Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group.

Background: Fractures of the clavicle were reported to represent 2.6% of all fractures with an overall incidence of 64 per 100,000 per year (1987, Malmö, Sweden). Midshaft fractures account for approximately 69% to 81% of all clavicle fractures.

Management of distal humerus fractures with minifragment fixation.

Minifragment implants provide several advantages for the stabilization of distal humerus fractures. Compared with small fragment implants, minifragment implants may provide enhanced fracture fixation because a greater number of screws can be placed into the distal fragments. In addition, minifragment plates are easier to contour and less prominent.

The application of dermatotraction for primary skin closure.

Management of an open wound is a problem frequently encountered in the treatment of fractures. Skin grafting, rotational flaps, free flaps, and healing by secondary intention add a considerable amount of morbidity and cost to the patient. Therefore, it is ideal to obtain primary closure when possible.

High-dose methotrexate in acute lymphoblastic leukemia: where is the evidence for its continued use?

High-dose intravenous methotrexate is an important component of many effective chemotherapeutic regimens for childhood acute lymphoblastic leukemia (ALL). Its use has a strong pharmacologic rationale: to overcome mechanisms of resistance of the malignant cells and to achieve cytotoxic concentrations in sanctuary sites for lymphoblasts. Although therapeutic progress in ALL during the past 4 decades has been closely associated with more widespread use of intravenous methotrexate and in progressively larger doses, little data exist to clearly support the use of high-dose intravenous methotrexate over a regimen of prolonged administration of low-dose methotrexate.

Treatment of proximal tibia fractures using the less invasive stabilization system: surgical experience and early clinical results in 77 fractures.

Objective: To summarize the surgical experience and clinical results of the first 89 fractures of the proximal tibia treated with the Less Invasive Stabilization System (LISS; Synthes, Paoli, PA).

Design: Retrospective analysis of prospectively enrolled patients into a database.

Setting: Academic level I trauma center.

Treatment of distal femur fractures using the less invasive stabilization system: surgical experience and early clinical results in 103 fractures.

Objective: To summarize the complications and early clinical results of 123 distal femur fractures treated with the Less Invasive Stabilization System (LISS; Synthes, Paoli, PA).

Design: Retrospective analysis of prospectively enrolled patients.

Setting: Two academic level I trauma centers.

Biomechanical evaluation of the less invasive stabilization system, angled blade plate, and retrograde intramedullary nail for the internal fixation of distal femur fractures.

Objective: To evaluate the stability of the retrograde intramedullary nail (IMN), angled blade plate (ABP), and a locked internal fixator (Less Invasive Stabilization System [LISS], Synthes, Paoli, PA) for internal fixation of distal femur fractures.

Design: Destructive biomechanical testing of matched pairs of fresh-frozen human cadaveric bone-implant constructs.

Setting: Biomechanical laboratory.

Status of methylthioadenosine phosphorylase and its impact on cellular response to L-alanosine and methylmercaptopurine riboside in human soft tissue sarcoma cells.

The aim of this study was to examine the expression of methylthioadenosine phosphorylase (MTAP) in 21 fresh tumor samples from patients with soft tissue sarcomas (STS) and 11 human soft tissue sarcoma cell lines, and to determine if loss of expression of this enzyme was correlated with increased sensitivity to L-alanosine and/or 6-methylmercaptopurine. We used a polyclonal antibody to measure the expression of MTAP in soft tissue sarcoma cell lines and in fresh tumor samples. Transfection of the HT-1080 cell line with a plasmid containing the cDNA for the MTAP gene was also performed to generate cell lines for in vitro and in vivo comparative sensitivity studies.

From eminence-based practice to evidence-based practice: a paradigm shift.

Evidence-based medicine differs from the traditional approach to health care in that in addition to relying on clinical experience, expert opinion, and knowledge of pathophysiology for clinical decision-making, clinicians identify important knowledge gaps and information needs, formulate answerable questions, identify potentially relevant research, assess the validity of evidence and results, and apply research evidence to individual patients in a way that takes into account the patients' particular experiences, expectations, and values. It is becoming increasingly important that physicians learn the concepts of EBM because many EBM-related concepts have become a part of daily clinical practice. This article uses examples from orthopedics to outline EBM principles and methods and the advantages of EBM over traditional approaches.

Reduced folate carrier mutations are not the mechanism underlying methotrexate resistance in childhood acute lymphoblastic leukemia.

Background: Although the majority of children with acute lymphoblastic leukemia (ALL) are cured with combination chemotherapy containing methotrexate (MTX), drug resistance contributes to treatment failure for a substantial fraction of patients. The primary transporter for folates and MTX is the reduced folate carrier (RFC). Impaired drug transport is a documented mechanism of MTX resistance in patients with ALL; however, to the authors' knowledge it is not known whether inactivating RFC mutations are a contributing factor.

Initial experience with proximal anastomoses performed with a mechanical connector.

Background: The Symmetry Bypass System Aortic Connector (St Jude Medical, Inc) is a novel device for the construction of sutureless proximal anastomoses. The connector allows attachment of saphenous vein grafts to the aorta without requiring aortic clamping. We report our initial clinical experience with this device.

Effect of osmolality on mucociliary transportability and rheology of cystic fibrosis and bronchiectasis sputum.

Objective: Water is the main constituent of mucus, and its concentration is likely to be important in all aspects of mucus function, including ciliary clearance. The objective of this study was to investigate the effect of water content and osmolality of the mucus on mucociliary transportability.

Methodology: Rheology and ciliary transportability of 10 sputum samples that had been subjected to various manipulations were measured using a mucus-depleted bovine trachea model.

Massive perineal wound slough after treatment of complex pelvic and acetabular fractures using a traction table.

An operating table with the capacity for skeletal traction against a pudendal post is a helpful and commonly used piece of equipment for certain pelvic and acetabular fracture patterns. Perineal soft tissue trauma and urogenital injuries are associated with some pelvic and acetabular fractures. The perineal region is vulnerable to compromise after such injuries.

Osteosarcoma cells, resistant to methotrexate due to nucleoside and nucleobase salvage, are sensitive to nucleoside analogs.

Purpose: To test a novel strategy for overcoming intrinsic resistance to methotrexate (MTX) in osteosarcoma (OS) due to nucleoside and nucleobase salvage (NS).

Methods: Four OS cell lines, found to be highly resistant to MTX, were tested to determine the dominant mechanism of resistance. Sensitivity to MTX was tested in the presence of dialyzed serum or the transport inhibitor dipyridamole (DP) to confirm the contribution of NS to MTX resistance.

Dextromethorphan is effective in the treatment of subacute methotrexate neurotoxicity.

Methotrexate-induced neurotoxicity (MTX-Ntox) is a frequent complication of methotrexate (MTX) therapy for patients with both malignant and inflammatory diseases. MTX-Ntox can occur after intrathecal MTX or after low-, intermediate-, or high-dose systemic administration. Symptoms can present in the acute, subacute, or late setting form, and can range from affective disorders, malaise, and headaches, to somnolence, focal neurologic deficits, and seizures.

Treatment of osteoporotic ankle fractures in the elderly: surgical strategies.

The goal of displaced ankle fracture treatment is to restore congruity and stability to the ankle mortise. However, adequate fixation in patients with osteoporosis is difficult due to poorly mineralized bone. This article presents alternative fixation strategies that can helpachieve ankle stability in this patient population.

Scapula fractures.

Scapula fractures are relatively rare fractures which are typically a result of high energy trauma. Associated multisystemic injuries, therefore, occur with a high frequency. The management of scapula fractures has historically been nonoperative, perhaps in part due to the paucity of information regarding outcomes, combined with a relative unfamiliarity with treating these injuries.