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Thumb Carpometacarpal (CMC) total joint arthroplasty is commonly performed with increasing numbers worldwide. We present a case of Prosthetic Joint Infection (PJI) leading to severe septic shock and disseminated septic emboli 8 months following uneventful thumb CMC arthroplasty. Such extensive and life-threatening infection following thumb CMC arthroplasty has not been reported. Level of Evidence: Level V (Therapeutic)

Platelet-Rich Plasma (PRP) injection has become a desirable alternative to Partial Plantar Fasciotomy (PPF) surgery and steroid injection for patients with chronic plantar fasciitis (CPF) due to its potential for shorter recovery times, reduced complications, and similar activity scores. As such, we compared PRP treatment to PPF surgery in patients with CPF. Between January 2015 and January 2017, patients were randomly divided into two groups, a PRP treatment group, and a PPF group. All procedures were performed by a single foot and ankle fellowship-trained specialist surgeon. Visual Analog Score (VAS) and Roles-Maudsley Scale (RM) were collected during the preoperative visit and 3, 6, and 12 months postoperatively. The patients were also closely followed by a physiotherapist. There were 16 patients in each group after four patients refused to participate. Patients in the PPF had low Roles-Maudsley Scale (RM) scores compared to the PRP group one-year after treatment (3.77 vs. 2.72, p < 0.0001). Both procedures showed a reduction in RM scores during the follow-up year (9 to 1.62 for PPF and 8.7 to 2.4 for PRP). There was no significant change in VAS pain between the two groups (p = 0.366). Patients treated with PRP injection reported a significant increase in their activity scores, shorter recovery time, and lower complication rates compared to PPF treatment. Moreover, with respect to existing literature, PRP may be as efficient as steroid injection with lower complication rates, including response to physical therapy. Therefore, PRP treatment may be a viable option before surgery as an earlier line treatment for CPF. Level of Clinical Evidence: II.

Shoulder dislocation occurs when the head of the humerus disengages from the glenoid bone. About 95% of shoulder dislocations are traumatic, while the other 5% are not trauma-related in a patient with predisposing factors such as generalized ligamentous laxity. Ninety percent of shoulders dislocate anteriorly from direct force on the arm in the "ABER" position (Abduction- External Rotation). Usually, dislocations are accompanied by injuries to the shoulder that may lead to recurrent anterior shoulder instability and in the long-run, osteoarthritis of the shoulder joint. In the case of traumatic shoulder dislocation in the younger population or competitive sport players, accompanied with bone injury on X-ray's (Bony Bankart or Hill-Sachs), surgical treatment is recommended as soon as possible to avoid recurring dislocation and further joint damage. There are several options to treat recurrent shoulder instability, including soft tissue procedures, bone procedures, and a combination of these procedures. Surgery can be performed by an open or arthroscopic approach.

Reverse oblique intertrochanteric fractures are classified by the AO/OTA as 31A3 and account for 2–23% of all trochanteric fractures. The Gamma 3-Proximal Femoral Nail (GPFN) and the Expendable Proximal Femoral Nail (EPFN) are among the various devises used to treat this fracture. The aim of this study was to compare outcomes and complication rates in patients with AO/OTA 31A1-3 fractures, treated by either a GPFN or an EPFN. A total of 67 patients (40 in the GPFN group and 27 in the EPFN group, average age 78.8 years) were treated in our institution between July 2008 and February 2016. Data on postoperative radiological variables, including peg location and tip–apex distance (TAD), as well as orthopedic complications, such as union rate, surgical wound infection and cut-outs rates were also recorded, along with the incidence of non-orthopedic complications and more surgical data. Functional results were evaluated and quantified using the Modified Harris Hip Score (MHHS) and by the Short Form 12 Mental Health Composite questionnaire (SF-12 MHC) in order to assess the quality of life. The total prevalence of postoperative orthopedic complications including postoperative infection showed a significant difference with a p-value of 0.016 in favor of the EPFN group. Nonetheless, the frequency of revision did not differ between the two groups, being 0.134. The main orthopedic complication in both groups was head cut-out of the GPFN lag screw and the EPFN expendable peg, which was 20% and 7.4%, respectively, and required a revision surgery using a long nail or total hip replacement (THR). However, the average TAD did not significantly differ between groups which might be due to a relatively low cohort to reach a significant difference. Nonunion rate of 5% occurred solely in the GPFN group, with similar results of intraoperative open reduction between both groups. The EPFN group achieved better scores in both questionnaires (p = 0.027 and p = 0.046, respectively). Both the MHHS and SF-12 MCS values significantly differed between groups, with the EPFN group achieving better scores than the GPFN group in both questionnaires (p = 0.027 and p

Proximal femur fractures are associated with an increased mortality rate in the elderly. Early weight-bearing presents as a modifiable factor that may reduce negative postoperative outcomes and complications. As such, we aimed to compare non-weight-bearing, partial-weight-bearing and full weight-bearing cohorts, in terms of risk factors and postoperative outcomes and complications. We retrospectively reviewed our database to identify the three cohorts based on the postoperative weight-bearing status the day of surgery from 2003 to 20014. We collected data on numerous risk factors, including age, cerebrovascular accident (CVA), pulmonary embolism (PE), surgical fixation method and diagnosis type. We also collected data on postoperative outcomes, including the number of days of hospitalization, pain levels, and mortality rate. We performed a univariate and multivariate analysis; P

Study Design: A retrospective cohort study.Purpose: This study aims to examine the effect of tranexamic acid (TXA) on postoperative wound healing in spine surgery.Overview of Literature: TXA (Cyklokapron, Hexakapron) is a widely used anti-fibrinolytic drug that is shown to be effective in mitigating hemorrhage during and after surgery by competitively blocking plasminogen in fibrinolytic cascade. Plasminogen also plays a role in inflammatory and infectious diseases. The modulation of this role by TXA may influence the development of postoperative infectious complications.Methods: We collected and reviewed the charts of 110 patients who underwent spine surgery at our academic center. We used multivariate regression analysis to assess the factors affecting surgical site infection (SSI).Results: Of the 110 patients included in this study, 21 patients (19%) were categorized as having postoperative wound complications, 16 patients (14%) had deep or superficial wound infection, and five patients (4%) had wound dehiscence. Patients with a higher surgical invasiveness index score, longer surgeries, and older patients were found to be at risk for wound complications. TXA was determined not to be a direct risk factor for wound healing complications and SSIs.Conclusions: We found no risk of wound healing complications and SSI directly attributable to preoperative and intraoperative treatment with TXA in spine surgeries.

We estimate physical health, mental health, and healthcare access conditions and behaviours among fishing industry participants from a public health survey in the United States. Human well-being is an increasingly important consideration in ecosystem models and fishery management. We use a standardized public health survey, the Behavioral Risk Factor Surveillance System, to estimate health-related aspects of well-being in fishing industry participants (including harvest, processing, and wholesaling sectors) in Washington state and compare to reference populations. We find that physical and mental health outcomes and healthcare access among fishing industry participants are broadly similar to other populations. However, fishing industry participants are more frequently affected by conditions that limit activity and tend to engage in potentially unhealthy behaviour at higher rates. Our work fills a gap on health-related well-being outcomes in the human dimensions of fisheries and demonstrates the role that public health surveys can play in the study of well-being in fishing communities.

Models of human dimensions of fisheries are important to understanding and predicting how fishing industries respond to changes in marine ecosystems and management institutions. Advances in computation have made it possible to construct agent-based models (ABMs) - which explicitly describe the behaviour of individual people, firms or vessels in order to understand and predict their aggregate behaviours. ABMs are widely used for both academic and applied purposes in many settings including finance, urban planning and the military, but are not yet mainstream in fisheries science and management, despite a growing literature. ABMs are well suited to understanding emergent consequences of fisher interactions, heterogeneity and bounded rationality, especially in complex ecological, social and institutional contexts. For these reasons, we argue that ABMs of human behaviour can contribute significantly to human dimensions of fisheries in three areas: (a) understanding interactions between multiple management institutions; (b) incorporating cognitive and behavioural sciences into fisheries science and practice; and (c) understanding and projecting the social consequences of management institutions. We provide simple examples illustrating the potential for ABMs in each of these areas, using conceptual ("toy") versions of the POSEIDON model. We argue that salient strategic advances in these areas could pave the way for increased tactical use of ABMs in fishery management settings. We review common ABM development and application challenges, with the aim of providing guidance to beginning ABM developers and users studying human dimensions of fisheries.

Introduction: Anticoagulation use in the elderly is common for patients undergoing femoral neck hip surgery. However, its use presents a challenge to balance it with associated comorbidities and benefits for the patients. As such, we attempted to compare the risk factors, perioperative outcomes, and postoperative outcomes of patients who used warfarin preoperatively and patients who used therapeutic enoxaparin. Methods: From 2003 through 2014, we queried our database to determine the cohorts of patients who used warfarin preoperatively and the patients who used therapeutic enoxaparin. Risk factors included age, gender, Body Mass Index (BMI) > 30, Atrial Fibrillation (AF), Chronic Heart Failure (CHF), and Chronic Renal Failure (CRF). Postoperative outcomes were also collected at each of the patients’ follow-up visits, including number of hospitalization days, delays to theatre, and mortality rate. Results: The minimum follow-up was 24 months and the average follow-up was 39 months (range: 24–60 months). In the warfarin cohort, there were 140 patients and 2055 patients in the therapeutic enoxaparin cohort. Number of hospitalization days (8.7 vs. 9.8, p = 0.02), mortality rate (58.7% vs. 71.4%, p = 0.003), and delays to theatre (1.70 vs. 2.86, p < 0.0001) were significantly longer for the anticoagulant cohort than the therapeutic enoxaparin cohort. Warfarin use best predicted number of hospitalization days (p = 0.00) and delays to theatre (p = 0.01), while CHF was the best predictor of mortality rate (p = 0.00). Postoperative complications, such as Pulmonary Embolism (PE) (p = 0.90), Deep Vein Thrombosis (DVT) (p = 0.31), and Cerebrovascular Accidents (CVA) (p = 0.72), pain levels (p = 0.95), full weight-bearing status (p = 0.08), and rehabilitation use (p = 0.34) were similar between the cohorts. Conclusion: Warfarin use is associated with increased number of hospitalization days and delays to theatre, but does not affect the postoperative outcome, including DVT, CVA, and pain levels compared to therapeutic enoxaparin use. Warfarin use proved to be the best predictor of hospitalization days and delays to theatre while CHF predicted mortality rate.

Study Design: Retrospective case series analysis. Objective: To identify relevant clinical and radiographic markers for patients presenting with infectious spondylo-discitis associated with spinal instability directly related to the infectious process. Methods: We evaluated patients presenting with de-novo intervertebral discitis or vertebral osteomyelitis /discitis (VOD) who initiated non-surgical treatment. Patients who failed conservative treatment and required stabilization surgery within 90 days were defined as “ failed treatment group” (FTG). Patients who experienced an uneventful course served as controls and were labeled as “ nonsurgical group” (NSG). A wide array of baseline clinical and radiographic parameters was retrieved and compared between 2 groups. Results: Overall 35 patients had initiated non-surgical treatment for VOD. 25 patients had an uneventful course (NSG), while 10 patients failed conservative treatment (“FTG”) within 90 days. Factors found to be associated with poorer outcome were intra-venous drug abuse (IVDA) as well as the presence of fever upon initial presentation. Radiographically, involvement of the same-level facets and the extent of caudal and rostral VB involvement in both MRI and CT were found to be significantly associated with poorer clinical and radiographic outcome. Conclusions: We show that clinical factors such as IVDA status and fever as well as the extent of osseous and posterior element involvement may prove to be helpful in favoring surgical treatment early on in the management of spinal infections.

Purpose:To determine if boney morphology influences the anatomic location of hip fractures in elderly patients.Methods:All patients with hip fractures between 2008 and 2012 who had hip radiographs taken prior to the fracture were reviewed. Fractures were classified as intracapsular or extracapsular and hip morphology was measured on the pre-fracture x-rays. Hip morphology was determined by alpha angle, lateral central edge angle, acetabular index, neck-shaft angle, hip axis length, femoral neck diameter, Tönnis classification for hip osteoarthritis (OA) and the presence of a crossover sign.Results:148 subjects (78.4% female, age 83.5 years) with proximal femur fractures were included. 44 patients (29.7%) had intracapsular fractures and 104 (70.3%) had extracapsular fractures. 48% of patients had previous hip fractures on the contralateral side and 74.6% had the same type of fracture bilaterally. The rates of bilateral intracapsular and extracapsular fractures were similar (33.7% vs. 40.9% respectively, p = 0.39). Extracapsular fractures had a statically significant higher neck-shaft angle, a shorter hip axis length, a narrower femoral neck diameter and a higher grade of Tönnis classification of OA ( p = 0.04, 0.046, 0.03, 0.02 respectively). Acetabular coverage and the proximal femoral head-neck junction, which were evaluated by lateral centre-edge angle (LCEA), acetabular index and the presence of a crossover sign, did not correlate with fracture type. The alpha angle > 40° had a statistically significant higher likelihood for extracapsular fractures ( p = 0.013).Conclusions:Acetabular coverage and proximal femoral head-neck junction morphology, were found to partially correlate with the location of hip fractures and do not fully elucidate fracture type susceptibility.

Capsulotomy is necessary to facilitate instrument manoeuvrability within the joint capsule in many arthroscopic hip surgical procedures. In cases where a clear indication for capsular closure does not exist, surgeon’s preference and experience often determines capsular management. The purpose of this study was to assess the influence of capsular closure on clinical outcome scores and satisfaction in patients who underwent hip arthroscopy surgery for femoroacetabular impingement (FAI) and labral tear. Data were prospectively collected and retrospectively analysed for hip arthroscopy surgeries with a minimum 2 years follow-up. Patients with developmental dysplasia of the hip, previous back or hip surgeries, and degenerative changes to this hip and secondary gains were excluded. Demographic data, intraoperative findings and patient-reported outcome scores were recorded, including the Modified Harris Hip Score (MHHS) and Hip Outcome Score (HOS). A total of 29 and 35 patients were included in the non-closure and closure groups, respectively. The mean follow-up time was over 3 years for both groups. The mean pre-operative and post-operative HOS scores and MHHS scores did not significantly differ between groups (pre-operative HOS: 65.6 and 66.3, P = 0.898; post-operative HOS: 85.4 and 87.2, P = 0.718; pre-operative MHHS: 63.2 and 58.4, P = 0.223; post-operative MHHS: 85.7 and 88.7, P = 0.510). Overall patient satisfaction did not differ significantly between groups (non-closure 86.3%, closure group 88.6%; P = 0.672). Capsular closure did not significantly influence satisfaction or clinical outcome scores in patients who underwent arthroscopic hip surgery for FAI or labral tear.

Study design A prospective randomized control study. Objective The aim of this study was to compare the complication rate in adolescent idiopathic scoliosis (AIS) posterior spinal fusion (PSF) surgery with and without drainage. Summary of background data PSF is the mainstay of surgical treatment for AIS. Drains are commonly used despite contradictory findings in the literature for their having any clear advantage. Methods A total of 100 AIS patients undergoing instrumented PSF were blindly randomized into two groups of either a deep drain or no drain. The collected data included wound follow-up findings, hemoglobin, hematocrit, vital signs and fever levels, and mean 20 months follow-up. Results Fifty-two patients were randomly allocated to the "no drain" group and 48 to the "drain" group. There were no differences in patient characteristics, surgical data, and hemoglobin and hematocrit levels between the two groups. Only 4 units of packed cells were given in total. Fever during the first postoperative 1 to 3 days was equal, but increased in the no drain group on day 6 (P = 0.017). Length of hospitalization was equal (6 days) for all the patients. The mean follow-up period was 20 months [8.5-30.7 (SD 6.4)]. Complications included one case (1.9%) of pneumonia in the "no-drain" group, wound dehiscence in two cases (3.8%) in the "no-drain" group and in one case (2.1%) in the "drain" group, and two cases (3.8%) of superficial wound infection in the "no-drain" group. There was no case of deep infection in either group. Conclusion The current results indicate that there is no advantage to deep drainage in AIS patients undergoing PSF. The number of wound healing complications was low and identical for both the drain and no-drain groups. Level of evidence 2.

Spatially-explicit ecosystem models are increasingly considered for informing fisheries management. The inputs of these models that determine species distributions in the modeled system are critical. There is a need for methods to estimate species distributions in spatially-explicit ecosystem models from presence-only data. To address this need, we used a method relying on binomial generalized additive models integrating environmental covariates. This method allows for the production of distribution maps for ecosystem models such as Atlantis models, and of preference functions for Ecospace models; preference functions define the preferences of species groups for certain environmental parameter values and are employed by Ecospace to allocate species group biomasses spatially. The key step of the method we used is the objective generation of pseudo-absences for each month, by sampling with replacement the centroids of the cells of fine-scale spatial grids defined for each month. To demonstrate the method, we applied it to the diving bird and surface-feeding bird groups represented in the Atlantis model for the Gulf of Mexico (GOM), and to the seabird group represented in the Ecospace model for the West Florida Shelf. We also employed the distribution maps we constructed to provide a basis for a hypothetical marine protected area (MPA) planning scenario aiming to secure food for seabirds. Specifically, we produced a hotspot map for seabirds for the U.S. GOM from the distribution map of the species group, and then combined the hotspot map for seabirds with a hotspot map for their main prey, forage fish (Clupeidae and Exocoetidae), to determine where the hotspots of seabirds and forage fish overlap. This analysis suggested that, to secure forage fish for seabirds in the U.S. GOM, hypothetical MPAs should be implemented primarily within the coastal regions of the Louisiana-Texas shelf, within the coastal region of West Florida located between Sarasota and Naples and/or within Apalachee Bay, Florida.

Femoral neck fractures (FNF) have been declared to be a worldwide epidemic, as their number is expected to surpass 6 million by the year 2050, with more than 7,000 cases per year in Israel. FNF are more common in patients older than 65 years, and are expected to become even more common as the population ages. Like in many other medical conditions, treatment must be adapted for the unique features of this population. In this report, we sought to review the extent of femoral neck fractures in the elderly and the accompanied clinical outcomes and economic implications. As this population constitutes a major part of the patients suffering from femoral neck fractures, and tend to suffer from a higher rate morbidity and mortality, the orthopedic surgeon must meticulously choose the appropriate treatment, in a relatively short timeframe of up to 24-48 hours. In order to do so, further high-quality research examining the clinical outcomes according to the treatment chosen in this special population is needed.

This study was designed to compare the results of clavicle fracture open reduction internal fixation (ORIF) with standard horizontal incision versus vertical incision. ORIF surgery performed between October 2012 and August 2016 was included. The surgical approach was chosen according to surgeon preference as vertical or horizontal. Functional outcomes, fracture union, complications, scar appearance, skin irritation, and denervation around the scar were assessed at a minimum follow-up of three months. Thirty-eight patients, age 39 ± 12 years, were operated upon, 22 through vertical incisions and 16 through horizontal incisions. There were no significant group differences in functional scores, fracture union, or complications. Two patients in the vertical incision group had a post-operative haematoma. The scar length was significantly shorter when a vertical incision was used (6.75 ± 1.25 cm vs 8.9 ± 2.3 cm, P = 0.001). The typical distribution of hypoesthetic skin area distal and lateral to the scar represented iatrogenic damage to the supraclavicular nerves and was found in 66% of patients. The mean hypoesthetic surface area was smaller in the vertical incision group (38 ± 29 cm2 vs 48 ± 28 cm2, P = non-significant). Vertical incision results in shorter scars but may be associated with increased incidence of haematomas. Meticulous closure of the subcutaneous tissue is recommended.

AimsIntra-articular90Yttrium (90Y) is an adjunct to surgical treatment by synovectomy for patients with diffuse-type tenosynovial giant-cell tumour (dtTGCT) of the knee, with variable success rates. Clinical information is, however, sparse and its value remains unclear. We investigated the long-term outcome of patients who underwent synovectomy with and without adjuvant treatment with90Yttrium.Patients and MethodsAll patients with dtTGCT of the knee who underwent synovectomy between 1991 and 2014 were included in the study. Group A patients underwent synovectomy and an intra-articular injection of90Yttrium between six and eight weeks after surgery. Group B patients underwent surgery alone.ResultsThere were 34 patients in group A and 22 in group B. Recurrence of dtTGCT was identified by MRI, which was undertaken in patients with further symptoms. At a mean follow-up of 7.3 years (2.5 to 25.4), there was residual disease in 15 patients in group A and 11 in group B (p ConclusionThere were no significant differences in outcome between patients treated surgically for dtTGCT of the knee with or without an adjuvant intra-articular injection of90Yttrium. We were unable to provide conclusive evidence of any benefits derived from the adjuvant treatment. Cite this article: Bone Joint J 2018;100-B:984–8.

Since the onset of fisheries science, monitoring programs have been implemented to support stock assessments and fisheries management. Here, we take inventory of the monitoring programs of the U.S. Gulf of Mexico (GOM) surveying fish and invertebrates and conduct a gap analysis of these programs. We also compile a large monitoring database encompassing much of the monitoring data collected in the U.S. GOM using random sampling schemes and employ this database to fit statistical models to then map the spatial distributions of 61 fish and invertebrate functional groups, species and life stages of the U.S. GOM. Finally, we provide recommendations for improving current monitoring programs and designing new programs, and guidance for more comprehensive use and sharing of monitoring data, with the ultimate goal of enhancing the inputs provided to stock assessments and ecosystem-based fisheries management (EBFM) projects in the U.S. GOM. Our inventory revealed that 73 fisheries-independent and fisheries-dependent programs have been conducted in the U.S. GOM, most of which (85%) are still active. One distinctive feature of monitoring programs of the U.S. GOM is that they include many fisheries-independent surveys conducted almost year-round, contrasting with most other marine regions. A major sampling recommendation is the development of a coordinated strategy for collecting diet information by existing U.S. GOM monitoring programs for advancing EBFM.

Physician recommendation for prophylactic surgical fixation of a femur with metastatic bone disease (MBD) is usually based on Mirels' criteria and clinical experience, both of which suffer from poor specificity. This may result in a significant number of these health compromised patients undergoing unnecessary surgery. CT-based finite element analyses (CTFEA) have been shown to accurately predict strength in femurs with metastatic tumors in an ex-vivo study. In order to assess the utility of CTFEA as a clinical tool to determine the need for fixation of patients with MBD of the femur, an ad hoc CTFEA was performed on a retrospective cohort of fifty patients. Patients with CT scans appropriate for CTFEA analysis were analyzed. Group 1 was composed of 5 MBD patients who presented with a pathologic femoral fracture and had a scan of their femurs just prior to fracture. Group 2 was composed of 45 MBD patients who were scheduled for a prophylactic surgery because of an impending femoral fracture. CTFEA models were constructed for both femurs for all patients, loaded with a hip contact force representing stance position loading accounting for the patient's weight and femur anatomy. CTFEA analysis of Group 1 patients revealed that they all had higher tumor associated strains compared to typical non-diseased femur bone strains at the same region (>45%). Based on analysis of the 5 patients in Group 1, the ratio between the absolute maximum principal strain in the vicinity of the tumor and the typical median strain in the region of the tumor of healthy bones (typical strain fold ratio) was found to be the 1.48. This was considered to be the predictive threshold for a pathological femoral fracture. Based on this typical strain fold ratio, twenty patients (44.4%) in Group 2 were at low risk of fracture and twenty-five patients (55.5%) high risk of fracture. Eleven patients in Group 2 choose not to have surgery and none fractured in the 5month follow-up period. CTFEA predicted that seven of these patients were below the pathological fracture threshold and four above, for a specificity of 63% Based on CTFEA, 39% of the patients with femoral MBD who were referred and underwent prophylactic stabilization may not have needed surgery. These results indicate that a prospective randomized clinical trial evaluating CTFEA as a criterion for determining the need for surgical stabilization in patients with MBD of the femur may be warranted.

Objectives Calcium pyrophosphate deposition (CPPD) is associated with osteoarthritis and is the cause of a common inflammatory articular disease. Ecto-nucleotide pyrophosphatase/phosphodiesterase 1 (eNPP1) is the major ecto-pyrophosphatase in chondrocytes and cartilage-derived matrix vesicles (MVs). Thus, eNPP1 is a principle contributor to extracellular pyrophosphate levels and a potential target for interventions aimed at preventing CPPD. Recently, we synthesized and described a novel eNPP1-specific inhibitor, SK4A, and we set out to evaluate whether this inhibitor attenuates nucleotide pyrophosphatase activity in human OA cartilage. Methods Cartilage tissue, chondrocytes and cartilage-derived MVs were obtained from donors with OA undergoing arthroplasty. The effect of SK4A on cell viability was assayed by the XTT method. eNPP1 expression was evaluated by western blot. Nucleotide pyrophosphatase activity was measured by a colorimetric assay and by HPLC analysis of adenosine triphosphate (ATP) levels. ATP-induced calcium deposition in cultured chondrocytes was visualized and quantified with Alizarin red S staining. Results OA chondrocytes expressed eNPP1 in early passages, but this expression was subsequently lost upon further passaging. Similarly, significant nucleotide pyrophosphatase activity was only detected in early-passage chondrocytes. The eNPP1 inhibitor, SK4A, was not toxic to chondrocytes and stable in culture medium and human plasma. SK4A effectively inhibited nucleotide pyrophosphatase activity in whole cartilage tissue, in chondrocytes and in cartilage-derived MVs and reduced ATP-induced CPPD. Conclusion Nucleotide analogues such as SK4A may be developed as potent and specific inhibitors of eNPP1 for the purpose of lowering extracellular pyrophosphate levels in human cartilage with the aim of preventing and treating CPPD disease.

Arthroscopic rotator cuff (RC) repair incorporates suture anchors to secure torn RC tendons to the greater tuberosity (GT) bone. RC repair strength depends on the anchor-bone interface and on the quality of the GT. We evaluated the effect of single and multiple corticosteroid injections on the pullout strength of suture anchors.Fifty rats were divided into those receiving saline solution injection (control group), a single methylprednisolone acetate (MTA) injection (MTA1 group), or 3 once-weekly MTA injections (MTA3 group). Rats were killed humanely at 1 or 4 weeks after the last injection. A mini-suture anchor was inserted into the humeral head through the GT. Specimens were tested biomechanically.At 1 week after the last injection, the mean maximal pullout strength was significantly reduced in the MTA1 group (63.5%) and MTA3 group (56%) compared with the control group (P .05 for both). Mean stiffness decreased significantly in both treatment groups compared with controls (P .05). At 4 weeks after the last injection, there was a significant increase in the mean maximal pullout strength after single and triple MTA injections compared with values recorded at the 1-week time point (P .05). At 4 weeks, the mean maximal pullout strength after a single MTA injection was 92.8% of the pullout strength measured in the control group.We showed a significant detrimental effect of corticosteroid exposure on the pullout strength of a suture anchor at 1 week. However, this effect was transient and resolved within a relatively short period. These findings indicate that a waiting period is required between subacromial corticosteroid injection and RC repair surgery that involves the use of suture anchors.

Mapping the spatial distributions of fish populations is an integral component of ecosystem-based fisheries management (EBFM). Particularly for red grouper ( Epinephelus morio ) and gag grouper (“gag”; Mycteroperca microlepis ), two economically important species, the lack of mapping due to data limitations (i.e., inconsistent capture in research surveys) has left a critical gap in the science needed to assess how ecosystem processes and EBFM measures in the Gulf of Mexico (GOM) impact their population dynamics. We combined multiple fisheries-dependent and fisheries-independent data sources to map the long-term spatial distributions of older juveniles and adults of red and gag groupers in the U.S. GOM, using spatio-temporal binomial generalized linear mixed models (GLMMs). Spatio-temporal binomial GLMMs rely on the idea that probability of encounter at a given site is more similar to probability of encounter at nearby sites than to probability of encounter at geographically remote locations; this tenet allows one to estimate a smoothed surface depicting how probability of encounter varies spatially. Our spatio-temporal binomial GLMMs do not integrate environmental covariates, yet they account for the effects of year and research survey. The distribution maps produced from the predictions of the spatio-temporal binomial GLMMs aligned with the current understanding of the long-term ontogenetic spatial distributions of red and gag groupers in the U.S. GOM. Red grouper was predicted to be encountered throughout the West Florida Shelf (WFS), primarily at depths ranging from 20 to 60 m. Both older juvenile and adult female gags were predicted to be encountered from Apalachicola, Florida, to the region northwest of Tampa, Florida, along the 20 m depth contour, especially in Apalachee Bay. The probability of encounter of adult female gag was also high in the Florida Middle Grounds and in deeper (>40 m) areas of the WFS. The probability of encounter of adult male gag was highest along the edge of the WFS, both inside recognized spawning grounds (including the Madison-Swanson marine protected area) and outside, i.e., below 27°N (including Pulley Ridge). The distribution maps produced are valuable for understanding the ecology of grouper species and can be used as a basis for further analyses. Our spatio-temporal binomial GLMM framework will serve many important EBFM projects, including the construction of reliable distribution maps in bulk for spatially explicit ecosystem models of the GOM, which will improve spatial distributions and species spatial overlaps in spatially explicit ecosystem models and, therefore, the trophic interactions predicted by these models.

The aim of this study was to evaluate outcomes after acetabular labral reconstruction using the indirect head of the rectus femoris tendon. The study hypothesis stated that arthroscopic acetabular labral reconstruction may improve patient reported outcomes in patients with labral tears that were not amenable to repair. Between 2009 and 2015, the senior author performed 31 acetabular labral reconstructions using the indirect head of the rectus femoris tendon. The graft is harvested through the same arthroscopic portals established for the procedure. The graft was gradually secured to the acetabular rim starting at its origin to the myotendinous junction, reestablishing the suction seal of the joint. Medical records and surgical reports were reviewed for demographic data, and outcome measures were assessed with pre- and postoperative modified Harris Hip Scores (mHHS). Twenty-two patients with follow-up of more than 2 years were evaluated. Fourteen procedures were revision hip arthroscopy and 8 were primary labral reconstruction in 13 males and 9 females. The median age was 43 (range 22–68 years old). The median follow-up time was 36.2 months with a range from 24 to 72 months. The median preoperative mHHS was 67.1. Postoperatively, patients improved to a median mHHS of 97.8 (range 73.7–100) (p

Worldwide, violence in healthcare settings is a common occurrence, causing stress, injury, and burnout among healthcare workers, and impacting their ability to provide safe, effective care for pati...

The objectives of this study are to survey the weight-bearing limitation practices and delay for returning to running and impact sports of high volume hip arthroscopy orthopedic surgeons. The study was designed in the form of expert survey questionnaire. Evidence-based data are scares regarding hip arthroscopy post-operative weight-bearing protocols. An international cross-sectional anonymous Internet survey of 26 high-volume hip arthroscopy specialized surgeons was conducted to report their weight-bearing limitations and rehabilitation protocols after various arthroscopic hip procedures. The International Society of Hip Arthroscopy invited this study. The results were examined in the context of supporting literature to inform the studies suggestions. Four surgeons always allow immediate weight bearing and five never offer immediate weight bearing. Seventeen surgeons provide weight bearing depending on the procedures performed: 17 surgeons allowed immediate weight bearing after labral resection, 10 after labral repair and 8 after labral reconstruction. Sixteen surgeons allow immediate weight bearing after psoas tenotomy. Twenty-one respondents restrict weight bearing after microfracture procedures for 3–8 weeks post-operatively. Return to running and impact sports were shorter for labral procedures and bony procedures and longer for cartilaginous and capsular procedures. Marked variability exists in the post-operative weight-bearing practices of hip arthroscopy surgeons. This study suggests that most surgeons allow immediate weight bearing as tolerated after labral resection, acetabular osteoplasty, chondroplasty and psoas tenotomy. For cartilage defect procedures, 6 weeks or more non-weight bearing is suggested depending on the area of the defect and lateral central edge angle. Delayed return to sports activities is suggested after microfracture procedures. The level of evidence was Level V expert opinions.

Most bio-economic models in fisheries assume perfectly rational profit-maximizing behaviour by fishing vessels. Here we investigate this assumption empirically. Using a flexible agent-based model of fishing vessels called POSEIDON, we compared predicted fishing patterns to observed patterns in logbook data, that resulted from a wide range of stylized decision-making processes in the U.S. west coast dover sole-thornyhead-sablefish (DTS) fishery, which is managed with tradable quotas (ITQs). We found that observed vessel behaviour was best predicted in the model by simple decision algorithms whereby vessels chose between exploring new fishing grounds and revisiting previous ones based on their and other vessels’ past successes. In contrast, when the model assumed that vessels were perfect profit maximizers, the model substantially overestimated their profits and utilization of quota of rare, constraining species that carry high quota costs, such as yelloweye rockfish. Our results suggest that bounded rationality is an important driver of vessel behaviour in this fishery.

Background The benefit of suction drains (SD) for the first 24-48 hours following joint replacement surgery is controversial. We aimed to determine if there is any difference in the early outcome of revision TKA when performed with, or without SD. Methods 83 cases indicated for revision knee arthroplasty were randomized to receive (42) or not receive (41) a deep intra-articlular drain. First-stage revisions for treating periprosthetic infection were excluded. Patients were statistically compared for demographic parameters, early complications and early knee functional outcome. The assessed outcomes included total blood loss, number of transfusions, fever and wound complication rate at 24 months follow-up. In addition, the change in knee society score at 12 weeks postoperatively was compared between the groups. Results There were no significant difference in demographic factors, wound complications, knee scores at 12 weeks and infection rate 24 months after surgery in either group. Average blood loss was 1856ml and 1533ml for the drain and no drain groups, respectively (P value=0.0470). The need for transfusion was significantly less in the no-drain group with an average of 0.15 unit/patient as compared to an average 0.37 unit/patient for the drain group (P value=0.0432). Conclusion We were unable to find a point of superiority for using a drain for revision knee arthroplasty. Future studies with longer follow-up and larger population of patients are needed to make a valid conclusion.

The objective of this study was to quantify the amount of ensuing internal rotation of the tibial component when positioned along the medial border of the tibial tubercle, thus establishing a reproducible intraoperative reference for tibial component rotational alignment during total knee arthroplasty (TKA). The angle formed from the tibial geometric centre to the intersection of both lines from the middle of the tibial tuberosity and its medial border was measured in 50 patients. The geometric centre was determined on an axial CT slice at 10 mm below the lateral tibial plateau and transposed to a slice at the level of the most prominent part of the tibial tuberosity. Similar measurements were taken in 25 patients after TKA, in order to simulate the intraoperative appearance of the tibia after making its proximal resection. This angle was found to be similar (n.s.) in normal and post-TKA tibiae [median 20.4° (range 15°–24°) vs. 20.7° (range 16°–25°), respectively]. In 89.3 % of the patients, the angle ranged from 17° to 24°. No statistical difference (p n.s.) was found between women and men in both normal [median −20.7° (range 16°–25°) vs. 19.9° (range 15°–24°)] and post-TKA tibiae [median 21.4° (range 19°–24°) vs. 20° (range 16°–25°)]. This study found that in 90 % of the patients, the medial border of the tibial tuberosity is internally rotated 17°–24° in relation to the line connecting the middle of the tuberosity to the tibial geometric centre. Since this anatomical landmark may be more easily identifiable intraoperatively than the commonly used “medial 1/3”, it can provide a better quantitative reference point and help surgeons achieve a more accurate tibial implant rotational position. Cohort and case control studies, Level III.

The Mayo metaphysical conservative femoral stem (Zimmer, Warsaw, Indiana) is a wedge-shaped implant designed to transfer loads proximally, reduce femoral destruction, and enable the preservation of bone stock in the proximal femur. Thus, it is a potentially preferred prosthesis for active, non-elderly patients who may require additional future surgeries. This retrospective case study analyzed the outcomes of consecutive patients who underwent total hip replacements with this stem between May 2001 and February 2013. All patients underwent clinical assessment, radiological evaluation for the presence and development of radiolucent lines, and functional assessment (numerical analog scale, Harris hip score, and Short Form-12 questionnaire). Ninety-five hips (79 patients) were available for analysis. The patients' mean age was 43 years (range, 18–64 years), and the mean follow-up was 97 months (range, 26.9–166 months). The postoperative clinical assessments and functional assessments revealed significant improvements. Sixteen patients (20.3%) had 18 orthopedic complications, the most common of which were an intraoperative femoral fracture and implant dislocation requiring revision surgeries in 10 hips (10.5%). Radiological analysis revealed evidence of femoral remodeling in 64 (67.4%) implants, spot welds (neocortex) in 35 (36.8%), and osteolysis in 3 (3.2%). These results suggest that the conservative hip femoral implant has an unacceptable complication rate for non-elderly patients. [ Orthopedics . 2018; 41(4):e516–e522.]

Sustainable management of complex human–environment systems, and the essential services they provide, remains a major challenge, felt from local to global scales. These systems are typically highly dynamic and hard to predict, particularly in the context of rapid environmental change, where novel sets of conditions drive coupled socio-economic-environmental responses. Faced with these challenges, our tools for policy development, while informed by the past experience, must not be unduly constrained; they must allow equally for both the fine-tuning of successful existing approaches and the generation of novel ones in unbiased ways. We study ocean fisheries as an example class of complex human–environmental systems, and present a new model (POSEIDON) and computational approach to policy design. The model includes an adaptive agent-based representation of a fishing fleet, coupled to a simplified ocean ecology model. The agents (fishing boats) do not have programmed responses based on empirical data, but respond adaptively, as a group, to their environment (including policy constraints). This conceptual model captures qualitatively a wide range of empirically observed fleet behaviour, in response to a broad set of policies. Within this framework, we define policy objectives (of arbitrary complexity) and use Bayesian optimization over multiple model runs to find policy parameters that best meet the goals. The trade-offs inherent in this approach are explored explicitly. Taking this further, optimization is used to generate novel hybrid policies. We illustrate this approach using simulated examples, in which policy prescriptions generated by our computational methods are counterintuitive and thus unlikely to be identified by conventional frameworks.

Background Functional scores and radiographs are often used to assess function and predict development of osteoarthritis in patients with multi-fragmentary tibial plateau fractures (TPFs). Locomotion, which is the primary goal of fracture treatment, is rarely assessed. The objective of this study was to assess functional ability of patients after TPF fixation using spatio-temporal gait analysis (STGA), and to compare STGA variables with self-reported functional scores and preoperative fracture characteristics. Methods Preoperative CT scans of 21 patients with complete articular multi-fragmentary TPFs were evaluated for number of fragments, maximum gap between the fragments and maximum articular depression. All patients underwent STGA (velocity, cadence, step length of the affected and the unaffected leg, single-limb support by the affected and the unaffected leg, and double-leg support) and filled the Knee Society Score and the Short Form-12 questionnaires on average 3 years (SD = 1.56, range, 2–5.8) post-injury. Findings Step length and single-limb support time of the affected leg were shorter compared to the unaffected leg (p = 0.02 and p = 0.007, respectively). Number of fracture fragments correlated with cadence (R = −0.461, p = 0.04) and velocity (R = −0.447, p = 0.04). Interpretation Given that both higher fracture comminution and deformity on the one hand and the above gait parameter alterations on the other hand are associated with knee osteoarthritis, STGA may be used for routine postoperative evaluation of patients after TPF fixation.

To be able to simulate spatial patterns of predator-prey interactions, many spatially-explicit ecosystem modeling platforms, including Atlantis, need to be provided with distribution maps defining the annual or seasonal spatial distributions of functional groups and life stages. We developed a methodology combining extrapolation and interpolation of the predictions made by statistical habitat models to produce distribution maps for the fish and invertebrates represented in the Atlantis model of the Gulf of Mexico (GOM) Large Marine Ecosystem (LME) (“Atlantis-GOM”). This methodology consists of: (1) compiling a large monitoring database, gathering all the fisheries-independent and fisheries-dependent data collected in the northern (U.S.) GOM since 2000; (2) compiling a large environmental database, storing all the environmental parameters known to influence the spatial distribution patterns of fish and invertebrates of the GOM; (3) fitting binomial generalized additive models (GAMs) to the large monitoring and environmental databases, and geostatistical binomial generalized linear mixed models (GLMMs) to the large monitoring database; and (4) employing GAM predictions to infer spatial distributions in the southern GOM, and GLMM predictions to infer spatial distributions in the U.S. GOM. Thus, our methodology allows for reasonable extrapolation in the southern GOM based on a large amount of monitoring and environmental data, and for interpolation in the U.S. GOM accurately reflecting the probability of encountering fish and invertebrates in that region. We used an iterative cross-validation procedure to validate GAMs. When a GAM did not pass the validation test, we employed a GAM for a related functional group/life stage to generate distribution maps for the southern GOM. In addition, no geostatistical GLMMs were fit for the functional groups and life stages whose depth, longitudinal and latitudinal ranges within the U.S. GOM are not entirely covered by the data from the large monitoring database; for those, only GAM predictions were employed to obtain distribution maps for Atlantis-GOM. Pearson residuals were computed to validate geostatistical binomial GLMMs. Ultimately, 53 annual maps and 64 seasonal maps (for 32 different functional groups/life stages) were produced for Atlantis-GOM. Our methodology could serve other world’s regions characterized by a large surface area, particularly LMEs bordered by several countries.

Excision of the proximal femur for tumour with prosthetic reconstruction using a bipolar femoral head places a considerable load on the unreplaced acetabulum.We retrospectively reviewed the changes which occur around the affected hip joint by evaluating the post-operative radiographs of 65 consecutive patients who underwent proximal prosthetic arthroplasty of the femur, and in whom an acetabular component had not been used. There were 37 men and 28 women with a mean age of 57.3 years (17 to 93). Radiological assessment included the extent of degenerative change in the acetabulum, heterotopic ossification, and protrusio acetabuli.The mean follow-up was 9.1 years (2 to 11.8). Degenerative changes in the acetabulum were seen in three patients (4.6%), Brooker grade 1 or 2 heterotopic ossification in 17 (26%) and protrusion of the prosthetic head in nine (13.8%).A total of eight patients (12.3%) needed a revision. Five were revised to the same type of prosthesis and three (4.6%) were converted to a total hip arthroplasty.We conclude that radiological evidence of degenerative change, heterotopic ossification and protrusion occur in a few patients who undergo prosthetic arthroplasty of the proximal femur for tumour. The limited extent of these changes and the lack of associated symptoms do not justify the routine arthroplasty of the acetabulum in these patients.Cite this article: Bone Joint J 2015;97-B:1704–9

This study examined the success and factors associated with failure, of using cement spacers impregnated with high-dose Ceftazidime and Vancomycin when performing two-stage revision for infected total knee arthroplasty (TKA).A retrospective analysis was performed using a prospectively collected database of 82 patients (median age 68 years, range 39-87) with a confirmed deep TKA infection treated with a two-stage revision. All cement spacers were impregnated with high-dose Ceftazidime and Vancomycin. The rate of success was recorded-an association between failure of treatment, and patient factors, previous surgical treatment, and microbial characteristics was sought.The mean time to infection from index arthroplasty was 45 months (range 3-240). The initial two-stage revision was successful in 70/82 patients (85.4 %), who remained free of infection at average follow-up of 36.2 months (range 24-85). A second two-stage revision for infection was required in 12/82 patients (14.6 %), which was successful in 4/12 (33 %). A third two-stage revision was performed in three patients, all of whom had a polymicrobial infection of which only one patient had successful eradication of infection. Recurrent infection was correlated with irrigation and debridement with implant retention prior to initial two-stage revision (p 0.01), polymicrobial infections (p = 0.035), and infections presenting6 months after index surgery (p = 0.031). No correlation was seen with age, BMI, type of organism, diabetes mellitus, or Charlson Comorbidity Index.The findings of this study suggest that the combination of Ceftazidime and Vancomycin in cement spacers is as efficacious as other published single or combined antibiotic mixtures, which is clinically relevant to clinicians treating this difficult problem in the setting of patients with compromised renal function.

This study reports the clinical outcome of reconstruction of deficient abductor muscles following revision total hip arthroplasty (THA), using a fresh–frozen allograft of the extensor mechanism of the knee. A retrospective analysis was conducted of 11 consecutive patients with a severe limp because of abductor deficiency which was confirmed on MRI scans. The mean age of the patients (three men and eight women) was 66.7 years (52 to 84), with a mean follow-up of 33 months (24 to 41). Following surgery, two patients had no limp, seven had a mild limp, and two had a persistent severe limp (p = 0.004). The mean power of the abductors improved on the Medical Research Council scale from 2.15 to 3.8 (p < 0.001). Pre-operatively, all patients required a stick or walking frame; post-operatively, four patients were able to walk without an aid. Overall, nine patients had severe or moderate pain pre-operatively; ten patients had no or mild pain post-operatively. At final review, the Harris hip score was good in five patients, fair in two and poor in four. We conclude that using an extensor mechanism allograft is relatively effective in the treatment of chronic abductor deficiency of the hip after THA when techniques such as local tissue transfer are not possible. Longer-term follow-up is necessary before the technique can be broadly applied. Cite this article: Bone Joint J 2015;97-B:1050–5.

Partial patellectomy (PP) and reattachment of the patellar ligament with transosseous suturing is the mainstay of surgical treatment for distal pole patellar fractures. An anchor suturing (AS) technique has recently been reported as an alternative to PP in such fractures and allows for bone-to-bone interface and possibly superior fracture healing than bone-to-tendon interface with PP. We present our experience with AS and compare it to PP. Between 2006 and 2011, 60 patients with distal pole patellar fracture underwent either AS (n = 27) or PP (n = 33). We retrospectively gathered their demographic data and information on fracture type, fixation technique, operation time, postoperative complications and knee range of motion. A telephone survey was performed to grade functional outcomes with standard questionnaires (the SF-12 for quality of life, the Kujala score for patellofemoral function and a visual analog scale [VAS] pain score). AS was equivalent to PP in terms of residual pain and functional outcomes (VAS: 2.45 vs. 2.26, p = 0.83 and Kujala score: 74.3 vs. 69, p = 0.351, respectively) as well as for knee range of motion. Complications included three cases of infection in each group, two cases of early hardware failure and one case of non-union in the AS group. Operation time was significantly shorter for AS compared to PP (68.5 vs. 79.1 min, p = 0.03). AS is non-inferior to PP for function and pain after distal pole patellar fractures and is superior to PP with regard to operative time. Common complications of this technique are hardware failure and infections. Therapeutic Level III