Cyclic testing of six-strand suture techniques for zone 2 flexor tendon lacerations.

Background: Biomechanical analysis using cyclic testing for repaired flexor tendons is a clinically relevant method. The aim of this study was to evaluate the tensile properties of two six-strand suture techniques, the triple looped suture and Yoshizu #1 suture techniques using cyclic testing under simulating early active mobilization conditions.

Methods: Twenty-five flexor digitorum profundus tendons harvested from fresh frozen human cadaver hands were repaired in zone 2 utilizing one of three repair techniques: the 2-strand modified Kessler (MK) technique as a control, the triple looped suture (TLS) and Yoshizu #1 suture (Y1) techniques.

Aortic Stenosis Phenotypes and Precision Transcatheter Aortic Valve Implantation.

Patients with a clinical indication for aortic valve replacement can either undergo surgical aortic valve replacement (SAVR) or Transcatheter Aortic Valve Implantation (TAVI). There are many different factors that go into determining which type of replacement to undergo, including age, life expectancy, comorbidities, frailty, and patient preference. While both options offer significant benefits to patients in terms of clinical outcomes and quality of life, there is growing interest in expanding the indications for TAVI due to its minimally invasive approach.

Outcomes in 937 Intermediate-Risk Patients Undergoing Surgical Aortic Valve Replacement in PARTNER-2A.

Background: The Placement of Aortic Transcatheter Valves 2A (PARTNER-2A) randomized trial compared outcomes of transfemoral transcatheter and surgical aortic valve replacement (SAVR) in intermediate-risk patients with severe aortic stenosis. The purpose of the present study was to perform an in-depth analysis of outcomes after SAVR in the PARTNER-2A trial.

Methods: From January 2012 to January 2014, 937 patients underwent SAVR at 57 centers.

A Model of Pressure, Oxygenation, and Perfusion Risk Factors for Pressure Ulcers in the Intensive Care Unit.

Background: Although most intensive care patients are at risk for pressure ulcers, not all experience such ulcers.

Objective: To examine a model of variables related to extrinsic and intrinsic pressure on skin and underlying tissues, oxygenation, perfusion, and baseline comorbid conditions to identify risk factors associated with pressure ulcers in critically ill adults.

Method: A retrospective chart review was conducted on patients identified by weekly rounds from January 2010 through October 2010 to determine the prevalence of pressure ulcers.

Gastric reflux: association with aspiration and oral secretion pH as marker of reflux: a descriptive correlational study.

Background: Gastric reflux leading to pulmonary aspiration is a frequent event in mechanically ventilated, gastric-fed patients, which can lead to ventilator-associated complications and pneumonia.

Objectives: The objectives of this study were to determine the association between gastric reflux and aspiration using the presence of pepsin in oral or tracheal secretions as a marker of reflux or aspiration and to determine the association between the pH (range, 0-14) and the presence of pepsin in oral secretions.

Methods: A descriptive correlational study was conducted in mechanically ventilated surgical or medical patients receiving gastric tube feedings.

Solitary osseous capillary-type vascular malformation of the distal humerus in a child.

Vascular malformations are abnormal proliferations of the endothelial lining of the blood vessels that are most commonly found in skin and can penetrate the local soft tissue and muscle. Only 1% of all vascular malformations are found in the bone. Skeletal vascular malformations of the long bones, including the humerus, are extremely rare entities that are particularly uncommon in children.

Role of new drugs for management of atrial fibrillation.

Objective: To evaluate the role of newer agents in the management of atrial fibrillation (AF).

Data Sources: EMBASE and MEDLINE were searched (up to June 2012) combining medication names with atrial fibrillation, humans, clinical trials, and pharmacoeconomic. References of the articles identified and www.

Heparin or 0.9% sodium chloride to maintain central venous catheter patency: a randomized trial.

Objective: To compare heparin (3 mL, 10 units/mL) and 0.9% sodium chloride (NaCl, 10 mL) flush solutions with respect to central venous catheter lumen patency.

Design: Single-center, randomized, open label trial.

Modified Oblique Keller Capsular Interposition Arthroplasty for Hallux Rigidus.

Introduction: This paper describes the modified oblique Keller capsular interposition arthroplasty, which may be indicated for patients with late-stage hallux rigidus who wish to retain joint motion.

Step 1 Exposure: Make dorsal medial longitudinal incision over MTP joint and retract dorsal cutaneous nerve of great toe laterally.

Step 2 Mobilize Extensor Hallucis Longus Tendon: Separate extensor hallucis longus from dorsal aspect of capsule and extensor hallucis brevis and retract laterally.

Patient compliance with clinical follow-up after total joint arthroplasty.

Background: Periodic clinical and radiographic evaluation is commonly recommended by orthopaedic surgeons to monitor patients following total joint arthroplasty, yet the compliance with and efficacy of patient follow-up protocols have not been well defined. The purpose of this study was to evaluate patient compliance with early clinical follow-up after total hip arthroplasty or total knee arthroplasty.

Methods: We performed a retrospective review of clinical follow-up compliance for 776 patients who had undergone a total joint arthroplasty in the lower extremity.

Timing of development of adjacent-level ossification after anterior cervical arthrodesis with plates.

Background Context: Although the prevalence and severity of adjacent-level ossification development after anterior cervical plating has previously been described, there are no investigations regarding the timing of ossification development.

Purpose: To determine the timing of adjacent-level ossification development and maturation and discern any differences in ossification development for patients who have a plate-to-disc distance (PDD) that is <5 mm versus =5 mm.

Study Design/setting: Retrospective study.

Anterior femoroacetabular impingement: a diverse disease with evolving treatment options.

Anterior femoroacetabular impingement (FAI) is a major etiologic factor in the pathogenesis of hip arthritis. In this condition, mechanical abnormalities of the hip joint lead to early hip dysfunction, inflammation, cartilage injury, and eventual joint degradation. FAI is now more commonly diagnosed and there is an increasing need for a thorough understanding of the broad spectrum of clinical presentation for the disease as well as more precise definition of the possible surgical options.

The early effects of sustained platelet-derived growth factor administration on the functional and structural properties of repaired intrasynovial flexor tendons: an in vivo biomechanic study at 3 weeks in canines.

Purpose: A bioactive fibrin-based delivery system was used to provide sustained administration of platelet-derived growth factor (PDGF-BB) in a clinically relevant model of intrasynovial flexor tendon repair. We hypothesized that PDGF-BB administered in this manner would improve the sutured tendon's functional and structural properties 3 weeks after repair.

Methods: A delivery system consisting of 30 microL of fibrin matrix, peptide, heparin, and 100 ng of PDGF-BB was incorporated into the repair sites of randomly selected medial or lateral forepaw flexor digitorum profundus tendons of 8 adult mongrel dogs.

How to write a systematic review.

Evidence-based medicine (EBM) is the combination of the best available research evidence with clinical experience and patient needs. The concept of EBM as a part of clinical decision making has become increasingly popular over the last decade. In the hierarchy of studies meta-analysis and systematic reviews occupy the highest levels.

Calcium pyrophosphate dihydrate deposition disease (pseudogout) after total knee arthroplasty.

The authors report a case of calcium pyrophosphate dihydrate deposition disease (pseudogout) presenting in the early period after primary total knee arthroplasty. The patient's symptoms resolved with conservative management including colchicine and indomethacin. The presentation of pseudogout resembles septic arthritis and should be included in the differential diagnosis to prevent unnecessary surgery in these patients.

Arthrodesis techniques in the management of stage II and III acquired adult flatfoot deformity.

The proper management of acquired flatfoot deformity requires obtaining a careful patient history and physical examination of the foot, ankle, and lower extremity. Accurate assessment of foot flexibility and localization of pain will aid in decision making. Nonsurgical management may not be successful in patients with advanced disease, particularly with the development of degenerative changes.

Clinical presentation of patients with tears of the acetabular labrum.

Background: The clinical presentation of a labral tear of the acetabulum may be variable, and the diagnosis is often delayed. We sought to define the clinical characteristics associated with symptomatic acetabular labral tears by reviewing a group of patients who had an arthroscopically confirmed diagnosis.

Methods: We retrospectively reviewed the records for sixty-six consecutive patients (sixty-six hips) who had a documented labral tear that had been confirmed with hip arthroscopy.

Surgical procedure profile in a comprehensive hip surgery program.

Surgical management of hip disease in adolescents and young to middle-aged adults is rapidly evolving, and a variety of operative techniques are needed to provide comprehensive care. The purpose of this study was to determine the utilization of surgical procedures and recent changes in procedure utilization in a comprehensive hip surgery program. We performed a retrospective review of 983 hip procedures in 854 patients performed over a seven year time period.

Detection of esophageal perforation using intraesophageal dye injection.

Objectives: Esophageal perforation complicating anterior cervical spine surgery is a potentially fatal complication. Early identification and immediate treatment may lower adverse effects for the patient. The purpose of this study is to assess the efficacy of intraesophageal dye injection to detect an esophageal injury and to test two novel techniques.

Thymoglobulin induction is safe and effective in live-donor renal transplantation: a single center experience.

Background: The relative benefit versus safety of induction therapy in live-donor renal transplant recipients is controversial. This paper presents observational data of live-donor recipients who received Thymoglobulin induction and standard maintenance immunosuppressive therapy.

Methods: Review and analysis of clinic records and electronic databases of live-donor renal transplants that received Thymoglobulin induction from May 1996 through 2003.

Use of the rat forelimb compression model to create discrete levels of bone damage in vivo.

Skeletal responses to damage are significant for understanding the etiology of stress fractures and possibly osteoporotic fractures. We refined the rat forelimb-loading model to produce a range of sub-fracture damage levels during in vivo cyclic loading. A total of 98 right forelimbs of anesthetized, male, 5-month old Fischer rats were loaded cyclically (2 Hz) in axial compression.