Arthroplasty vs. Internal Fixation for the Treatment of Minimally Displaced Femoral Neck Fractures
Arthroplasty be the optimal treatment for displaced femoral neck fracture management. For minimally displaced femoral neck fractures, internal fixation remains the preferred approach.The study suggests arthroplasty may reduce the risk of mortality & reoperation compared to internal fixation. This finding is counter to many surgical practices, but consistent with a mounting body of evidence.
Failure of Conservative Management in the Treatment of Calcific Tendinitis of the Shoulder
Shoulder calcific tendinitis results in 7% of shoulder discomfort and is caused by calcium deposits in the rotator cuff tendons. Physical therapy and corticosteroid injections are the first line treatments. If that doesn't work, arthroscopy is considered. The size of the lesion may influence the efficacy of conservative treatment. Preoperative planning and discussion should be included.
Optimal Fixation of the Capitellar Fragment in Distal Humerus Fractures
The study determined if orthogonal or parallel plate position provides superior fixation of the separate capitellar fragment often present in intraarticular distal humerus fractures. It was found that orthogonal plating would provide stiffer fixation as well as screw trajectories perpendicular to the fracture plane by a posterolateral plate compared to a parallel plate construct.
Reduced Fluoroscopy, Radiation Dose, and Surgical Time with Dedicated Spine Radiology Technologist
The purpose of this study was to investigate the fluoroscopy time and radiation exposure during pediatric spine surgery using a DRT with extensive experience in spine operating rooms compared to all other radiology technologists. It was found that the use of DRT was independently associated with a significant reduction in total fluoroscopy time, radiation exposure, total surgical time, and EBL.
Latissimus Dorsi, Pectoralis Major, and Pectoralis Minor Transfers in SCC Deficient Shoulders
Pma and Pmi transfers are less successful in generating internal rotational moment arms than LD. The transplanted LD can also generate internal rotational moment arms and mimics the subscapularis biomechanical features. Both the Pma and LD transfers had significantly reduced adducting moment arms, which clinically may result in decreased adduction.
Weightbearing CT to Diagnose Syndesmotic Instability in Weber B Lateral Malleolar Fractures
Early diagnosis of syndesmotic instability is critical for optimizing clinical outcomes, but more subtle instability can be difficult to identify. WBCT affords a unique opportunity to evaluate such injuries in 3D compared to more traditional 2D syndesmosis measurement. WBCT can be used for assessment of the wide range of syndesmotic injuries and their 3D character.
Rotating platform: High conformity, low wear
Early failures were often due to aseptic loosening, malalignment, instability, 7 severe prosthetic restraint. New problems like increased contact stresses, abnormal kinematics, & increased polyethylene shear stresses were observed due to improve surgical technique. Current TKA Design include protecting the fixation interface by limiting prosthetic loosening and reducing polyethylene wear
Medial Pivot: More Predictable, Physiologic Kinematics
Total knee arthroplasty is a reliable treatment for end stage arthritis with ten-year survivorship. However, patient dissatisfaction can be 15-20% despite of good long-term survivorship. Medical pivot designs do not lead to loosening but they promote normal knee kinematics & enhance AP stability. They might lead to better patient satisfaction and better patient activity.
Why would you leave Cement - You can’t beat it
Cement fixation has been the gold standard when performing a total knee arthroplasty (TKA). However, cemented TKAs were associated with less predictable outcomes survivorship with those early generation implants. In today’s time, cemented TKA’s are enjoying the phase of resurgence. Cement less implants have higher costs but 10 times quicker in operative time than cemented.
Should We Use Vancomycin Powder Topically?
Surgical site infection is an vital issue. In spine surgery, the use of vancomycin has become routine to inhibit surgical site infections. Vancomycin powder reduces rate of hip and knee prosthetic joint infection without local and systemic adverse reactions. It should also be contemplated in primary & revision joint arthroplasty.
Advanced Clinical Practice for IgG4-related dacryoadenitis/sialadenitis and autoimmune pancreatitis
IgG4-related illness is a new systemic disorder affecting multiple organs. In IgG4-RD, the lacrimal, salivary, and pancreatic glands are affected. Lip and core needle biopsies are useful for IgG4-DS diagnosis. Early treatment is required to protect gland function. The use of glucocorticoids and steroid-sparing medicines may help manage IgG4-DS.
JAK Inhibitors in Rheumatoid Arthritis
JAK inhibitors have changed the way RA is managed. This is because the JAK pathway is linked to numerous cytokines that are linked to RA pathogenesis. JAK inhibitors offer quick action, role in reducing central pain processing, effect on structural damage and radiographic progression, and safety.
Autoinflammatory Vasculitis Syndromes: An Emerging Diseases
AIDs should be considered in children with inflammatory episodes that recur or persist over months or years in the absence of other causes. Vasculitis is most common in FMF. Try to identify clinical pattern consistent with one of the known AIDs but may need to thing outside those boxes. Genetic testing remains the mainstay of diagnosis & functional analysis assists with precision medicine.
Juvenile Idiopathic Arthritis (JIA) treatment recommendations and guidelines
Individuals with JIA whose biologic dose was increased from standard to high dose displayed an improvement in disease activity scores, similar to the improvement observed in patients whose biologic dose was increased from standard to high dose. For individuals who do not respond well to standard dose therapy, raising the biologic dose to a high level may be a realistic option to consider.
Sjogren's Update APLAR 2021
Sjogren's syndrome is a rhematic, autoimmune illness that affects middle-aged women. Currently, Patients have a sex bias due to the X chromosome dosage effect (IL 17). Sjögren's has no effective disease-modifying drugs. Several failed clinical trials approved Metformin as a new agent. Recent COVID-19 pandemic has shown that a COVID-19 infection is a trigger for anti-Ro.
Prevention of infective complications in SLE
Infection in patients with SLE was associated with a five-fold increase in standardized mortality ratio. Factors related to increased risk of infection include immunosuppressive medications, disease activity, impaired immune response, and renal impairment. Clinical outcomes reports of LN patients primarily focused on the efficacy and toxicities of different therapeutic interventions.
APLAR Consensus Statement on SLE Management
There are 34 consensus statements released by the APLAR SLE Special Interest Group. More discussion needed on: role of belimumab in lupus nephritis; role of COVID-19 immunisation; role of thrombopoietin receptor agonists in renal protection; Pregnancy, assisted reproduction, and obstetric APS require another Delphi.
Updates on Immune Mediated Necrotising Myopathy
Idiopathic inflammatory myopathies (IIM) are systemic conditions with dominant manifestations on skeletal muscle. There is a raised serum level of muscle enzymes. Immune Mediated Necrotising Myopathy (IMNM) is more frequently associated with sarcolemmal MHC1 expression, complement deposition in muscle capillaries, more lymphatic infiltrates, & more regenerative fibres.
ACR response in Psoriatic Arthritis
Classification of Criteria for Psoriatic arthritis (CASPAR) states that a patient must have inflammatory articular disease (joint, spine or entheseal) with ≥3 joints. As per SELECT PsA 1 and PsA 2 studies, it was found that there is significant greater ACR20 response rate vs placebo at week 12 in non-bDMARD IR and bDMARD-IR patients.
Understanding the Predictors of Long-Term Organ Damage
SLE is a chronic and debilitating disease characterized by flares, progressive end organ damage as well as increased mortality. Several factors linked to organ damage that can categorized as fixed factors (age, pre-existing organ damage, race, sex), increased modifiable factors (steroids use, hypertension, higher disease activity, active renal involvement), & decreased modifiable factors.
