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

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.

Results: Operative fixation of mid-shaft clavicle fractures increased by 368% and by 349% in California and New York, respectively, while the number of patients with clavicle fractures presenting to emergency departments remained stable.

Conclusion: The incidence of operative fixation of mid-shaft clavicle fractures has increased substantially at a similar rate in two states over a short period of time.

PDF LINK

Intra-articular Injections for Osteoarthritis

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.

PDF LINK

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.

There are several well-characterized causes of plantar fasciitis: A flat foot, a supinated foot, a tight Achilles tendon, age, excessive walking or standing, poorly cushioned footwear, obesity, occupations with prolonged standing, pes planus (flat feet), pes cavus (high-arched feet), overpronation.

weak plantar flexor and intrinsic muscles of the foot, running for exercise or competition and other conditions that reduce the shock-absorbing power of the feet. PF is painful, can alter daily activities and presents as a sharp pain localized to the plantar foot and medial heel.

PDF LINK

Crystal Induced Arthropathies

Acute gout most frequently involves the first metatarsophalangeal (MTP) joint at first presentation. However, it has non-specific radiographic features. Chronic gout has a characteristic radiographic appearance with tophus considered to be a hallmark feature.

Tophi are seen as focal eccentric soft tissue swelling of the affected joints or soft tissues resulting in a "lumpy bumpy appearance" and cause well-defined punched out juxta-articular erosions with sclerotic rims and overhanging edges due to pressure on the adjoining bone. Normal bone mineralisation and joint spaces are preserved till late in the disease.

It occurs in asymmetrical polyarticular distribution with involvement of the feet, ankles, knees, hands, and elbows, in decreasing order of frequency

PDF LINK

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?

Antioxidant Enzymes in Rheumatoid Arthritis

Joint destruction in rheumatoid arthritis (RA) is due to tissue injury in the area caused by inflammatory reactions, release of MMPs and free radicals produced by neutrophils and macrophages.

The control of free radical production may have therapeutic roles thus the study was done to check the status of lipid peroxidation product malondialdehyde (MDA) and a few antioxidant enzymes in RA patients.

45 RA patients and 40 controls were selected. Controls were asymptomatic and RA patients were selected according to ACR criteria. RA patients had significantly high MDA, SOD and ALP and reduced activity of catalase and GR as compared to controls. SOD showed positive correlation with ALP.

PDF LINK

Systemic Amyloidosis with Predominant Spine Involvement

Primary systemic amyloidosis with main bone involvement is a rare disease. Clinical symptoms and radiographic findings are usually nonspecific and may be confused with primary bone tumor, metastatic disease, metabolic disorders or infections. The occurrence of an amyloidoma in the spine is rare.

We describe the case of a 57-year old man presenting with a pathological fracture of T7 in presence of a large, soft tissue mass narrowing the spinal canal, responsible for a worsening paraplegia.

Diagnosis of systemic amyloidosis was made after surgical treatment. Pathological examination showed an amorphous eosinophilic material, positive staining with Congo red, birefringence under polarized light relating to amyloid, with the presence of rare plasma cells.

PDF LINK