Biosensors For the Measurement of C-Terminal Telopeptide of Type I Collagen (CTX-I)

In the last few years, research on the use of biochemical markers of bone turnover has greatly improved. Among the several available bone turnover markers, monitoring serum C-terminal cross-linked telopeptides is one of the most accurate one.

Manual and automated immunoassays are available for the measurement of CTX, which show high analytical performance. However, they are very expensive, time-consuming and require technical experts to perform the CTX assay.

Different research groups have proposed novel immunosensing methods to detect CTX biomarker. It is a hope that the development of a rapid and inexpensive point-of-care device can aid in monitoring the bone metabolism more frequently, which can be helpful in indicating the early stages of bine loss.

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Extensor Tendon Injury in the Distal Forearm of Right Hand Owing to Accident

A Bangladeshi 24 year old man was admitted to the hospital with a right hand injury. The examination showed that the tendons of the right hand of the patient were severely injured.

X-ray report showed no bone injury. Within 24 h of the accident surgery was performed but the patient was unable to move the thumb. Therefore a second time surgery was performed.

In the second surgery extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), abductor pollicis brevis (APB), extensor pollicis brevis (EPB) were found defected and all separated tendons were repaired effectively.

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Extensor Tendon Injury in the Distal Forearm of Right Hand Owing to Accident

A Bangladeshi 24 year old man was admitted to the hospital with a right hand injury. The examination showed that the tendons of the right hand of the patient were severely injured.

X-ray report showed no bone injury. Within 24 h of the accident surgery was performed but the patient was unable to move the thumb. Therefore a second time surgery was performed.

In the second surgery extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), abductor pollicis brevis (APB), extensor pollicis brevis (EPB) were found defected and all separated tendons were repaired effectively.

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Rheumatoid Arthritis and Osteoporosis: A Case Study

Metadichol is a Nano emulsion of long-chain alcohols called as Policosanol and is present in foods such as rice, sugar cane, wheat, and peanuts. Metadichol acts on Nuclear Vitamin D receptors (VDR) that are present in cells throughout the body to stimulate the immune system and inhibit a variety of disease processes, resulting from inflammation to infection.

We present a case study of a patient with Rheumatoid arthritis with the high levels of RF antibodies, CRP and ESR levels, and low bone mineral density leading to osteoporosis. The case report shows how Metadichol by its actions on the VDR has affected key biomarkers and mitigated the disease conditions without any side effects. Also, his bone density improved dramatically.

Metadichol is safe because it consists of natural components of conventional foods and has no known adverse side effects. Its constituents are present in many foods that we consume every day.

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Rheumatoid Arthritis and Osteoporosis: A Case Study

Metadichol® is a Nano emulsion of long-chain alcohols called as Policosanol and is present in foods such as rice, sugar cane, wheat, and peanuts.

Metadichol® acts on Nuclear Vitamin D receptors (VDR) that are present in cells throughout the body to stimulate the immune system and inhibit a variety of disease processes, resulting from inflammation to infection.

We present a case study of a patient with Rheumatoid arthritis with the high levels of RF antibodies, CRP and ESR levels, and low bone mineral density leading to osteoporosis.

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Rocuronium as Selective Local Musclerelaxant in Orthopedic Surgery

A variety of surgeries need profound muscular block solely in an exceedingly restricted surgical field. Recent accessibility of sugammadex, a cyclodextrin derivative antitoxic substance active on an amino steroid muscle relaxant, has offered the likelihood of maintaining a prolonged deep neuromuscular paralysis with a rapid reversal at the end of surgery.

As a consequence, complete post anesthesia recovery is often rapidly obtained under safe clinical conditions.

However, in selected patients, a muscle relaxant can be locally injected at low doses in one or more muscles concerned within the surgical technique without a systemic paralysis.

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Non-typhoidal Salmonella Osteomyelitis of the Femoral Neck in an Immunocompetent Child

We report a case of Salmonella osteomyelitis of the femoral neck in a healthy child. Such an occurrence in an immunocompetent child is extremely rare and has not yet been reported in the English literature.

Salmonella should be considered among the causative agents in acute osteomyelitis. Prompt antibiotic treatment is pivotal for preventing complications and decreasing the disease burden.

The non-typhoidal Salmonella serotype (NTSS) is one of the most important enteric pathogens in Taiwan, which most often results in self-limited acute gastroenteritis. However, approximately 5-7.6% of patients develop bacteremia.

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Towards Consensus on the Reporting of Core Outcome Domains in Total Joint Replacement Clinical Trials

There is no consensus on how to report total joint replacement (TJR) trials. To our knowledge, core outcome domains for TJR clinical trials have not been defined.

Our objective was to develop data-driven, consensus-based, preliminary recommendations for core outcome domains for TJR clinical trials.

We surveyed two groups of experts/stakeholders, who rated potential core outcome domains (mapped to Outcome Measures in Rheumatology Trials filter 2.0 framework) for their relevance to TJR clinical trials during the 2014 American Academy of Orthopaedic Surgeons.

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Spondylodiscitis in a Geriatric Male

The incidence of Pyogenic Spondylodiscitis (PS) seems to be increasing in the last years as a result of the higher life expectancy of older patients with chronic debilitating diseases; also a number of co-morbidities have been found to increase the risk of disease such as diabetes (11-31%), immunosuppression, intravenous drug use, alcoholism, chronic debility disease with decubitus ulcers, malignancy, alcohol use and renal failure. 

Vertebral Fracture

The source of infection in the elderly has been related to the use of intravenous access devices and the asymptomatic urinary infections . A single organism is usually involved, although polymicrobial infections do occur in chronic and debility conditions. Staphylococcus aureus is the most common organism isolated implicated into 15- 84% of nontuberculosis cases of infection and frequently observed as complication of invasive spinal procedures (17-33%).  Read More>>>>

Rocuronium as Selective Local Musclerelaxant in Orthopedic Surgery

A variety of surgeries need profound muscular block solely in an exceedingly restricted surgical field. Recent accessibility of sugammadex, a cyclodextrin derivative antitoxic substance active on an amino steroid muscle relaxant, has offered the likelihood of maintaining a prolonged deep neuromuscular paralysis with a rapid reversal at the end of surgery.

As a consequence, complete post anesthesia recovery is often rapidly obtained under safe clinical conditions.

However, in selected patients, a muscle relaxant can be locally injected at low doses in one or more muscles concerned within the surgical technique without a systemic paralysis.

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Personalized Medicine for Metal on Metal Hip Resurfacing: Predictors for the 10 Years Success of the Birmingham Hip Resurfacing

Metal-on-metal hip resurfacing arthroplasty was introduced to preserve patients’ bone and facilitate revision surgery. This prospective cohort study aims to determine a prognostic model (OsBHR) to predict which patient and surgeon related factors predict better long term implant survival for the Birmingham Hip Resurfacing (BHR).

Between 1997 and 2002, details of 4490 patients (4945 hips) treated by hip resurfacing arthroplasty using the BHR prosthesis were entered in a prospective international registry and available for analysis. Implant survival was determined using the Kaplan-Meier estimator and a shared frailty proportional hazard model was used to determine predictors of implant revision.

prognostic equation suggested a minimum diameter of 50 mm should be used for male and 52 mm for female patients to ensure a minimum 10-year survival rate of 95% for in procedures performed by an average surgeon.

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Cementless Long Stem Total Hip Replacement for Revision of Failed Hemiarthroplasty

The total hip replacement after failure of hemiarthroplasty (unipolar or bipolar) has been associated with very high rates complications (intra- and postoperative).

Forty patients 24 males and 16 females with a mean age of 58 years (range: 48-68) had total hip arthroplasty (THA) revision of aseptic loosening of hip hemiarthroplasty.

The mean duration of the follow-up was 42 months (range: 30-72), and the cases lost in follow up were excluded from the study. Failure was defined as revision arthroplasty or radiographic evidence of stem loosening, indicated by an Engh fixation score ≤ 10. Vertical femoral migration of >5 mm was defined as subsidence.

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A Case of Crowned Dens Syndrome with Huge Calcifications

An 81-year-old woman presented to our hospital with a 1-month history of headache and neck pain. She had no neurological symptoms, articulation disorder, or swallowing disorder.

The plain radiograph showed calcification deposits around the atlantoaxial joint and anterior vertebral body. The computed tomography scan of her neck showed details of these calcifications.

Huge crownshaped deposits of hydroxyapatite or calcium pyrophosphate dihydrate were seen. The C-reactive protein level was slightly increased to 0.78 mg/dL. Oral non-steroidal anti-inflammatory drug therapy resulted in complete improvement of her symptoms.

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Evaluation of Humeral Head Cartilage Using the Magnetic Resonance Imaging T1ρ Relaxation Time Mapping Technique

To evaluate the difference in the age-related cartilage changes of the humeral head with T1ρ relaxation time mapping and assess the normal distribution of the proteoglycan content of the humeral head in healthy volunteers without any symptoms or structural disorders.

Twenty male volunteers (10 young subjects, 10 elderly subjects) for each generation group (mean age, young subjects: 30.2 ± 2.3 years; elderly subjects: 62.6 ± 6.2 years) participated in this study.

Spectral attenuated inversion recovery T2-weighted imaging and T1ρ relaxation time mapping were performed using 3.0-Tesla magnetic resonance imaging.

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In Situ Tarsal Metatarsal Dowel Arthrodesis with Trephine Reamers and Cancellous Bone Plugs: A Technique Guide and Case Report

Tarsalmetatarsal (TMT) osteoarthritis is encountered frequently. Pathology at the TMT joints play a role in continued foot fatigue and further compensation of gait laterally to avoid discomfort over the medial and central columns of the midfoot.

Sequeula and further pathology to the central TMT joints are multifactorial. Recalcitrant pain, subtle instability, and arthrosis are commonly observed.

Patients who fail nonoperative treatment are subjective to reconstructive surgical treatment. We present a straightforward stepwise technique for an in situ arthrodesis of the central TMT joints.

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Primary Cutaneous Squamous Cell Carcinoma of Thigh A Case Report and Review of Literature

The Change of Bone Erosion using Denosumab to Rheumatoid Artiritis

A 49-year-old woman presented to our hospital for treatment of rheumatoid arthritis (RA). Although she was taking methotrexate (8 mg/week), her symptoms had not resolved.

SDAI was 26.2 at the first visit. We recommended biological agents, but she refused. Therefore, methotrexate was increased to 16 mg/week over a 1-year period, resulting in improvement of SDAI to 3.4.

Bone mineral density (BMD) was measured during treatment, revealing low BMD at L2-L4 (0.834 g/cm2), so alendronate was started (35 mg/week).

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Treatment by Quacks Still An Issue of Concern

It was not all about writing a research paper or a case report. This time it was writing our experience regarding mismanagement of simple injuries or fractures by quacks.Lots of patients frequently come to our orthopaedic OPD with complaints of deformities, stiffness of joint, non union of fractures or an ugly swelling.

It is not uncommon to see patient left handicapped by a quack after a simple fracture. Not only do these quacks treat injuries but they also put their hands on other orthopaedic ailments like rheumatoid arthritis.

Most of time history is same.History of trauma sustaining injury to limbs and often injury is of 5 to 6 months old.

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Intra-articular Injections for Osteoarthritis: From Bench to Bedside, can we Teach Old Drugs New Tricks?

The two articles in this month’s press of The Journal of Arthritis, one by Ekinci et al. titled ‘A New Treatment Option in Osteoarthritis: Prolotherapy Injections’ and the other by Senatorov et al. titled ‘Clinical Outcome of Hylan G-F 20 Injections in Shoulder and Hip Osteoarthritis: A Retrospective Review’ raise several important points surrounding the topic of intra-articular injections.

Firstly that there is a paucity of high quality literature in the field that often leads to inconclusive or misrepresented conclusions on drug efficacy in established treatments. The articles also highlight the heterogeneity in injection procedure, site, concentration, preparation and outcome measurements.

This editorial will, therefore, provide a concise review on some of the current injection therapies and suggest possible improvements to methodological structure to inspire readers strive for high quality data. Further, through an example of a possible novel therapy, Actovegin, this editorial will hopefully challenge readers’ way of thinking to consider the reapplication of established drugs; posing the question can you teach an old drug new tricks?

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How to Control the Calamities and Protect the Earth

Now a day the calamities are more destructive element in the world. It destroys the life, crops, houses, trees, and many other things. The Area which is affected by it goes not less than 20 years back.

The pollution of the Air, Water, Soils, Replacement of minerals, occupies the land, Day by day less number of birds, Animals and aquatic creatures, Manufacture of synthetic items, Chemicals and management of plants (trees) are reason behind it.

God has given us every things to clean the environment for example we can take birds Vulture, Eagle, Kite, Wood Peker, Ravan, crow and many others birds. Now we cannot find many kinds of birds.

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Can Metal Levels be Measured at a Community Laboratory?

There remain concerns about the ability of community laboratories to accurately measure blood metal levels as one piece of the monitoring and treatment algorithms for patients with a metal-on-metal total hip arthroplasty (THA).

The purpose of this study is to compare serum cobalt and chromium levels obtained from one group of patients at a single reference laboratory to levels from a different group of patients measured at multiple community laboratories.

We compare serum metal levels performed prospectively at a single reference laboratory on 57 patients to levels performed retrospectively on 160 patients in community laboratories. All patients had unilateral metal-on-metal bearing hips.

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Plantar Fasciitis: What Does the Evidence Show?

Plantar Fasciitis (PF) is caused by repetitive and excessive tensile stress applied to the PF, which leads to fibrosis and inflammatory and degenerative changes.

The PF is a membrane that connects the heel bone and the toes, and has a thick structure with bonding strength.

PF plays a complex role in the protection and support of the foot itself, and is also important for support of body weight.

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Intra-articular Injections for Osteoarthritis: From Bench to Bedside, can we Teach Old Drugs New Tricks?

The two articles in this month’s press of The Journal of Arthritis, one by Ekinci et al. titled ‘A New Treatment Option in Osteoarthritis: Prolotherapy Injections’ and the other by Senatorov et al.

Titled ‘Clinical Outcome of Hylan G-F 20 Injections in Shoulder and Hip Osteoarthritis: A Retrospective Review’ raise several important points surrounding the topic of intra-articular injections.

Firstly that there is a paucity of high quality literature in the field that often leads to inconclusive or misrepresented conclusions on drug efficacy in established treatments.

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The Rising Incidence of Operative Treatment of Mid-shaft Clavicle Fractures

To evaluate whether the incidence of operative fixation of mid-shaft clavicle fractures has increased.

State Emergency Department Databases (SEDD) and State Ambulatory Surgery Databases (SASD) were used to identify patients presenting with mid-shaft clavicle fractures from 2005 to 2010 in California and New York State.

Patients were identified by International Classification of Disease, Ninth Edition (ICD-9) and Current Procedural Terminology (CPT) codes. Multivariable logistic regression analysis was conducted to illustrate any demographic trends regarding patients undergoing operative fixation.

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Dance-based Exercise Therapy for People with Arthritis: An Update and Commentary

Arthritis, a broad term used to describe more than 100 different health conditions that result in considerable physical disability, is very challenging to treat effectively, regardless of disease type.

This brief review revisits the research base concerning the use of dance-based therapeutic exercises as a possible adjunct for ameliorating arthritis.

The goal was to provide an overview of the potential of this form of therapy for arthritis patients as well as health professionals working with this population.

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The Effects of Vitamin D Supplementation in Patients with Knee Osteoarthritis: Uncontrolled Open Label Clinical Trial

Osteoarthritis (OA) is a degenerative disease that affects joints. The current relationship between low vitamin D levels, functions, and symptoms of osteoarthritis is controversial.

The aim of this study is to investigate the relationship between knee osteoarthritis and serum levels of vitamin D. An uncontrolled open label clinical trial conducted on patients with low vitamin D levels using the Western Ontario and McMaster Universities Arthritis Index (WOMAC criteria).

The WOMAC criteria used objectively to assess knee-joint function and symptoms before and after vitamin D3 supplementation. The study conducted from March 2013 to October 2015 at King Abdulaziz Medical City.

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Minimal Invasive Percutaneous Repair of Acute Closed Rupture of Achilles Tendon

Achilles tendon injuries are fairly common nowadays due to prevalence of comorbid conditions. The proposed lines of treatment in the literature are conservative treatment with cast immobilization, open surgical repair and minimal invasive lines of treatment with percutaneous repair.

To achieve optimum return of function, surgical repair is clearly superior to non-operative treatment.

The purpose of this study is to determine the results of minimal invasive Percutaneous repair of acute closed rupture of Achilles tendon with special emphasis on how to protect the sural nerve during the procedure.

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First and Second Metacarpal Bone Fusion for First Carpometacarpal Joint Arthritis in Rheumatoid Arthritis: A Case Report

A case of rheumatoid thumb carpometacarpal (CMC) arthritis with advanced osteolysis is reported.

Although CMC joint arthrodesis was performed, bone union was not achieved, and pain and instability persisted. Therefore, first and second metacarpal bone fusion was performed with satisfactory results.

While CMC joint arthrodesis or arthroplasty is typically performed, first and second metacarpal bone fusion appears to be a useful treatment option when there is marked osteolysis.

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A Review of Competency Based Orthopaedic Training in the UK: A Trainee?s Perspective

This review explores the concepts and methodology in competency based education, with reference to orthopaedic training in the United Kingdom.

In 2006, a new competency based curriculum for postgraduate training in Trauma and Orthopaedics was approved by the Postgraduate Medical Education Training Board.

Though the curriculum is now widely accepted, few surgeons have a theoretical knowledge of the basis for competency-based medical education, beyond their own area of involvement.

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Improved Outcomes in Juvenile Idiopathic Arthritis Following Antihistamine Treatment in Patients with Concurrent Allergic Rhinitis

Fifty-two JIA patients with AR were enrolled and consecutively randomized. The control group comprised 26 patients who were treated with methotrexate (MTX) 10-15 mg/m2/week orally for 12 months and enteric-coated diclofenac sodium 0.5-2 mg/kg/day orally for 12 weeks.

The test group comprised 26 patients who received adjunctive therapy with oral and intranasal antihistamines for 12 months, in addition to MTX and diclofenac.

The responses were evaluated using American College of Rheumatology (ACR) pediatric (Pedi) 30/50/70 criteria, AR score, 27-joint Juvenile Arthritis Disease Activity Score (JADAS-27), and laboratory variables.

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