Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 473 | Issue 9 | Sep, 2015

A Diagnostic Serum Antibody Test for Patients With Staphylococcus aureus Osteomyelitis

Kohei Nishitani MD, PhD, Christopher A. Beck PhD, Alexander F. Rosenberg PhD, Stephen L. Kates MD, Edward M. Schwarz PhD, John L. Daiss PhD

Because immunity againsthas not been fully elucidated, there is no diagnostic test to gauge how robust a patient’s host response is likely to be. Therefore, we aimed to develop a test for specific antibodies in serum with diagnostic and prognostic potential.

Analysis of Orthopaedic Research Produced During the Wars in Iraq and Afghanistan

George C. Balazs MD, Jonathan F. Dickens MD, Alaina M. Brelin MD, Jared A. Wolfe MD, John-Paul H. Rue MD, Benjamin K. Potter MD

Military orthopaedic surgeons have published a substantial amount of original research based on our care of combat-wounded service members and related studies during the wars in Iraq and Afghanistan. However, to our knowledge, the influence of this body of work has not been evaluated bibliometrically, and doing so is important to determine the modern impact of combat casualty research in the wider medical community.

Percutaneous Distraction Pinning for Metacarpophalangeal Joint Stabilization After Blast or Crush Injuries of the Hand

Matthew A. Langford MD, Kevin Cheung BS, Zhongyu Li MD, PhD

Unstable, severely comminuted fractures of the metacarpophalangeal (MCP) joint are difficult to treat. Closed treatment and casting of these fractures often fail to maintain proper alignment and impede wound care where concomitant open injuries such as gunshot wounds are present. Conventional pinning or plating techniques are not feasible if extensive bone loss and comminution are present. A distraction pinning technique represents a potential alternative, but results with this approach, to our knowledge, have not been reported.

Osteoblasts Have a Neural Origin in Heterotopic Ossification

ZaWaunyka W. Lazard BS, Elizabeth A. Olmsted-Davis PhD, Elizabeth A. Salisbury PhD, Zbigniew Gugala MD, PhD, Corrine Sonnet PhD, Eleanor L. Davis, Eric Beal BS, Eroboghene E. Ubogu MD, Alan R. Davis PhD

Heterotopic ossification (HO) is the process of bone formation at a nonskeletal site. Recently, we showed that the earliest steps occur in sensory nerves. We now extend these studies by identifying unique osteogenic progenitors within the endoneurial compartment of sensory nerves.

Preventing Heterotopic Ossification in Combat Casualties—Which Models Are Best Suited for Clinical Use?

Keith A. Alfieri MD, Benjamin K. Potter MD, Thomas A. Davis PhD, Matthew B. Wagner PhD, Eric A. Elster MD, Jonathan A. Forsberg MD

To prevent symptomatic heterotopic ossification (HO) and guide primary prophylaxis in patients with combat wounds, physicians require risk stratification methods that can be used early in the postinjury period. There are no validated models to help guide clinicians in the treatment for this common and potentially disabling condition.

What Risk Factors Predict Recurrence of Heterotopic Ossification After Excision in Combat-related Amputations?

Gabriel J. Pavey MD, Elizabeth M. Polfer MD, Kyle E. Nappo MD, Scott M. Tintle MD, Jonathan A. Forsberg MD, Benjamin K. Potter MD

Heterotopic ossification (HO) is common after combat-related amputations and surgical excision remains the only definitive treatment for persistently symptomatic HO. There is no consensus in the literature regarding the timing of surgery, and recurrence frequency, reexcision, and complications have not been reported in large numbers of patients.

Botulinum Toxin-induced Muscle Paralysis Inhibits Heterotopic Bone Formation

Brandon J. Ausk PhD, Ted S. Gross PhD, Steven D. Bain PhD

Short-term muscle atrophy induced by botulinum toxin A (BTxA) has been observed to impair osteogenesis in a rat closed femur fracture model. However, it is unclear whether the underlying mechanism is a direct effect of BTxA on muscle-bone interactions or an indirect effect that is driven by skeletal unloading. Because skeletal trauma in the closed fracture model also leads to disuse atrophy, we sought to mitigate this confounding variable by examining BTxA effects on muscle-bone interactions in two complementary in vivo models in which osteogenesis is induced in the absence of skeletal unloading. The overall aim of this study was to identify a potential strategy to inhibit pathological bone formation and heterotopic ossification (HO).

Early Characterization of Blast-related Heterotopic Ossification in a Rat Model

Ammar T. Qureshi PhD, Erica K. Crump BA, Gabriel J. Pavey MD, Donald N. Hope MD, Jonathan A. Forsberg MD, Thomas A. Davis PhD

Heterotopic ossification (HO) affects the majority of combat-related lower extremity wounds involving severe fracture and amputation. Defining the timing of early osteogenic-related genes may help identify candidate prophylactic agents and guide the timing of prophylactic therapy after blast and other combat-related extremity injuries.

Bioburden Increases Heterotopic Ossification Formation in an Established Rat Model

Gabriel J. Pavey MD, Ammar T. Qureshi PhD, Donald N. Hope MD, Rebecca L. Pavlicek PhD, Benjamin K. Potter MD, Jonathan A. Forsberg MD, Thomas A. Davis PhD

Heterotopic ossification (HO) develops in a majority of combat-related amputations wherein early bacterial colonization has been considered a potential early risk factor. Our group has recently developed a small animal model of trauma-induced HO that incorporates many of the multifaceted injury patterns of combat trauma in the absence of bacterial contamination and subsequent wound colonization.

What Is the Magnitude and Long-term Economic Cost of Care of the British Military Afghanistan Amputee Cohort?

D. S. Edwards FRCS(Tr&Orth), Rhodri D. Phillip FRCP, Nick Bosanquet MSc, Anthony M. J. Bull PhD, Jon C. Clasper FRCS(Tr&Orth)

Personal protection equipment, improved early medical care, and rapid extraction of the casualty have resulted in more injured service members who served in Afghanistan surviving after severe military trauma. Many of those who survive the initial trauma are faced with complex wounds such as multiple amputations. Although costs of care can be high, they have not been well quantified before. This is required to budget for the needs of the injured beyond their service in the armed forces.

Cathodic Electrical Stimulation Combined With Vancomycin Enhances Treatment of Methicillin-resistant Staphylococcus aureus Implant-associated Infections

Scott Nodzo MD, Menachem Tobias MS, Lisa Hansen MS, Nicole R. Luke-Marshall PhD, Ross Cole BS, Linda Wild MD, Anthony A. Campagnari PhD, Mark T. Ehrensberger PhD

Effective treatments for implant-associated infections are often lacking. Cathodic voltage-controlled electrical stimulation has shown potential as a treatment of implant-associated infections of methicillin-resistant(MRSA).

Porphyrin-adsorbed Allograft Bone: A Photoactive, Antibiofilm Surface

Sana S. Dastgheyb PhD, Cyrus B. Toorkey PhD, Irving M. Shapiro BDS, PhD, Noreen J. Hickok PhD

Allograft bone is commonly used to augment bone stock. Unfortunately, allograft is prone to bacterial contamination and current antimicrobial therapies are inadequate. Photoactivated porphyrins combat bacterial growth by production of reactive oxygen species (ROS); however, to our knowledge, they have not been tested in the setting of allograft bone.

Rifamycin Derivatives Are Effective Against Staphylococcal Biofilms In Vitro and Elutable From PMMA

Carlos J. Sanchez PhD, Stefanie M. Shiels PhD, David J. Tennent MD, Sharanda K. Hardy BS, Clinton K. Murray MD, Joseph C. Wenke PhD

Local antimicrobial delivery through polymethylmethacrylate beads (PMMA), commonly vancomycin, is used for the treatment of contaminated open fractures but has limited activity againstbiofilms, which occur commonly in such fractures. Rifamycins have activity against biofilms and are an effective treatment for osteoarticular infections involving staphylococcal biofilms, but there are limited studies evaluating the activity of rifamycin derivatives, other than rifampin, against biofilms ofand evaluating incorporation of these drugs into PMMA for treatment of contaminated open fractures.

Hydrogel-based Delivery of rhBMP-2 Improves Healing of Large Bone Defects Compared With Autograft

Laxminarayanan Krishnan PhD, Lauren B. Priddy MS, Camden Esancy BS, Mon-Tzu Alice Li PhD, Hazel Y. Stevens BS, Xi Jiang BS, Lisa Tran MD, David W. Rowe PhD, Robert E. Guldberg PhD

Autologous bone grafting remains the gold standard in the treatment of large bone defects but is limited by tissue availability and donor site morbidity. Recombinant human bone morphogenetic protein-2 (rhBMP-2), delivered with a collagen sponge, is clinically used to treat large bone defects and complications such as delayed healing or nonunion. For the same dose of rhBMP-2, we have shown that a hybrid nanofiber mesh-alginate (NMA-rhBMP-2) delivery system provides longer-term release and increases functional bone regeneration in critically sized rat femoral bone defects compared with a collagen sponge. However, no comparisons of healing efficiencies have been made thus far between this hybrid delivery system and the gold standard of using autograft.

Immunomodulatory Peptide IDR-1018 Decreases Implant Infection and Preserves Osseointegration

Hyonmin Choe MD, PhD, Arvind S. Narayanan MS, Deep A. Gandhi, Aaron Weinberg DMD, PhD, Randall E. Marcus MD, Zhenghong Lee PhD, Robert A. Bonomo MD, Edward M. Greenfield PhD

Innate defense regulator peptide-1018 (IDR-1018) is a 12-amino acid, synthetic, immunomodulatory host defense peptide that can reduce soft tissue infections and is less likely to induce bacterial resistance than conventional antibiotics. However, IDRs have not been tested on orthopaedic infections and the immunomodulatory effects of IDR-1018 have only been characterized in response to lipopolysacharide, which is exclusively produced by Gram-negative bacteria.

Can Cytoprotective Cobalt Protoporphyrin Protect Skeletal Muscle and Muscle-derived Stem Cells From Ischemic Injury?

Heather-Marie P. Wilson PhD, Robert E. Welikson PhD, Jun Luo MD, PhD, Thomas J. Kean PhD, Baohong Cao MD, PhD, James E. Dennis PhD, Margaret D. Allen MD

Extremity trauma is the most common injury seen in combat hospitals as well as in civilian trauma centers. Major skeletal muscle injuries that are complicated by ischemia often result in substantial muscle loss, residual disability, or even amputation, yet few treatment options are available. A therapy that would increase skeletal muscle tolerance to hypoxic damage could reduce acute myocyte loss and enhance preservation of muscle mass in these situations.

Does Coordinated, Multidisciplinary Treatment Limit Medical Disability and Attrition Related to Spine Conditions in the US Navy?

Gregg Ziemke PT, MS, MHA, OCS, CAPT, MSC, USN, Marco Campello PT, PhD, Rudi Hiebert ScM, Shira Schecter Weiner PT, PhD, Chris Rennix ScD, Margareta Nordin DrMedSci

Musculoskeletal conditions account for the largest proportion of cases resulting in early separation from the US Navy. This study evaluates the impact of the Spine Team, a multidisciplinary care group that included physicians, physical therapists, and a clinical psychologist, for the treatment of active-duty service members with work-disabling, nonspecific low back pain at the Naval Medical Center, Portsmouth, VA, USA. We compared the impact of the introduction of the Spine Team in limiting disability and attrition from work-disabling spine conditions with the experience of the Naval Medical Center, San Diego, CA, USA, where there is no comparable spine team.

Blast Injury in the Spine: Dynamic Response Index Is Not an Appropriate Model for Predicting Injury

Edward Spurrier BM, FRCS(Tr+Orth), James A. G. Singleton MRCS, RAMC, Spyros Masouros PhD, Iain Gibb FRCS Ed, FRCR, RAMC, Jon Clasper DM, DPhil

Improvised explosive devices are a common feature of recent asymmetric conflicts and there is a persistent landmine threat to military and humanitarian personnel. Assessment of injury risk to the spine in vehicles subjected to explosions was conducted using a standardized model, the Dynamic Response Index (DRI). However, the DRI was intended for evaluating aircraft ejection seats and has not been validated in blast conditions.

Whole-body Vibration at Thoracic Resonance Induces Sustained Pain and Widespread Cervical Neuroinflammation in the Rat

Martha E. Zeeman MS, Sonia Kartha BS, Nicolas V. Jaumard PhD, Hassam A. Baig MS, Alec M. Stablow, Jasmine Lee, Benjamin B. Guarino BS, Beth A. Winkelstein PhD

Whole-body vibration (WBV) is associated with back and neck pain in military personnel and civilians. However, the role of vibration frequency and the physiological mechanisms involved in pain symptoms are unknown.

What Risk Factors Are Associated With Musculoskeletal Injury in US Army Rangers? A Prospective Prognostic Study

Deydre S. Teyhen PT, PhD, Scott W. Shaffer PT, PhD, Robert J. Butler PT, PhD, Stephen L. Goffar PT, PhD, Kyle B. Kiesel PT, PhD, Daniel I. Rhon PT, DSc, Jared N. Williamson DPT, Phillip J. Plisky PT, DSc

Musculoskeletal injury is the most common reason that soldiers are medically not ready to deploy. Understanding intrinsic risk factors that may place an elite soldier at risk of musculoskeletal injury may be beneficial in preventing musculoskeletal injury and maintaining operational military readiness. Findings from this population may also be useful as hypothesis-generating work for particular civilian settings such as law enforcement officers (SWAT teams), firefighters (smoke jumpers), or others in physically demanding professions.

What is the Best Clinical Test for Assessment of the Teres Minor in Massive Rotator Cuff Tears?

Philippe Collin MD, Thomas Treseder MD, PhD, Patrick J. Denard MD, Lionel Neyton MD, Gilles Walch MD, Alexandre Lädermann MD

Few studies define the clinical signs to evaluate the integrity of teres minor in patients with massive rotator cuff tears. CT and MRI, with or without an arthrogram, can be limited by image quality, soft tissue density, motion artifact, and interobserver reliability. Additionally, the ill-defined junction between the infraspinatus and teres minor and the larger muscle-to-tendon ratio of the teres minor can contribute to error. Therefore, we wished to determine the validity of clinical testing for teres minor tears.

What Are the Prognostic Factors for Radiographic Progression of Knee Osteoarthritis? A Meta-analysis

Alex N. Bastick MD, MSc, Janneke N. Belo MD, PhD, Jos Runhaar PhD, Sita M. A. Bierma-Zeinstra PhD

A previous systematic review on prognostic factors for knee osteoarthritis (OA) progression showed associations for generalized OA and hyaluronic acid levels. Knee pain, radiographic severity, sex, quadriceps strength, knee injury, and regular sport activities were not associated. It has been a decade since the literature search of that review and many studies have been performed since then investigating prognostic factors for radiographic knee OA progression.

High Survivorship With Cementless Stems and Cortical Strut Allografts for Large Femoral Bone Defects in Revision THA

Young-Hoo Kim MD, Jang-Won Park MD, Jun-Shik Kim MD, Devarshi Rastogi MD

Numerous studies have investigated the clinical and radiographic results of revision THAs with use of cementless stems and cortical strut allografts. However, to our knowledge, no long-term followup studies have evaluated patients undergoing revision THA with use of cortical strut allografts where the allografts provided the primary stability for extensively coated femoral stems in the presence of extensive femoral diaphyseal bone defects.

Are Complications Associated With the Repiphysis® Expandable Distal Femoral Prosthesis Acceptable for Its Continued Use?

Eric L. Staals MD, Marco Colangeli MD, Nikolin Ali MD, José M. Casanova MD, PhD, Davide M. Donati MD, PhD, Marco Manfrini MD

Reconstruction of the distal femur after resection for malignant bone tumors in skeletally immature children is challenging. The use of megaprostheses has become increasingly popular in this patient group since the introduction of custom-made, expandable devices that do not require surgery for lengthening, such as the RepiphysisLimb Salvage System. Early reports on the device were positive but more recently, a high complication rate and associated bone loss have been reported.

Are Volar Locking Plates Superior to Percutaneous K-wires for Distal Radius Fractures? A Meta-analysis

Harman Chaudhry MD, Ydo V. Kleinlugtenbelt MD, Raman Mundi MD, Bill Ristevski MD, J. C. Goslings MD, PhD, Mohit Bhandari MD, PhD

Distal radius fractures are common, costly, and increasing in incidence. Percutaneous K-wire fixation and volar locking plates are two of the most commonly used surgical treatments for unstable dorsally displaced distal radius fractures. However, there is uncertainty regarding which of these treatments is superior.

Extrinsic Muscle Forces Affect Ankle Loading Before and After Total Ankle Arthroplasty

Tassos Natsakis PhD, Josefien Burg PhD, Greta Dereymaeker MD, PhD, Jos Vander Sloten PhD, Ilse Jonkers PhD

Joint loading conditions have an effect on the development and management of ankle osteoarthritis and on aseptic loosening after total ankle arthroplasty (TAA). Apart from body weight, compressive forces induced by muscle action may affect joint loading. However, few studies have evaluated the influence of individual muscles on the intraarticular pressure distribution in the ankle.

Deltoid Tuberosity Index: A Simple Radiographic Tool to Assess Local Bone Quality in Proximal Humerus Fractures

Christian Spross MD, Nicola Kaestle MD, Emanuel Benninger MD, Jürgen Fornaro MD, Johannes Erhardt MD, Vilijam Zdravkovic MD, Bernhard Jost Prof, MD

Osteoporosis may complicate surgical fixation and healing of proximal humerus fractures and should be assessed preoperatively. Peripheral quantitative CT (pQCT) and the Tingart measurement are helpful methods, but both have limitations in clinical use because of limited availability (pQCT) or fracture lines crossing the area of interest (Tingart measurement). The aim of our study was to introduce and validate a simple cortical index to assess the quality of bone in proximal humerus fractures using AP radiographs.

A High-grade Sarcoma Arising in a Patient With Recurrent Benign Giant Cell Tumor of the Proximal Tibia While Receiving Treatment With Denosumab

Luis A. Aponte-Tinao MD, Nicolas S. Piuzzi MD, Pablo Roitman MD, German L. Farfalli MD

A giant cell tumor of bone is a primary benign but locally aggressive neoplasm. Malignant transformation in a histologically typical giant cell tumor of bone, without radiotherapy exposure, is an uncommon event, occurring in less than 1% of giant cell tumors of bone. Although surgery is the standard initial treatment, denosumab, a monoclonal antibody drug that inhibits receptor activator of nuclear factor-κB ligand (RANKL), has shown considerable activity regarding disease and control of symptoms in patients with recurrence, unresectable, and metastatic giant cell tumors of bone.

Erratum to: Is Neuraxial Anesthesia Safe in Patients Undergoing Surgery for Treatment of Periprosthetic Joint Infection?

Mohammad R. Rasouli MD, Priscilla K. Cavanaugh MS, Camilo Restrepo MD, Hasan Huseyin Ceylan MD, Mitchell G. Maltenfort PhD, Eugene R. Viscusi MD, Javad Parvizi MD

Erratum to: The Minimum Clinically Important Difference of the Patient-rated Wrist Evaluation Score for Patients With Distal Radius Fractures

Monique M. J. Walenkamp MD, MSCE, Lara M. Vos MD, Robert-Jan Muinck Keizer MD, Melvin P. Rosenwasser MD, J. Carel Goslings MD, PhD, Niels W. L. Schep MD, PhD, MSCE
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