Calcificació del supraespinós

La calcificació del espai subacromial es un enigma interessant amb una clinica força constant.

Aqui tenim l'evolució de una de coneguda

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Smart Sutures That Detect Infections

Surgical sutures are mindless threads no more. Researchers have now coated them with sensors that could monitor wounds and speed up healing.
The electronic sutures, which contain ultrathin silicon sensors integrated on polymer or silk strips, can be threaded through needles, and in animal tests researchers were able to lace them through skin, pull them tight, and knot them without degrading the devices.
The sutures can precisely measure temperature—elevated temperatures indicate infection—and deliver heat to a wound site, which is known to aid healing. And John Rogers, professor of materials science and engineering at the University of Illinois at Urbana-Champaign and inventor of the smart sutures, imagines that they could also be laden with devices that provide electrical stimulation to heal wounds. "Ultimately, the most value would be when you can release drugs from them in a programmed way," he says. The researchers could do that by coating the electronic threads with drug-infused polymers, which would release the chemicals when triggered by heat or an electrical pulse.
The smart sutures, reported online in the journal Small, rely on silicon-based devices that flex and stretch. Rogers and his colleagues make the devices with silicon membranes and gold electrodes and wires that are just a few hundred nanometers thick and patterned in a serpentine shape. The technology, which they have also used in inflatable catheters and medical tattoos (see "Stick-On Electronic Tattoos"), is being commercialized by MC10, a Cambridge, Massachusetts–based startup Rogers cofounded (see "Making Stretchable Electronics").
The researchers first use chemicals to slice off an ultrathin film of silicon from a silicon wafer. With a rubber stamp, they lift off and transfer the nanomembranes to polymer or silk strips. Then they deposit metal electrodes and wires on top and encapsulate the entire device in an epoxy coating.
They have built two types of temperature sensors on the sutures. One is a silicon diode that shifts its current output with temperature; the other, a platinum nanomembrane resistor, changes its resistance with temperature. The micro-heaters, meanwhile, are simply gold filaments that heat up when current passes through them.
All the materials used in the devices are safe for use in the body, and the biggest challenge was to make the sutures flexible, Rogers says. Silicon is brittle, so making the nanomembranes as thin as possible and laying them out in a winding pattern was key for elasticity. Placing the silicon halfway between the top epoxy and bottom polymer surfaces of the suture is also crucial. "When you bend the entire construct, the top surface is in tension and the bottom is in compression, but at midpoint the strains are very small," he says.
The researchers have tested the sutures' mechanical flexibility and toughness on incisions in rat skin, but they haven't tested the temperature sensing and heating capabilities in animals yet. They are also working on making the devices wireless.

Per poc guanyen els extramedulars...

Injury. 2012 Aug 23.

Extra- and intramedullary implants for the treatment of pertrochanteric fractures - Results from a Finnish National Database Study of 14,915 patients.

Yli-Kyyny TT, Sund R, Juntunen M, Salo JJ, Kröger HP.

Department of Orthopedics, Traumatology, and Hand Surgery, Kuopio University Hospital, P.O. Box 1777, 70211 Kuopio, Finland.

Abstract

We analysed registry-based data on 14,915 patients treated for pertrochanteric fracture obtained from the Finnish Health Care Register during the years 1999-2009. Data on the comorbidities, residential status and deaths of the cohort were extracted from several Finnish registries using patients' unique personal identification numbers. The use of intramedullary implants increased substantially during the study period. One-year mortality was slightly higher in the patients treated with intramedullary implant (26.6% vs. 24.9%; P=0.011). In the first year after the fracture, there were more new operations on hip and thigh in patients treated with an intramedullary implant.  Our findings suggest that more expensive intramedullary implants do not lead to better clinical outcomes than extramedullary implants for the treatment of pertrochanteric fractures.

Injection of the Subacromial Bursa

La infiltracio del espai subacromial es un procediment força freqüent a urgències. Sempre ha estat controvertida la via de acces a la infiltracio d'aquest espai ...anterior , extern, posterior...Article i treball ben fets...

Injection of the Subacromial Bursa in Patients with Rotator Cuff Syndrome: A Prospective, Randomized Study Comparing the Effectiveness of Different Routes
J Bone Joint Surg Am, 2012 Aug 15;94(16):1442-1447. doi: 10.2106/JBJS.K.00534
Richard A. Marder, MD; Sunny H. Kim,

Conclusions: 

The anterior and lateral routes of subacromial bursal injection were more accurate than the posterior route. The accuracy of subacromial bursal injection was significantly different between males and females, mainly because of a lower accuracy of bursal injection with use of the posterior route in females. The present study suggests that the posterior route is the least accurate method for injection of the subacromial bursa in females.

prova

http://youtu.be/TJ8XaS6cBwg

COMARCALS

Recordeu que el dia 9 de Novembre es fan els comarcals a Puigcerda. Aquest cop es la Dra Boo qui te de presentar un cas clinic que no estigui resolt, que tingui espai per a la discussio ja sigui pel mateix procés com per el procediment possible a emprar.

Calendaris 2012 i 2013

Hola a tots
He refet el calendari de sessions fins desembre del 2013. Solament hi falten especificar lessessions de residents del dimarts i les de interserveis de dijous a final de mes. Qui no sàpiga fer anar el blog nomes cal que m'ho digui que li ensenyarem...

Semàntica dificil, retard de consolidacio-pseudoartrosi

Mireu aquest article, a tot arreu tenen feina per definir aquets termes...

Variability in the Definition and Perceived Causes of Delayed Unions and Nonunions: A Cross-Sectional, Multinational Survey of Orthopaedic Surgeons. Mohit Bhandari, MD,
J Bone Joint Surg Am, 2012 Aug 01;94(15):e109 1-6. doi: 10.2106/JBJS.K.01344

Lauge Hansen

La classificació de les lesions traumàtiques ha servit per avaluar les que son iguals. Comparar resultats de procesos iguals es molt important per no perdre's en el desordre. Dir que un resultat es bo o no actualment ja no es vàlid.
Dedicat als R petits . La classificacio de Lauge hansen de les fractures bimaleolars es un classic. Aqui teniu una de animada per entendre-ho millor.

Repassant un cas...examen de la estabilitat del colze. (Special Tests During Elbow Evaluation   http://youtu.be/9-xjNT3QlUc ). Recordar 2 test per avaluar la estabilitat en valg del llig col·lateral medial.

Milking maneuver and the moving valgus stress test.

1- The milking maneuver is done by pulling on the patient’s thumb with the arm supinated and the elbow flexed beyond 90º  creating a valgus stress.

http://youtu.be/HpwmRWJa5vY  Elbow - Milking manoeuver

2.- For the moving valgus stress test, the arm is taken to maximal external rotation of the shoulder while the milking maneuver is done. The elbow is then flexed and extended with the constant valgus torque, and the test is considered  positive when the medial elbow pain is reproduced and is maximum between 70º and 120º.

http://youtu.be/plk7G2s8V30 Moving Valgus Stress Test

RadioGraphics

RadioGraphics es la revista filial de Radiology amb intencio + docent que de recerca. En aquest article ens mostren els eponims de noms de fractures per aquelles discusions de la Sessio...jo crec que...


Radiologic History: Musculoskeletal Eponyms: Who Are Those Guys?

Tim B. Hunter

, 
 RadioGraphics, May 2000, 20,819-836.


http://radiographics.rsna.org/content/20/3/819.full#sec-4

PREZI

Sorprès agradablement per aquest sistema de presentacions  http://prezi.com/index/

Te de bo que pots fer un macro-planning de tota la presentació en un sol full. Tan sols cal posar els conceptes i idees en el full ( escenificats per texts , videos del youtube, fotos  i  planificar el recorregut de la presentació . Tot es canviable i variable. Podeu fer una presentacio de power classica si trasformeu el vostre ppt en pdf . Us aconsello veure'n algun per que com el power point si abuses del zoom i els giravolts sembla el circ du Soleil.

petons canalla

Shoulder Dislocations on Prezi

Sessions 2012

Hem posat el calendari de les sessions de servei ( Unitats) dels dijous al mati en la seccio SESSIONS / 2012
Recordeu que es tracta de que ho facin els adjunts de la Unitat no els Residents. Tambe hi ha el calendari de les bibliogràfiques i les sessions de residents pero el trobareu buit. Cal que l'ompliu amb un mes vista . Parleu amb els vostres Tutors...!

JHB

Al fi !........Mori la Moore ! Una bona idea per un treball !!

1.

Injury. 2011 Dec 29. [Epub ahead of print]  PMID: 22209383 Monoblock hemiarthroplasties for femoral neck fractures - A part of orthopaedic history? Analysis of national registration of hemiarthroplasties 2005-2009. Rogmark C, Leonardsson O, Garellick G, Kärrholm J. Source Department of Orthopaedic Surgery, Skane University Hospital, Malmö, Sweden; Swedish Hip Arthroplasty Register, Registercentrum VGR, Gothenburg, Sweden. Abstract This study from the Swedish Hip Arthroplasty Register (SHAR) compares cemented (Thompson(®), Exeter Trauma Stem (ETS)(®)) and uncemented (Austin-Moore(®)) monoblock hemiarthroplasties (n=1116 and 616, respectively) with modular ones (n=18,659). Austin-Moore(®) prostheses lead to more re-operations (6.7%) compared to modular implants (3.5%) and Thompson(®)/ETS(®) (2.4%). A Cox regression analysis, adjusting for other risk factors, shows twice the risk of re-operation for Austin-Moore(®) implants (CI 1.5-2.8), in particular, due to periprosthetic fracture (5.4; CI 3.2-9.1) and dislocation (1.9; CI 1.3-3.0). The Thompson(®)/ETS(®) implants do not influence the overall risk of re-operation (0.7; CI 0.5-1.2) compared to modular implants and decrease the risk of re-operation due to infection (0.2;CI 0.04-0.7). An increased risk of re-operation is also seen in men, age groups 75-85 years and <75 years and after secondary fracture surgery. Both Swedish and Australian orthopaedic surgeons have decreased their use of Austin-Moore(®) implants after reports from their national arthroplasty registers identifying inferior outcome for this implant. Due to the increased risk of re-operations, it should not be used in modern orthopaedic care. Cemented Thompson(®) or ETS(®) implants could still be suitable for the oldest, low-activity patients. To finally decide if there is a place for them, patient-reported outcome must be analysed as well.