A novel load-sensing sliding hip screw to aid in the assessment of intertrochanteric fracture healing.

Bone healing after sliding hip screw internal fixation of intertrochanteric hip fractures is difficult to monitor with radiography. In this study, we describe and evaluate a device to non-invasively determine the loading on the screw implant as a possible qualitative indicator of bone healing. A novel load-sensing sliding hip screw (LS-SHS) was fabricated containing a radio-dense tungsten indicator rod that moves and can be measured within the screw cannulation when the screw bends under load via plain radiography.

Synovial fluid pH sensor for early detection of prosthetic hip infections.

We describe an implantable sensor developed to measure synovial fluid pH for noninvasive early detection and monitoring of hip infections using standard-of-care plain radiography. The sensor was made of a pH responsive polyacrylic acid-based hydrogel, which expands at high pH and contracts at low pH. A radiodense tantalum bead and a tungsten wire were embedded in the two ends of the hydrogel in order to monitor the change in length of the hydrogel sensor in response to pH via plain radiography.

Measuring Orthopedic Plate Strain to Track Bone Healing Using a Fluidic Sensor Read via Plain Radiography.

Objective: We describe a fluidic X-ray visualized strain indicator under applied load (X-VISUAL) to quantify orthopedic plate strain and inform rehabilitative care.

Methods: The sensor comprises a polymeric device with a fluidic reservoir filled with a radio-dense fluid (cesium acetate) and an adjoining capillary wherein the liquid level is measured. A stainless-steel lever attaches to the plate and presses upon the acrylic bulb with a displacement proportional to plate bending strain.

Noninvasively Imaging pH at the Surface of Implanted Orthopedic Devices with X-ray Excited Luminescence Chemical Imaging.

Implanted medical device-associated infections are a leading cause of fixation failure, and early diagnosis is the key to successful treatment. During infection, acidosis near the implant plays a role in antibiotic resistance and low pH is a potential infection indicator. Herein, we describe a pH sensor which attaches to the implants to noninvasively image local pH with high spatial resolution.

An implanted pH sensor read using radiography.

A biomedical sensor was developed to measure local pH near orthopedic implants to detect and study implant-associated infection. The sensor is read using plain radiography, a technique which is noninvasive, inexpensive, ubiquitously available in medical facilities, and routinely used in diagnosis and follow-up. The sensor comprises a radiopaque tungsten indicator pin embedded within a chemically responsive hydrogel that exhibits a pH-dependent swelling.

Incidence, Positional Distribution, Severity, and Time Missed in Medial Collateral Ligament Injuries of the Knee in NCAA Division I Football Athletes.

Introduction: We studied injury to the medial collateral ligament (MCL) in National Collegiate Athletic Association (NCAA) Division I football players, their incidence, magnitude of injury, distribution by position, and missed time, which has not previously been described in a consecutive series.

Methods: The knee injuries sustained in 163 consecutive NCAA Division I collegiate football players at our institution were evaluated over a span of 6 years.

Results: The incidence of MCL injuries with any knee injury was 29% (47 of 163).

Rates of osteoporosis screening and treatment following vertebral fracture.

Background Context: Osteoporosis remains an underrecognized and undertreated disease entity in the orthopaedic setting, accounting for substantial long-term morbidity and mortality. Osteoporosis is often not diagnosed or treated until multiple fractures have occurred. Vertebral compression fractures are the most common sentinel fracture, providing an opportunity to intervene with antiresorptive therapy before more debilitating fractures occur.

Unilateral S2 alar-iliac screws for spinopelvic fixation.

Background: This study compared the clinical complications, radiographic measurements of deformity, and quality of life outcomes for patients with scoliosis undergoing thoracolumbar fusions for spinopelvic fixation (SPF) utilizing unilateral S2 alar-iliac (S2AI) screw or unilateral iliac bolt fixation.

Methods: This retrospective review was performed in 29 patients who underwent SPF at one institution; 10 patients received unilateral S2AI screws, and 19 patients received unilateral iliac bolts. The following variables were studied: reoperation rates, pseudarthrosis, sacral insufficiency fracture, hardware prominence, infection, proximal junctional kyphosis (PJK), deformity correction (radiographs), windshield wipering, hardware fracture, and hardware removal.

Symptomatic sacrococcygeal joint dislocation treated using closed manual reduction: A case report with 36-month follow-up and review of literature.

Dislocation of the sacrococcygeal joint is a rare injury from trauma to the buttocks, most often from falling backwards. Standard of care for this injury has not been determined because it is rare. Left untreated this can cause coccydynia in the long-term.

C1-2 Fixation Approach for Patients With Vascular Irregularities: A Case Report.

In posterior spinal fusion (PSF), the vertebral artery is most vulnerable to injury at C1-2. C2 pedicle screws are often placed into the dorsomedial isthmus of C2. Alternative techniques include C2 laminar screws and wiring techniques.

X-ray excited luminescent chemical imaging (XELCI) for non-invasive imaging of implant infections.

X-ray excited luminescent chemical imaging (XELCI) uses a combination of X-ray excitation to provide high resolution and optical detection to provide chemical sensing. A key application is to detect and study implant-associated infection. The implant is coated with a layer of X-ray scintillators which generate visible near infrared light when irradiated with an X-ray beam.

Anterior Cervical Discectomy With Fusion Using a Local Source for Cancellous Autograft: A Biomechanical Analysis of Vertebral Body Stability in an Osteopenic Bone Model.

Background: Anterior cervical discectomy with fusion is an effective treatment for patients having cervical radiculopathy and myelopathy. To reduce morbidity associated with autograft taken from the iliac crest without sacrificing high fusion rates, a novel technique that harvests bone from the vertebral body adjacent to the operative disc space has been proposed. The effects of square and round bone graft harvest techniques on the mechanical stability of the osteopenic donor vertebrae are unknown.

Implantable strain sensor to monitor fracture healing with standard radiography.

Current orthopaedic clinical methods do not provide an objective measure of fracture healing or weight bearing for lower extremity fractures. The following report describes a novel approach involving in-situ strain sensors to objectively measure fracture healing. The sensor uses a cantilevered indicator pin that responds to plate bending and an internal scale to demonstrate changes in the pin position on plain film radiographs.

Indications for Direct Laryngoscopic Examination of Vocal Cord Function Prior to Anterior Cervical Surgery.

Recurrent laryngeal nerve palsy (RLNP) is among the most common complications in both thyroid surgeries and anterior approaches to the cervical spine, having both a diverse etiology and presentation. Most bilateral paresis, with subsequent devastating impact on patients, are due to failure to recognize unilateral recurrent laryngeal nerve paralysis and, although rare, are entirely preventable with appropriate history and screening. Recurrent laryngeal nerve palsy has been shown to present asymptomatically in as high as 32% of cases, which yields limitations on exclusively screening with physical examination.

Prevention and Management of Postoperative Delirium in Elderly Patients Following Elective Spinal Surgery.

Study Design: This study is a systematic review.

Objective: Propose an evidence-based algorithm for prevention, diagnosis, and management of postoperative delirium in geriatric patients undergoing elective spine surgery.

Summary Of Background Data: Delirium is associated with longer stays after elective surgery, increased risk of readmission, and $6.

Maximum pain on visual analog scales in spinal disorders.

Background Context: Determining pain intensity is largely dependent on the patient's report.

Purpose: The objective of this study was to test the hypothesis that patients initially reporting a pain score of 10 out of 10 on the visual analog scale (VAS) would experience symptom improvement to a degree similar to patients reporting milder pain.

Study Design: This study is a retrospective chart review.

Allogeneic and Autogenous Bone Grafts Are Affected by Historical Donor Environmental Exposure.

Background: Bone graft materials are routinely evaluated for infectious agents; however, data regarding contamination of bone graft from environmental exposure of the donors to osteotoxic substances such as lead are not routinely available. In animal models, stored lead in bone has been shown to impair fracture healing and osteocyte function. In clinical studies, lead is linked to skeletal disease at relatively low concentrations.

Financial Implications of Hospital Readmission After Hip Fracture.

Introduction: Hip fracture is the leading orthopedic discharge diagnosis associated with 30-day readmission in terms of numbers. Because readmission to the hospital following a hip fracture is so common, it adds considerably to the costs on an already overburdened health care system.

Methods: Patients aged 65 and older admitted to a 261-bed university-affiliated level 3 trauma center between April 30, 2005, and September 30, 2010, with a unilateral, native, nonpathologic low-energy proximal femur fracture were identified from a fracture registry and included for analysis.

Nonsurgical Management of Early-onset Scoliosis.

Early-onset scoliosis is potentially fatal if left untreated. Although surgical management with growing instrumentation may be necessary, this is not a panacea and is associated with high complication rates. Recent evidence has demonstrated that nonsurgical treatment can be an effective early management strategy in delaying or even precluding the need for surgery, especially surgery with growing instrumentation.

Smoking Cessation Related to Improved Patient-Reported Pain Scores Following Spinal Care in Geriatric Patients.

Introduction: We examined rates of smoking cessation and the effect of smoking cessation on pain and disability scores in a geriatric patient population.

Methods: Prospectively maintained database records of 6779 patients treated for painful spinal disorders were examined. The mean duration of care was 8 months.

Mortality and Financial Burden of Periprosthetic Fractures of the Femur.

Objective: This study examines patient factors to identify risks of 12-month mortality following periprosthetic femur fractures. Hospital charges were analyzed to quantify the financial burden for treatment modalities.

Methods: Data were retrospectively analyzed from a prospective database at a university hospital setting.

Scapular dyskinesis following displaced fractures of the middle clavicle.

Purpose: To evaluate the rate of scapular dyskinesis and resulting patient outcomes after treatment of displaced midshaft clavicle fractures.

Methods: Skeletally mature patients with isolated, displaced midshaft clavicle fractures treated with or without surgery over a 16-month period were recruited. The minimum length of follow-up at study examination was 12 months.

Hospital readmission after hip fracture.

Introduction: Readmission to the hospital following a hip fracture is common, often involves an adverse event, and strains an already overburdened health care system.

Objectives: To assess the rate of 30-day readmission to the hospital after discharge for care of hip fracture. A secondary objective was measurement of the 30-day mortality rate for those patients readmitted versus those patients not readmitted to the hospital after discharge.

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

Introduction: Bedrest is often used for temporary management, as well as definitive treatment, for many spinal injuries. Under such circumstances patients cannot remain flat for extended periods due to possible skin breakdown, blood clots, or pulmonary complications. Kinetic therapy beds are often used in the critical care setting, although this is felt to be unsafe for turning patients with spine fractures.

Effects of varying locations for biceps tendon tenotomy and superior labral integrity on shoulder stability in a cadaveric concavity-compression model.

Purpose: The purpose of this study was to examine the location of biceps tenotomy and the integrity of the superior labrum as they relate to superior glenohumeral joint stability in a cadaveric concavity-compression model.

Methods: Eight cadaveric glenoid labrums were mounted individually onto a load cell with the corresponding humerus fixed to the loading arm in the hanging-arm position. All surrounding soft tissue was removed except the labrum and proximal stump of the long head of the biceps (LHB) tendon, simulating a biceps tenotomy.