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| News in Brief - June 2010 Brief items of the latest industry news... |
| Readers Comments Unedited readers comments about Orthopaedic Product News ... |
| Biomaterial Stretches Like Muscle Many research groups are trying to develop materials with similar properties to muscles... |
| CT Technique is More Specific than X-rays in Detecting Thoracic, Lumbar Spine Fractures When trauma patients receive a CT scan of the chest, abdomen, and pelvis, (CT spine reformatting) it... |
| Dietary Protein May Reduce Hip Fractures in the Elderly Seniors who consume a higher level of dietary protein are less likely to suffer... |
| West Midlands Consultant Wins National Award for Rheumatology Family Support Network A specialist consultant from the West Midlands Paediatric Rheumatology Network... |
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News In Brief
 Surgeons keen to help their patients realise the benefits of a partial knee replacement have been urged to take a comprehensive training course first and then back it up with ongoing professional development through the sharing of their experiences with fellow surgeons.
That’s the advice of consultant orthopaedic surgeon Graham Keys who says he would also like to see the process go even further to mirror the situation in the US where, in approving the Oxford Partial Knee Replacement, the FDA designated that surgeons had to attend a live instructional course before they operate themselves.
Mr Keys, who uses the Oxford Partial Knee at Macclesfield General Hospital in Cheshire, UK, says, “Not only do you see the surgeon doing a video link live operation but you can interact with that surgeon. Having done these things myself, I know how instructive it is for these surgeons because they find out the difficulties others have with the operation. Even those who have done a few can come back and learn how and where they may have gone wrong. Then they can learn with lectures all about the principles of what they are aiming to do and they can play around in the laboratories afterwards on plastic knees.”
And he says surgeons performing partial knee replacements should never stop learning. “We run master classes which are user groups. Those of us who have been doing partial knees for a long period of time run these classes with surgeons who have done maybe 10 or 20 of them who will come along and bring all their queries and they can speak to a group of more experienced surgeons and we can pool our experience and discuss problems and new techniques and instruments.”Dr Richard Keen, a bone health expert recently stated that including osteoporosis indicators in QOF would be a cheap and effective way to prevent fractures and hospital admissions.
Dr Keen, director of the Metabolic Bone Disease Unit at the Royal National Orthopaedic Hospital in Stanmore, north London, said relatively few GPs had signed up to the osteoporosis directed enhanced service, introduced in 2008.
He said a 50 year-old woman has a one in two chance of suffering an osteoporosis fracture and two-thirds of sufferers with a vertebral fractures go undetected.
He said by including a ‘relatively simple and cheap’ process in the QOF to identify and register those at risk, it would cut hospital admissions significantly.
Osteoporosis was one of a number of clinical areas left out of the QOF in 2007 as access targets were included for the first time.
NICE guidance recommends female fracture patients over the age of 75 are treated with a bisphosphonate.
Source: Healthcare RepublicA £5m outpatient centre designed for the Royal National Orthopaedic Hospital has been opened by the Duke of York in London.
The centre, developed by Ridgeford Properties and Manhattan Loft Corporation, will treat many of the nation’s acute spinal injuries most complex orthopaedic conditions.
The building spans three floors and boasts the latest healthcare facilities within its clinics, imaging (both X-ray and ultrasound), orthotics, occupational therapy, physiotherapy, pre-operative assessment and plaster theatre.
The facility boasts public artwork in the form of two-storey glass fins on the south and west wing of the building. The glass fins display MRI scans that have been transposed to create shadowy and transparent ‘hands’ that meet at the corner of the building.
Source: BuildingThe mortality rate within the first 90 days of shoulder arthroplasty in patients with proximal humeral fractures is about 3%, it has been claimed.
According to new research looking into the dangers of using shoulder arthroplasty to treat proximal humeral fractures, the surgeons behind the paper showed that those with a fracture were six times more likely to need repeat surgery than patients without one.
Lead researcher Eugene Farng told Ortho Supersite: “Serious complications requiring re-admission occur three per cent of the time for elective surgery.
“Fracture and medical comorbidity are all independent predictors of complication, and the type of procedure and hospital volume were not associated with complications.”
The study looked at 15,000 sets of patient records, which covered a ten year period between 1995 and 2005.
Some 95% of patients with fractures underwent hemiarthroplasty of the shoulder.
Speaking at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons recently, orthopaedic expert Asheesh Bedi claimed that surgeons should be wary of using prophylaxis as a preventative measure for thromboembolism during shoulder arthroplasty.FRAX® is a free online fracture-risk calculator (www.shef.ac.uk/FRAX) that has been developed by the World Health Organisation Collaborating Centre for Metabolic Bone Diseases at the University of Sheffield, UK. More and more physicians around the world are using the tool as an aid in making informed treatment decisions in the course of a clinical assessment of their patients.
FRAX® calculates the 10-year probability of a major fracture and until now was only accessible as an online questionnaire in clinical settings, via the internet. Biomaterial Stretches Like Muscle Many research groups are trying to develop materials with similar properties to muscles. One of the big difficulties is creating anything with just the right muscle-like elasticity Now researchers at the University of British Columbia (UBC) in Vancouver, Canada, have synthesized a protein-based material that stretches exactly like the real thing. The new material achieves the elasticity of muscle by mimicking the microscopic structure of a giant muscle protein called titin. Hongbin Li, a chemist at the UBC, and his colleagues constructed the new material that imitates this structure. They chose a mechanically stable protein sequence that folds in on itself to form globules, and another protein called resilin to serve as the floppy connectors. The result was a “mini-titin” – a protein that resembled titin structurally but is much smaller, Li says. The researchers chemically linked the individual protein strands together to form a hydrogel and then tested the material’s mechanical properties. The team describes the work in a recent issue of the journal Nature. When they tested the material, Li and his colleagues found that it behaved much like real muscle tissue. When stretched a little bit, it bounces back like an elastic rubber band. If stretched more vigorously, the beadlike protein domains unfold, and it dissipates some energy before returning to its original state. “It’s a nice progression along the lines of building an artificial muscle,” says physicist David Weitz of Harvard University, whose group studies the structure of muscle protein networks. Other groups are working on creating electroactive polymers, which contract when stimulated by an electric signal, so that the “muscle” can be controlled. The current material does not have this feature, but adding that would be “the next step”, Weitz says. Artificial muscles could one day be used as scaffolds for growing muscle to repair damage in patients; in biologically compatible devices for medical applications; even to control robots without using motors. However, since proteins tend to unravel at high temperatures and under harsh environmental conditions, this does not make them ideal for industrial applications. Source: Technology Review CT Technique is More Specific than X-rays in Detecting Thoracic, Lumbar Spine Fractures When trauma patients receive a CT scan of the chest, abdomen, and pelvis, (CT spine reformatting) it eliminates the need for X-rays of the thoracic and/or lumbar spine to detect spinal fractures. This technique can lower cost and overall patient radiation exposure, according to a study to be presented at the ARRS 2010 Annual Meeting in San Diego, CA, USA.  CT spine reformatting is performed after a CT scan is complete. It helps the radiologist assess the thoracic and/or lumbar regions of the spine without additional imaging, which can reduce cost and patient radiation exposure.
“Background research shows that CT is much more sensitive and specific than X-rays in detecting thoracic and lumbar spine fractures,” said Viesha Ciura, MD, lead author of the study. “Our study looked at the percentage of trauma patients who had both reformatted CT data and X-rays of the thoracic and/or lumbar region of the spine and the additional radiation dose and cost associated with the unnecessary X-rays,” said Ciura.
The study, performed at the University of Calgary, Foothills Medical Centre, included 897 trauma CT scans with spine reformats. 19% of the patients with reformatted CT data showing the spine also had X-rays of the same segment of the spine. “In patients with spinal fractures detected on the CT spine reformats, the X-rays provided no additional information, and in fact, some of these fractures were not seen on the X-rays,” said Ciura. “Our calculations suggest that in every 1,000 trauma patients, the added radiation dose from spine X-rays that may not have been needed is 170 mSv; the additional cost per 1,000 trauma patients was $19,678.93,” she said.
“At a time where radiation issues are gaining increasing importance in considering the utilization of diagnostic imaging, the addition of what appear to be unnecessary X-rays as part of managing trauma needs to be reconsidered,” said Ciura.
“At our institution, we have introduced a new protocol, that all trauma patients undergoing CT of the chest, abdomen, and pelvis also have CT reformats of the thoracic and lumbar spine to decrease the costs and excess radiation exposure associated with additional imaging,” she said.
Source: American College of Radiology
Dietary Protein May Reduce Hip Fractures in the Elderly Seniors who consume a higher level of dietary protein are less likely to suffer hip fractures than seniors whose daily dietary protein intake is less, according to a new study by the Institute for Aging Research of Hebrew SeniorLife in Boston, an affiliate of Harvard Medical School. The study, which examined the daily protein intake of 946 seniors from the Framingham Osteoporosis Study, found that individuals who were in the lowest 25% of dietary protein intake had approximately 50% more hip fractures than those who consumed greater amounts of dietary protein. Those who suffered hip fractures consumed less than the 46 grams of dietary protein per day recommended for adults.  “Study participants who consumed higher amounts of protein in their diet were significantly less likely to suffer a hip fracture,” says senior study author Marian T. Hannan, D.Sc., M.P.H., co-director of the Musculoskeletal Research Program at the Institute for Aging Research.
The study, which was funded in part by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, will be published in May in the online-first edition of Osteoporosis International. It builds on previous studies that included mostly women and reported a relationship between greater dietary protein intake and decreased risk of hip fracture.
While other studies have shown that dietary protein intake is also linked with higher bone mineral density, Dr. Hannan says dietary protein may further protect elderly people against hip fracture by building stronger muscles in the legs. Most fractures occur after a fall, which may be caused by less muscle mass and decreased strength in the lower extremities.
Dr. Hannan, an associate professor of medicine at Harvard Medical School, recommends that older women consume at least 46 grams of protein per day, and that older men consume at least 56 grams of protein daily. This can come from both animal sources and plants. The study did not examine the type of protein consumed.
In addition to increased dietary protein, Dr. Hannan says regular exercise to build stronger muscles and better balance, as well as other falls prevention strategies, such as reducing hazards in the home, can help protect seniors against falls and hip fractures.
More than 25 million Americans over the age of 50 have either osteoporosis, a disease in which bones become fragile and more likely to break, or osteopenia, a condition in which bone mineral density is lower than normal, but not low enough to be considered osteoporosis. More than 95% of hip fractures in people over the age of 65 are caused by falls and can lead to severe health problems, including decreased quality of life and premature death.
Scientists at the Institute for Aging Research conduct rigorous medical and social studies, leading the way in developing strategies for maximising individuals’ strength, vigor and physical well-being, as well as their cognitive and functional abilities in late life.
Founded in 1903, Hebrew SeniorLife, an affiliate of Harvard Medical School, is a nonprofit organisation devoted to innovative research, health care, education and housing that improves the lives of seniors.
Source: Institute for Aging Research
West Midlands Consultant Wins National Award for Rheumatology Family Support Network A specialist consultant from the West Midlands Paediatric Rheumatology Network in the UK has been awarded a top prize by a panel of clinical experts for establishing a much needed clinical support network for young patients and their families in the West Midlands. Dr Kathryn Bailey, Chair of the network, topped the national ‘Patient in Focus’ awards run by the National Rheumatoid Arthritis Society (NRAS). Dr Bailey was presented her award at the British Society for Rheumatology Conference in Birmingham in April. Dr Bailey picked up the award for creating a West Midlands-wide support network trying to get parents and their children with Juvenile Idiopathic Arthritis (JIA) involved in deciding what type of care they need through the medium of a DVD. On receiving her award, Dr Kathryn Bailey, Chair of the West Midlands Paediatric and Adolescent Rheumatology Network said: “Juvenile Arthritis is one of the commonest causes of disability beginning in childhood. In the West Midlands we recognise the variation of patient experiences in accessing paediatric rheumatology services and the care they then receive. The West Midlands Paediatric and Adolescent Rheumatology Network was established to try and address some of these differences and support the professionals working within the area. I am very proud of the work that the families and young people have done to put this DVD together and hope that it can now be used to help make a difference for those who suffer with Juvenile Arthritis.” Ailsa Bosworth is the founder and Chief Executive of the National Rheumatoid Arthritis Society (NRAS) and a member of the judging panel for the Patients in Focus Award. She said: “The judges were unanimously impressed with this work. A picture paints a thousand words and this DVD is very powerful viewing which has led to a much better understanding by commissioners and others of the specific issues faced by families of children with Juvenile Idiopathic Arthritis (JIA). We are delighted to recognise Dr. Bailey and her team in this way.” |
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