Keeping you up to date on recent headlines in orthopedics healthcare:

Disagreement exists on how to treat a shoulder separation ... . While low-level shoulder separations can commonly be treated nonsurgically and high-level injuries often require surgery, a literature review published in the April 2009 issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS) finds that many surgeons still disagree on the best course of treatment for those injuries that fall in between. Shoulder separations, clinically known as acromioclavicular joint injuries, represent nearly half of all athletic shoulder injuries. These injuries result from a fall onto the tip of the shoulder with the arm tucked in toward the body. The treatment of the mid level injuries (type III) remains controversial, with nonsurgical treatment favored in most instances and reconstruction of the acromioclavicular joint reserved for cases in which the joint demonstrates persistent instability. Although the issue has not been fully researched yet, the study authors suggest that certain patients with Type III injuries, such as heavy laborers and athletes who perform frequent overhead motions, might benefit more from surgical reconstruction. (

Surgeons should be aware of interrelated symptoms when dealing with dwarfism ... . According to a literature review published in the April 2009 issue of the Journal of the American Academy of Orthopaedic Surgeons, treating patients with dwarfism is an extremely complex process. Orthoaedic surgeons and others caring for people with this disorder should be aware of its many manifestations. For example, limb lengthening treatments for those living with achondroplasia have been met with mixed results. Some studies have found that height can be gained with growth hormone injections, but the authors question whether the average height increase of six to eight centimeters is worth undergoing five years of daily injections. Surgical treatments can produce greater increases in height, but also carry a much higher risk of complications. The authors also found that early diagnosis and treatment of the manifestations of achondroplasia, sometimes even before they become symptomatic, may produce better outcomes for patients later in life. (

Orthopaedic surgeons saving lives in the combat theater ... . Orthopedic surgeons play a crucial role in the care of active duty military personnel according to a Forum article in the April 2009 issue of The Journal of Bone and Joint Surgery (JBJS). Surgical teams are providing treatment as soon as possible after injury, thereby saving lives and helping injured personnel obtain optimal function. Orthopaedic surgeons are highly skilled at repairing the limb injuries that comprise approximately 70% of combat injuries. Those injuries are typically caused by high-energy weapons and are highly damaging to bone and soft-tissue. Injuries caused by explosive devices are common in Iraq and often combine penetrating, blunt, and burn injuries. In Iraq, nine out of 10 wounded service members survive. Damage control orthopedics, such as rapid amputation and fracture stabilization, is being done at the far-forward field hospital before the wounded service member is transported for systemic stabilization with blood and fluids to an ICU-equipped facility. A service member is transported from the field to a more advanced facility for additional surgery in Germany within 12 to 48 hours and eventually to the U.S. for rehabilitation. During the Vietnam War, this transport took an average of 45 days. (

Access to osteoporosis testing for Americans in jeopardy ... . In an effort to protect patient access to osteoporosis testing and reduce the physical and economic burden of osteoporosis for millions of Americans, Congress introduced the "Medicare Fracture Prevention and Osteoporosis Testing Act of 2009," (S. 769 and H.R. 1894). The DXA Task Force, comprised of the National Osteoporosis Foundation, American Association of Clinical Endocrinologists, American College of Obstetricians and Gynecologists, American College of Rheumatology, American Society for Bone and Mineral Research, International Society for Clinical Densitometry and The Endocrine Society urges Congress to pass this legislation to reverse the drastic cuts in Medicare reimbursement for Dual Energy X-ray Absorptiometry (DXA), the imaging procedure accepted as the gold standard for diagnosing osteoporosis. Outside the hospital setting, Medicare reimbursement for DXA has been reduced to levels substantially below the cost to perform the procedure. As a result, many physicians and clinics around the country are discontinuing this necessary health service greatly limiting the public's access to the test and jeopardizing patients' quality of healthcare, the group task force said. A 2008 study by Kaiser in Southern California found that increased use of DXA testing and osteoporosis treatment over a five-year period (2002-2006) resulted in a 37% reduction in hip fractures and $30.8 million in savings in a single year in 11 Kaiser health centers. (

Antibiotic spacers fill the gap for people with infected hip replacements .... Newly developed antibiotic spacers successfully eradicated infection in more than 90% of patients with total knee and hip replacements, and allowed them to be successfully re-implanted, according to a study published in the online edition of the Journal of Arthroplasty. The study showed that antibiotic spacers, which prevent total bed rest and allow patients to move during the six or more weeks of antibiotic treatment, also facilitate complex revision surgery that is needed once the infection is gone. Antibiotic spacers are made out of traditional bone cement, the same material used to attach knee and hip replacements. The cement is filled with a high dose of powder antibiotics; the antibiotics then leach out of the spacer over a six-week period, delivering a high dose to the infected area. This not only fills the gap and heals the problem, but it also gives surgeons more space and soft tissue to work with later on. Additional antibiotics are also given intravenously to maximally treat the infection. (

Knitting cartilage with stem cells .... In Scotland, one might guess that "advanced knitting techniques" refers to kilt making, but the Scottish Stem Cell Network (SSCN) thinks otherwise. At the recent SSCN conference in Edinburgh on March 24, Professor Anthony Hollander described a new method of stitching cartilage together by using bone marrow stem cells as needle and thread. This novel procedure could be the first ever treatment to successfully heal torn meniscal cartilage in human knees.

Anthony Hollander, Arthritis Research Campaign (ARC) Professor of Rheumatology & Tissue Engineering at the University of Bristol, is no stranger to stem cell research. Four years ago, his research team successfully grew cartilage in vitro from bone marrow stem cells. It took them just over a month to grow a half-inch of cartilage, and since then, Professor Hollander has been looking forward to the day when his research could move out of the laboratory and into the hands of physicians and their patients. Professor Hollander's team is working on a preclinical model of the treatment, and they hope to start human clinical trials in one year. (Reference: The Scotsman, "Need new cartilage? Grow your own" March 25, 2009)

— Compiled by Holland Johnson, MDD

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