In vivo recruitment patterns in the anterior oblique and dorsoradial ligaments of the first carpometacarpal joint.

The anterior oblique ligament (AOL) and the dorsoradial ligament (DRL) are both regarded as mechanical stabilizers of the thumb carpometacarpal (CMC) joint, which in older women is often affected by osteoarthritis. Inferences on the potential relationship of these ligaments to joint pathomechanics are based on clinical experience and studies of cadaveric tissue, but their functions has been studied sparsely in vivo. The purpose of this study was to gain insight into the functions of the AOL and DRL using in vivo joint kinematics data.

Interactive Instrument-Driven Image Display in Laparoscopic Surgery.

Background: A significant limitation of minimally invasive surgery is dependence of the entire surgical team on a single endoscopic viewpoint. An individualized, instrument-driven image display system that allows all operators to simultaneously define their viewing frame of the surgical field may be the solution. We tested the efficacy of such a system using a modified Fundamentals of Laparoscopic Surgery™ (Society of American Gastrointestinal and Endoscopic Surgeons, Los Angeles, CA) bead transfer task.

Early osteoarthritis of the trapeziometacarpal joint is not associated with joint instability during typical isometric loading.

The saddle-shaped trapeziometacarpal (TMC) joint contributes importantly to the function of the human thumb. A balance between mobility and stability is essential in this joint, which experiences high loads and is prone to osteoarthritis (OA). Since instability is considered a risk factor for TMC OA, we assessed TMC joint instability during the execution of three isometric functional tasks (key pinch, jar grasp, and jar twist) in 76 patients with early TMC OA and 44 asymptomatic controls.

Wrist range of motion and motion frequency during toy and game play with a joint-specific controller specially designed to provide neuromuscular therapy: A proof of concept study in typically developing children.

Upper extremities affected by hemiplegic cerebral palsy (CP) and other neuromuscular disorders have been demonstrated to benefit from therapy, and the greater the duration of the therapy, the greater the benefit. A great motivator for participating in and extending the duration of therapy with children is play. Our focus is on active motion therapy of the wrist and forearm.

Biomechanics of head impacts associated with diagnosed concussion in female collegiate ice hockey players.

Epidemiological evidence suggests that female athletes may be at a greater risk of concussion than their male counterparts. The purpose of this study was to examine the biomechanics of head impacts associated with diagnosed concussions in a cohort of female collegiate ice hockey players. Instrumented helmets were worn by 58 female ice hockey players from 2 NCAA programs over a three year period.

Emergency department external fixation for provisional treatment of pilon and unstable ankle fractures.

Unstable ankle fractures and impacted tibial pilon fractures often benefit from provisional external fixation as a temporizing measure prior to definitive fixation. Benefits of external fixation include improved articular alignment, decreased articular impaction, and soft tissue rest. Uniplanar external fixator placement in the Emergency Department (ED ex-fix) is a reliable and safe technique for achieving ankle reduction and stability while awaiting definitive fixation.

Design and Kinematic Evaluation of a Novel Joint-Specific Play Controller: Application for Wrist and Forearm Therapy.

Background: The wrist extensors and flexors are profoundly affected in most children with hemiparetic cerebral palsy (CP) and are the major target of physical therapists' and occupational therapists' efforts to restore useful hand functions. A limitation of any therapeutic or exercise program can be the level of the child's engagement or adherence. The proposed approach capitalizes on the primary learning avenue for children: toy play.

Septic ankle with purulence tracking up the flexor hallucis longus tendon sheath leading to deep venous thrombosis/pulmonary embolism and compartment syndrome.

Unlabelled: The differential diagnosis for lower extremity swelling and ankle pain is broad and can have overlapping and related diagnoses. If there is concern for more than one diagnosis, the practitioner should perform a thorough physical examination, order the appropriate studies, and perform the correct procedures to completely diagnose and treat the patient. This article presents the case of a 19-year-old male who presented with 5 days of left ankle pain, fevers, and swelling without any known trauma to the area.

Atypical Parkinsonian syndromes with very poor striatal uptake on 123I-ioflupane SPECT imaging.

We report a case series of unusual I-ioflupane SPECT imaging findings. Three patients with atypical parkinsonian symptoms underwent I-ioflupane imaging to assist in diagnosis. The patients had complete or near-complete absence of striatal activity.

In Vivo kinematics of the trapeziometacarpal joint during thumb extension-flexion and abduction-adduction.

Purpose: The primary aim of this study was to determine whether the in vivo kinematics of the trapeziometacarpal (TMC) joint differ as a function of age and sex during thumb extension-flexion (Ex-Fl) and abduction-adduction (Ab-Ad) motions.

Methods: The hands and wrists of 44 subjects (10 men and 11 women with ages 18-35 y and 10 men and 13 women with ages 40-75 y) with no symptoms or signs of TMC joint pathology were imaged with computed tomography during thumb extension, flexion, abduction, and adduction. The kinematics of the TMC joint were computed and compared across direction, age, and sex.

Is early osteoarthritis associated with differences in joint congruence?

Previous studies suggest that osteoarthritis (OA) is related to abnormal or excessive articular contact stress. The peak pressure resulting from an applied load is determined by many factors, among which is shape and relative position and orientation of the articulating surfaces or, referring to a more common nomenclature, joint congruence. It has been hypothesized that anatomical differences may be among the causes of OA.

Comparison of transhumeral socket designs utilizing patient assessment and in vivo skeletal and socket motion tracking: a case study.

Purpose: This case study compares the impact of two prosthetic socket designs, a "traditional" transhumeral (TH) socket design and a Compression Released Stabilized (CRS) socket.

Methods: A CRS socket was compared to the existing socket of two persons with transhumeral amputation. Comparisons included assessments of patient comfort and satisfaction with fit, as well as dynamic kinematic assessment using a novel high-speed, high-resolution, bi-plane video radiography system (XROMM, for X-ray Reconstruction of Moving Morphology).

Prospective analysis of a novel orthopedic residency advocacy education program.

Introduction: Future physician leaders must be able to critically assess health care policy and patient advocacy issues. Currently, no nationally accepted, standardized curriculum to provide advocacy education during orthopedic residency training exists. We therefore developed an "Advocacy" curriculum for our orthopedic residents designed to direct particular attention to patient advocacy, specialty advocacy, and healthcare policy.

Sports-specific issues in men's and women's lacrosse.

Boys'/men's and girls'/women's lacrosse are the fastest-growing sports at the high school and college levels and are team sports with unique medical issues and injuries. The rules of the game are very different for the women's game compared with those for the men's game. Youth rules include modifications that take into account physical and cognitive maturational differences.

Contribution of the medial malleolus to tibiotalar joint contact characteristics.

Background: Isolated medial malleolus fractures are typically treated operatively to minimize the potential for articular incongruity, instability, nonunion, and posttraumatic arthritis. The literature, however, has not clearly demonstrated inferior outcomes with conservative treatment of these injuries. This study measured the effects of medial malleolus fracture and its resultant instability on tibiotalar joint contact characteristics.

The Effect of C-Arm Position on Radiation Exposure During Fixation of Pediatric Supracondylar Fractures of the Humerus.

Background: Closed reduction and percutaneous pinning of a pediatric supracondylar fracture of the humerus requires operating directly next to the C-arm to hold reduction and perform fixation under direct imaging. This study was designed to compare radiation exposure from two C-arm configurations: with the image intensifier serving as the operating surface, and with a radiolucent hand table serving as the operating surface and the image intensifier positioned above the table.

Methods: We used a cadaveric specimen in this study to determine radiation exposure to the operative elbow and to the surgeon at the waist and neck levels during simulated closed reduction and percutaneous pinning of a pediatric supracondylar fracture of the humerus.

Head-impact mechanisms in men's and women's collegiate ice hockey.

Context: Concussion injury rates in men's and women's ice hockey are reported to be among the highest of all collegiate sports. Quantification of the frequency of head impacts and the magnitude of head acceleration as a function of the different impact mechanisms (eg, head contact with the ice) that occur in ice hockey could provide a better understanding of this high injury rate.

Objective: To quantify and compare the per-game frequency and magnitude of head impacts associated with various impact mechanisms in men's and women's collegiate ice hockey players.

A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2014 Updates.

Since the publication of "A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals" in 2008, prevention of healthcare-associated infections (HAIs) has become a national priority. Despite improvements, preventable HAIs continue to occur. The 2014 updates to the Compendium were created to provide acute care hospitals with up-to-date, practical, expert guidance to assist in prioritizing and implementing their HAI prevention efforts.

Batting cage performance of wood and nonwood youth baseball bats.

The purpose of this study was to examine the batting cage performance of wood and nonwood baseball bats used at the youth level. Three wood and ten nonwood bats were swung by 22 male players (13 to 18 years old) in a batting cage equipped with a 3-dimensional motion capture (300 Hz) system. Batted ball speeds were compared using a one-way ANOVA and bat swing speeds were analyzed as a function of bat moment of inertia by linear regression.

Biomechanical evaluation of the suture anchors used in open-door laminoplasty: a cadaveric study.

Study Design: A cadaveric study.

Objective: To determine whether the use of suture anchors is warranted in cervical laminoplasty.

Summary Of Background Data: The use of suture anchors to stabilize elevated laminae has been popularized in laminoplasty.

TMEFF2 deregulation contributes to gastric carcinogenesis and indicates poor survival outcome.

Purpose: The role and clinical implication of the transmembrane protein with EGF and two follistatin motifs 2 (TMEFF2) in gastric cancer is poorly understood.

Experimental Design: Gene expression profile analyses were performed and Gene Set Enrichment Analysis (GSEA) was used to explore its gene signatures. AGS and MKN45 cells were transfected with TMEFF2 or control plasmids and analyzed for gene expression patterns, proliferation, and apoptosis.

Resident duty hours: a survey of internal medicine program directors.

Introduction: In 2011, the Accreditation Council for Graduate Medical Education (ACGME) implemented new Common Program Requirements to regulate duty hours of resident physicians, with three goals: improved patient safety, quality of resident education and quality of life for trainees. We sought to assess Internal Medicine program director (IMPD) perceptions of the 2011 Common Program Requirements in July 2012, one year following implementation of the new standards.

Methods: A cross-sectional study of all IMPDs at ACGME-accredited programs in the United States (N = 381) was performed using a 32-question, self-administered survey.

Structural and Functional Support in the Prediction of Smoking Cessation in Caregivers of Children with Asthma.

Caregivers of children with asthma smoke at rates similar to the general population. Research on the relative importance of structural or functional social support in smoking cessation has been mixed. Participants were smokers (N = 154) who were caregivers of children with asthma.

The morphology of the thumb carpometacarpal joint does not differ between men and women, but changes with aging and early osteoarthritis.

The high prevalence of thumb carpometacarpal (CMC) joint osteoarthritis (OA) in women has been previously linked to the articular morphology of the trapezium. Studies report conflicting results on how the articular shapes of male and female trapezia compare to one another, however, mainly because their findings are based on data from older cadaveric specimens. The purpose of this in vivo study was to dissociate the effect of sex from that of aging and early OA by using cohorts of healthy young and healthy older subjects, as well as patients with early stage OA.

ACGME Accreditation of Orthopaedic Surgery Subspecialty Fellowship Training Programs.

Background: Orthopaedic surgery training in the United States consists of a five-year-minimum orthopaedic surgery residency program, followed by optional subspecialty fellowship training. There is an increasing trend for trainees to complete at least one fellowship program following residency training, with approximately 90% of current trainees planning to complete a fellowship. The purpose of this investigation was to assess the overall variability of orthopaedic subspecialty fellowships in terms of characteristics, match process, and the tendency to be accredited by the Accreditation Council for Graduate Medical Education.