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Orthopedic Clinics of North America

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https://www.readbyqxmd.com/read/28577787/orthobiologics
#1
EDITORIAL
Frederick M Azar
No abstract text is available yet for this article.
July 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28577786/restorative-tissue-transplantation-options-for-osteochondral-lesions-of-the-talus-a-review
#2
REVIEW
John Chao, Andrew Pao
Symptomatic osteochondral lesions of the talus remain a challenging problem due to inability for cartilage lesions to heal. Numerous treatment options exist, including nonoperative management, marrow stimulating techniques, and autograft-allograft. Arthroscopic marrow stimulation forms fibrocartilage that has been shown to be biomechanically weaker than hyaline cartilage. Restorative tissue transplantation options are being used more for larger and cystic lesions. Newer biologics and particulated juvenile cartilage are currently under investigation for possible clinical efficacy...
July 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28577785/osseous-healing-in-foot-and-ankle-surgery-with-autograft-allograft-and-other-orthobiologics
#3
REVIEW
Jane C Yeoh, Brandon A Taylor
In the surgical treatment of foot and ankle abnormality, many problems require bone grafting for successful osseous union. Nonunion, reconstruction, and arthrodesis procedures pose specific challenges due to bony defects secondary to trauma, malunions, or previous surgery. Nonunion in foot and ankle arthrodesis is a significant risk and is well documented in recent literature. This article is a review of the recent literature regarding the use of bone graft and orthobiologics in foot and ankle surgery.
July 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28577784/autologous-blood-and-platelet-rich-plasma-injections-for-treatment-of-lateral-epicondylitis
#4
REVIEW
James H Calandruccio, Murphy M Steiner
Lateral epicondylitis (tennis elbow) is a frequent cause of elbow pain; most patients (80%-90%) are successfully treated with standard nonoperative methods (rest, nonsteroidal anti-inflammatory drugs, bracing, and physical therapy). Autologous blood injections and platelet-rich plasma injections are the two most frequently used orthobiologic techniques in the treatment of lateral epicondylitis. Studies of the effectiveness of autologous blood injections and platelet-rich plasma report varying outcomes, some citing significant clinical relief and others reporting no beneficial effect...
July 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28577783/biologic-approaches-to-problems-of-the-hand-and-wrist
#5
REVIEW
Murphy M Steiner, James H Calandruccio
Orthobiologics are not used as frequently in the hand and wrist as in other sites. The most frequently reported is the use of bone morphogenetic protein for the treatment of Kienböck disease. Animal studies have described improved tendon healing with the use of platelet-rich plasma (PRP), but no clinical studies have confirmed these results. PRP has been reported to produce improvements in the outcomes of distal radial fractures and osteoarthritis of the trapeziometacarpal in small numbers of patients. The use of orthobiologics in the hand and wrist are promising, but clinical trials are necessary to establish efficacy and safety...
July 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28577782/orthobiologics-in-pediatric-sports-medicine
#6
REVIEW
Christopher C Bray, Clark M Walker, David D Spence
Orthobiologics are biological substances that allow injured muscles, tendons, ligaments, and bone to heal more quickly. They are found naturally in the body; at higher concentrations they can aid in the healing process. These substances include autograft bone, allograft bone, demineralized bone matrix, bone morphogenic proteins, growth factors, stem cells, plasma-rich protein, and ceramic grafts. Their use in sports medicine has exploded in efforts to increase graft incorporation, stimulate healing, and get athletes back to sport with problems including anterior cruciate ligament ruptures, tendon ruptures, cartilage injuries, and fractures...
July 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28577781/orthobiologics-in-pediatric-orthopedics
#7
REVIEW
Robert F Murphy, James F Mooney
Orthobiologics are biologic devices or products used in orthopedic surgery to augment or enhance bone formation. The use of orthobiologics in pediatric orthopedics is less frequent than in other orthopedic subspecialties, mainly due to the naturally abundant healing potential and bone formation in children compared with adults. However, orthobiologics are used in certain situations in pediatric orthopedics, particularly in spine and foot surgery. Other uses have been reported in conjunction with specific procedures involving the tibia and pelvis...
July 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28577780/role-of-bone-marrow-aspirate-in-orthopedic-trauma
#8
REVIEW
Patrick C Schottel, Stephen J Warner
Bone marrow aspirate grafting entails mesenchymal stem cell-containing bone marrow harvesting and injection into a fracture site to promote bone formation. Although the use of bone marrow aspirate in orthopedic trauma is not widespread, an increasing number of studies are reporting clinical success. Advantages of using bone marrow aspirate are that it is readily obtainable, has low harvest morbidity, and can be easily and quickly injected. However, no universally accepted role for its use exists. Future studies directly comparing bone marrow aspirate with conventional techniques are needed to define its role in the treatment of orthopedic trauma patients...
July 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28577779/bone-morphogenetic-protein-is-there-still-a-role-in-orthopedic-trauma-in-2017
#9
REVIEW
Eric A Barcak, Michael J Beebe
Approximately 10 years ago bone morphogenic protein (BMP) was seen as a miraculous adjuvant to assist with bone growth. However, in the face of an increasing number of complications and a lack of understanding its long-term effects, it is unclear what role BMP has in the current treatment of orthopedic trauma patients. This article reviews the current recommendations, trends, and associated complications of BMP use in fracture care.
July 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28577778/bone-substitute-materials-and-minimally-invasive-surgery-a-convergence-of-fracture-treatment-for-compromised-bone
#10
REVIEW
Thomas A Russell, Gerard Insley
This article focuses on the understanding of the biochemistry and surgical application of bone substitute materials (BSMs) and particularly the newer calcium phosphate materials that can form a structural orthobiologic matrix within the metaphyseal components of the periarticular bone. Six characteristics of BSMs are detailed that can be used as a guide for the proper selection and application of the optimal BSM type for periarticular fracture repair. These 6 characteristics of BSMs are divided into 2 pillars...
July 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28577777/applications-of-tissue-engineering-in-joint-arthroplasty-current-concepts-update
#11
REVIEW
Hussein A Zeineddine, Todd J Frush, Zeina M Saleh, Mouhanad M El-Othmani, Khaled J Saleh
Research in tissue engineering has undoubtedly achieved significant milestones in recent years. Although it is being applied in several disciplines, tissue engineering's application is particularly advanced in orthopedic surgery and in degenerative joint diseases. The literature is full of remarkable findings and trials using tissue engineering in articular cartilage disease. With the vast and expanding knowledge, and with the variety of techniques available at hand, the authors aimed to review the current concepts and advances in the use of cell sources in articular cartilage tissue engineering...
July 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28577776/does-prior-cartilage-restoration-impact-outcomes-following-knee-arthroplasty
#12
REVIEW
Rachel M Frank, Craig J Della Valle, Darren R Plummer, Peter N Chalmers, Brian J Cole
This study compared patients who failed a cartilage restoration procedure and underwent ipsilateral knee arthroplasty with matched control subjects undergoing knee arthroplasty without prior cartilage restoration. Although patients with a failed cartilage procedure derived benefit from knee arthroplasty, their magnitude of improvement and final outcomes scores were lower than the matched control subjects. In this cohort, the cartilage patients also experienced little to no benefit from cartilage restoration, suggesting that unmeasured shared patient characteristics may play a role...
July 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28336048/infection
#13
EDITORIAL
Frederick M Azar
No abstract text is available yet for this article.
April 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28336047/posttraumatic-reconstruction-of-the-foot-and-ankle-in-the-face-of-active-infection
#14
REVIEW
Brandon Jonard, Erin Dean
Posttraumatic infection of the foot and ankle is a challenging issue for orthopedic surgeons. Making the diagnosis often requires combining laboratory and radiologic testing, patient examination, and history. Patient comorbidities should be identified and optimized whenever possible. Treatment must combine effective antibiotic therapy with thorough debridement of the infected zone. Reconstruction often requires a 2-staged approach using antibiotic spacers and temporary external fixation, with the goal of obtaining a functional, pain-free limb that is free of infection...
April 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28336046/charcot-arthropathy-versus-osteomyelitis-evaluation-and-management
#15
REVIEW
John Womack
Charcot arthropathy of the foot and ankle is a severe complication of peripheral neuropathy and is most commonly seen in the developed world in association with diabetes mellitus. Correct diagnosis and differentiation from osteomyelitis of the foot and ankle are critical to guide treatment. It can exist concomitantly with osteomyelitis, typically in the setting of an advanced midfoot ulcer. Simple plain radiographs and contrasted MRI studies often yield inconclusive or confusing data. Correct use of imaging studies and a clinical algorithm can be effective tools to help make accurate and early diagnoses and guide clinical interventions for these conditions...
April 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28336045/atypical-hand-infections
#16
REVIEW
Edward Chan, Mark Bagg
Atypical infections of the hand are caused by organisms such as Mycobacterium, fungi, and viruses, and often do not respond to conventional management. They exist within a wide spectrum of presentations, ranging from cutaneous lesions to deep infections such as tenosynovitis and osteomyelitis. Having a high clinical suspicion for atypical hand infections is vital because diagnosis often requires special tests and/or cultures. Obtaining a detailed medical, work, and travel history is extremely important. An indolent clinical course, late diagnosis, and delayed treatment are common...
April 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28336044/flexor-tenosynovitis
#17
REVIEW
Brad T Hyatt, Mark R Bagg
For patients with suspected flexor tenosynovitis, the mainstay of diagnosis is a thorough history and physical examination. The examination is guided by evaluating the patient for Kanavel's four cardinal signs. Empiric antibiotics should be started immediately on diagnosis covering skin flora and gram-negative bacteria. Typically, surgery is required. Appropriate exposure is required for adequate treatment and incisions should be tailored to preserve areas of skin compromised from draining sinuses and abscess pressure...
April 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28336043/pediatric-septic-arthritis
#18
REVIEW
Nicole I Montgomery, Howard R Epps
Acute septic arthritis is a condition with the potential for joint destruction, physeal damage, and osteonecrosis, which warrants urgent identification and treatment. The organism most frequently responsible is Staphylococcus aureus; however, our understanding of pathogens continues to evolve as detection methods continue to improve. MRI has improved our ability to detect concurrent infections and is a useful clinical tool where available. The treatment course involves intravenous antibiotics followed by transition to oral antibiotics when clinically appropriate...
April 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28336042/acute-hematogenous-osteomyelitis-in-children-pathogenesis-diagnosis-and-treatment
#19
REVIEW
Shawn S Funk, Lawson A B Copley
Acute hematogenous osteomyelitis (AHO) in children is an ideal condition to study due to its representation of a wide spectrum of disorders that comprise pediatric musculoskeletal infection. Proper care for children with AHO is multidisciplinary and collaborative. AHO continues to present a significant clinical challenge due to evolving epidemiology and complex pathogenesis. A guideline-driven, multidisciplinary approach has been introduced and shown to effectively reduce hospital stay, improve the timing and selection of empirical antibiotic administration, reduce delay to initial MRI, reduce the rate of readmission, and shorten antibiotic duration...
April 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28336041/double-edged-sword-musculoskeletal-infection-provoked-acute-phase-response-in-children
#20
REVIEW
Michael Benvenuti, Thomas An, Emilie Amaro, Steven Lovejoy, Gregory Mencio, Jeffrey Martus, Megan Mignemi, Jonathan G Schoenecker
The acute phase response has a crucial role in mounting the body's response to tissue injury. Excessive activation of the acute phase response is responsible for many complications that occur in orthopedic patients. Given that infection may be considered continuous tissue injury that persistently activates the acute phase response, children with musculoskeletal infections are at markedly increased risk for serious complications. Future strategies that modulate the acute phase response have the potential to improve treatment and prevent complications associated with musculoskeletal infection...
April 2017: Orthopedic Clinics of North America
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