>
<link>http://www.josr-online.com/content/4/1/15</link>
<description><![CDATA[Background:
Musculoskeletal disorders specially knee osteoarthritis are the most common causes of morbidity in old patients. Disturbance of the mechanical axis of the lower extremity is one of the most important causes in progression of knee osteoarthritis. The purpose of the present study was to analyze the surgical results of distal femoral varus osteotomy in patients with genu valgum.
Methods:
In this study, after recording history and physical examination, appropriate radiographs were taken. We did varus distal femoral osteotomy by standard medial subvastus approach and 90-angle blade plate fixation then followed the patients clinically and radiographically.
Results:
This study was done on 23 knees (16 patients) age 23.3 years (range, 17 to 41 years). The mean duration of following up was 16.3 months (range, 8 to 25 months). Based on paired T test, there were statistically significant difference between pre- and postoperative tibiofemoral and congruence angles (p < 0.001, t = 21.3 and p < 0.001, t = 10.1 respectively). Pearson correlation between the amount of tibiofemoral and congruence angle correction was also statistically significant (p = 0.02 and r = 0.46).
Conclusion:
Distal femoral varus osteotomy with blade plate fixation can be a reliable procedure for the treatment of valgus knee deformity. In this procedure, with more tibiofemoral angle correction, more congruence angle correction can be achieved. Therefore, along with genu valgum correction, the patella should be stabilized simultaneously.]]></description>
</item>

<item rdf:about="http://www.josr-online.com/content/4/1/14">
<title>Negative pressure wound therapy for soft tissue injuries around the foot and ankle </title>
<link>http://www.josr-online.com/content/4/1/14</link>
<description><![CDATA[Background:
This study was performed to evaluate the results of negative pressure wound therapy (NPWT) in patients with open wounds in the foot and ankle region.Materials and methodsUsing a NPWT device, 16 patients were prospectively treated for soft tissue injuries around the foot and ankle. Mean patient age was 32.8 years (range, 3–67 years). All patients had suffered an acute trauma, due to a traffic accident, a fall, or a crush injury, and all had wounds with underlying tendon or bone exposure. Necrotic tissues were debrided before applying NPWT. Dressings were changed every 3 or 4 days and treatment was continued for 18.4 days on average (range, 11–29 days).
Results:
Exposed tendons and bone were successfully covered with healthy granulation tissue in all cases except one. The sizes of soft tissue defects reduced from 56.4 cm2 to 42.9 cm2 after NPWT (mean decrease of 24%). In 15 of the 16 cases, coverage with granulation tissue was achieved and followed by a skin graft. A free flap was needed to cover exposed bone and tendon in one case. No major complication occurred that was directly attributable to treatment. In terms of minor complications, two patients suffered scar contracture of grafted skin.
Conclusion:
NPWT was found to facilitate the rapid formation of healthy granulation tissue on open wounds in the foot and ankle region, and thus, to shorten healing time and minimize secondary soft tissue defect coverage procedures.]]></description>
</item>

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