Biofeedback in medicine: who, when, why and how?

Biofeedback is a mind-body technique in which individuals learn how to modify their physiology for the purpose of improving physical, mental, emotional and spiritual health. Much like physical therapy, biofeedback training requires active participation on the part of patients and often regular practice between training sessions. Clinical biofeedback may be used to manage disease symptoms as well as to improve overall health and wellness through stress management training.

Generalized ligamentous laxity as a predisposing factor for primary traumatic anterior shoulder dislocation.

Hypothesis: The purpose of this study was to determine whether generalized ligamentous laxity and increased shoulder external rotation represent predisposing factors for primary traumatic anterior shoulder dislocation in young, active patients. We hypothesized that generalized ligamentous laxity and increased shoulder external rotation would be more common in individuals with first-time traumatic shoulder dislocations compared with controls.

Materials And Methods: This retrospective case-control study examined hyperlaxity and shoulder external rotation >85° in 57 consecutive individuals (age <30 years) who sustained a primary traumatic anterior shoulder dislocation between 2003 and 2006.

Deaf epistemology: Deafhood and Deafness.

Deaf epistemology constitutes the nature and extent of the knowledge that deaf individuals acquire growing up in a society that relies primarily on audition to navigate life. Deafness creates beings who are more visually oriented compared to their auditorily oriented peers. How hearing individuals interact with deaf individuals shapes how deaf individuals acquire knowledge and how they learn.

Clavicle fractures in 2010: sling/swathe or open reduction and internal fixation?

Clavicle fractures are common, and they comprise close to 3% of all fractures seen in fracture clinics. Midshaft fractures account for approximately 80% of all clavicle fractures and are the focus of this article. In carefully selected cases primary plate fixation of displaced midshaft clavicle fractures improves outcome, results in earlier return to function, and reduces the nonunion and symptomatic malunion rate significantly compared with nonoperative treatment.

Calcium sulfates: what is the evidence?

Calcium sulphate has been used extensively as a bioabsorbable bone substitute for 90 years. Its advantages include its low cost, ready availability and unlimited supply, lack of donor site morbidity, use as a delivery vehicle for other compounds (especially antibiotics), inherent osteoconductive properties (based on a structure similar to bone), and its proven safety record. We sought to determine the evidence-based medical studies (prospective and/or randomized clinical trials) that support the use of calcium sulphate as a bioabsorbable bone substitute.

Bone morphogenetic proteins in open fractures: past, present, and future.

The management of open fractures continues to be complicated by high rates of treatment failure and significant patient disability and dissatisfaction. The use of bone morphogenetic proteins (BMPs) in the treatment of open fractures has been assessed by a number of different clinical trials, both in the acute management of open fractures and in the delayed reconstruction of bone defects secondary to open fracture. This review describes the scientific basis for the use of BMPs in open fractures, reviews the current evidence for their use in open fractures, provides grades of recommendation for the different uses of BMPs in open fractures, and identifies important areas for additional research.

Immediate plate osteosynthesis of open fractures of the humeral shaft.

Background: The aim of this study was to assess the outcome of immediate plate osteosynthesis in the surgical treatment of open humeral shaft fractures.

Methods: In a Level I trauma center and teaching hospital, we reviewed 53 patients with open humeral diaphyseal fractures who were treated with immediate open reduction and plate fixation from April 1988 to August 1998. Forty-six patients were available for adequate follow-up and assessment.

External fixation of distal radius fractures.

Fractures of the distal radius are the most common fractures that occur in patients between ages 15 and 75 years. Many methods for treating displaced distal radius fractures are available. All forms of treatment involve obtaining fracture reduction, which may then be maintained by casting, functional bracing, external fixation, percutaneous pinning, internal fixation, or a combination of these methods.

Development of the radiographic union score for tibial fractures for the assessment of tibial fracture healing after intramedullary fixation.

Background: : The objective was to evaluate the newly developed Radiographic Union Score for Tibial fractures (RUST). Because there is no "gold standard," it was hypothesized that the RUST score would provide substantial improvements compared with previous scores presented in the literature.

Methods: : Forty-five sets of X-rays of tibial shaft fractures treated with intramedullary fixation were selected.

Do corticosteroids reduce the risk of fat embolism syndrome in patients with long-bone fractures? A meta-analysis.

Background: Fat embolism syndrome (FES) is a potentially lethal condition most commonly seen in polytrauma patients with multiple long-bone fractures. Treatment has centred around supportive care and early fracture fixation. Several small clinical trials have suggested corticosteroids benefit patients with FES, but this treatment remains controversial.

When VSEPR fails: experimental and theoretical investigations of the behavior of alkaline-earth-metal acetylides.

The synthesis, structural, and spectral characterization as well as a theoretical study of a family of alkaline-earth-metal acetylides provides insights into synthetic access and the structural and bonding characteristics of this group of highly reactive compounds. Based on our earlier communication that reported unusual geometry for a family of triphenylsilyl-substituted alkaline-earth-metal acetylides, we herein present our studies on an expanded family of target derivatives, providing experimental and theoretical data to offer new insights into the intensively debated theme of structural chemistry in heavy alkaline-earth-metal chemistry.

Mortality and complications following stabilization of femoral metastatic lesions: a population-based study of regional variation and outcome.

BACKGROUND: It is considered that patients at risk for spontaneous fracture due to metastatic lesions should undergo surgical stabilization before fracture occurs; however, prophylactic stabilization is associated with surgical morbidity and mortality. We sought to compare pathological fracture fixation versus prophylactic stabilization of diaphyseal femoral lesions for patients with femoral metastases and assess the rate of prophylactic surgery completed in all regions of Ontario. METHODS: Using population data sets, we identified all patients who had undergone femoral stabilization, either for pathological femoral fractures or for prophylactic fixation of femoral metastases before pathological fractures, between 1992 and 1997 in Ontario.

Mechanistic study of LiNH(2)BH(3) formation from (LiH)(4) + NH(3)BH(3) and subsequent dehydrogenation.

The formation of LiNH(2)BH(3) from (LiH)(4) and NH(3)BH(3) and the subsequent dehydrogenation have been studied computationally at the CCSD(T)/6-311++G(3d,2p)//MP2/6-311++G(2d,p) level. A cubic unit of (LiH)(4) is predicted to react readily with NH(3)BH(3) to form LiNH(2)BH(3) plus H(2). The (LiH)(4) tetramer enables dehydrogenation through the exchange of a hydride vertex of (LiH)(4) and NH(2)BH(3)(-) where NH(2)BH(3)(-) is formed when the hydride vertex of (LiH)(4) abstracts a proton from NH(3).

Salvage of failed hip fracture fixation.

Nonunion of fractures about the femoral neck and intertrochanteric hip regions is uncommon. Patients who develop nonunions of these fractures typically exhibit marked pain and disability, thereby presenting a treatment challenge to the orthopaedic surgeon. Factors that guide the choice of salvage treatment include the anatomic site of the nonunion, the quality of the remaining proximal bone and articular surface, and patient factors (such as age and activity level).

Intramedullary versus extramedullary fixation for subtrochanteric femur fractures.

Objectives: Both intramedullary and extramedullary internal fixation has been advocated for the treatment of subtrochanteric femur fractures. Is there clinical evidence to recommend one method of internal fixation over the other?

Data Sources: A search of MEDLINE (1950 to June 2007), CINAHL (1982 to June 2007), and EMBASE (1980 to June 2007) was performed. Results were limited to English language studies.

Minimally invasive hip fracture surgery: are outcomes better?

Objectives: Intertrochanteric hip fractures have high morbidity and mortality rates. The purpose of this study was to determine if minimally invasive plating, nailing, or external fixation operations lead to improved outcomes for intertrochanteric hip fractures compared with standard insertion of a sliding hip screw (SHS).

Data Sources: A systematic search of MEDLINE (1996 to June 2007) and EMBASE (1980 to June 2007) was performed.

Open reduction and internal fixation compared with circular fixator application for bicondylar tibial plateau fractures. Surgical technique.

Background: Standard open reduction and internal fixation techniques have been successful in restoring osseous alignment for bicondylar tibial plateau fractures; however, surgical morbidity, especially soft-tissue infection and wound necrosis, has been reported frequently. For this reason, several investigators have proposed minimally invasive methods of fracture reduction followed by circular external fixation as an alternative approach. To our knowledge, there has been no direct comparison of the two operative approaches.

Biomechanical evaluation of extramedullary versus intramedullary fixation for reverse obliquity intertrochanteric fractures.

Objectives: This study evaluated the 135-degree hip screw, 95-degree hip screw, and intramedullary hip screw (IMHS) for fixation of reverse obliquity intertrochanteric fractures.

Methods: Twelve matched pairs of human femora (mean age 64 years) were obtained. Osteotomies were created in left femurs at a 33-degree angle, running inferolaterally from the lesser trochanter to mimic reverse obliquity intertrochanteric fractures.

Endohedral hydrogen exchange reactions in C60 (nH2@C60, n = 1-5): comparison of recent methods in a high-pressure cooker.

The interactions of several H(2) molecules [(H(2))(n), n = 1-5] within C(60), C(70), and C(82) have been studied with several DFT methods as well as with MP2 and SCS-MP2. As expected, B3LYP significantly underestimates dispersion interactions, while the M05-2X and M06-2X methods are in much better agreement with MP2 and SCS-MP2 results. Degenerate hydrogen exchange reactions were calculated for 3H(2) --> 3H(2) inside C(60), C(70), and C(82).

The effect of cement mixing time on the biomechanics of cement augmented plated fractures in canine femora.

Objective: The goal of this study was to determine the effect of cement mixing time and, hence, cement viscosity on the biomechanical behavior of femoral fracture fixation.

Design: Cadaveric plated canine femoral fracture model, comparing treatments in matched pairs.

Setting: Orthopaedic biomechanics laboratory.

A multicenter, prospective, randomized, controlled trial of open reduction--internal fixation versus total elbow arthroplasty for displaced intra-articular distal humeral fractures in elderly patients.

We conducted a prospective, randomized, controlled trial to compare functional outcomes, complications, and reoperation rates in elderly patients with displaced intra-articular, distal humeral fractures treated with open reduction-internal fixation (ORIF) or primary semiconstrained total elbow arthroplasty (TEA). Forty-two patients were randomized by sealed envelope. Inclusion criteria were age greater than 65 years; displaced, comminuted, intra-articular fractures of the distal humerus (Orthopaedic Trauma Association type 13C); and closed or Gustilo grade I open fractures treated within 12 hours of injury.