Devoted to disseminating new and important orthopaedic knowledge,Clinical Orthopaedics and Related Research (CORR) is a leading peer-reviewed orthopaedic journal and a publication of The Association of Bone and Joint Surgeons. CORR brings readers the latest clinical and basic research and informed opinions that shape today's orthopaedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. Learn more about CORR.
Abstract Irreparable distal biceps tendon tears typically are treated using a free tendon graft. We asked whether our new method to
fix the graft—using two suture anchors—yields similar results to our previous bone canal method. We compared the two methods
for strength, endurance, and clinical findings. There were two groups, the suture anchor group (Group A, seven patients) and
the bone canal group operated on before suture anchors (Group B, seven patients). The patients were males with a mean age
at surgery of 44.9 years. The operative delay from primary trauma to index surgery averaged 5.9 months. The minimum followup
was 2 years (mean, 11.1 years; range, 2–23 years). The mean arc of elbow motion was 0° to 132°, pronation 83°, and supination
80°. Compared with the contralateral side, the maximal peak torque was 84% in supination and 91% in pronation, and the maximal
static elbow flexion strength was 94%. The Mayo elbow score averaged 99 in Group A and 100 in Group B. There were no major
differences between the two groups. Our novel modification to fix a tendon graft yields equal clinical outcomes compared with
the bone canal method for treatment of irreparable distal biceps tendon injuries.
Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Content Type Journal Article
Category Original Article
DOI 10.1007/s11999-008-0389-y
Authors
Martti Vastamäki, Invalid Foundation ORTON Orthopaedic Hospital Helsinki Finland
Heidi Vastamäki, Invalid Foundation ORTON Orthopaedic Hospital Helsinki Finland
Abstract Recent studies suggest US medical schools are not effectively addressing musculoskeletal medicine in their curricula. We examined
if there were specific areas of weakness by analyzing students’ knowledge of and confidence in examining specific anatomic
regions. A cross-sectional survey study of third- and fourth-year students at Harvard Medical School was conducted during
the 2005 to 2006 academic year. One hundred sixty-two third-year students (88% response) and 87 fourth-year students (57%
response) completed the Freedman and Bernstein cognitive mastery examination in musculoskeletal medicine and a survey eliciting
their clinical confidence in examining the shoulder, elbow, hand, back, hip, knee, and foot on a one to five Likert scale.
We specifically analyzed examination questions dealing with the upper extremity, lower extremity, back, and others, which
included more systemic conditions such as arthritis, metabolic bone diseases, and cancer. Students failed to meet the established
passing benchmark of 70% in all subgroups except for the others category. Confidence scores in performing a physical examination
and in generating a differential diagnosis indicated students felt below adequate confidence (3.0 of 5) in five of the seven
anatomic regions. Our study provides evidence that region-specific musculoskeletal medicine is a potential learning gap that
may need to be addressed in the undergraduate musculoskeletal curriculum.
Content Type Journal Article
Category Original Article
DOI 10.1007/s11999-008-0379-0
Authors
Charles S. Day, Beth Israel Deaconess Medical Center Department of Orthopaedic Surgery 330 Brookline Avenue Boston MA 02215 USA
Albert C. Yeh, Beth Israel Deaconess Medical Center Department of Orthopaedic Surgery 330 Brookline Avenue Boston MA 02215 USA
Abstract The use of silicone products combined with free flap transfer is well established in reconstructive surgery. We determined
the risk of thrombosis as a result of direct contact between the silicone sheet and the point of microanastomosis. We performed
microvascular surgery in 24 female Chinchilla Bastard rabbits weighing 3500 to 4000 g using two groups: Group 1 (n = 12),
microanastomosis directly in contact with silicone sheets; and Group 2 (n = 12), microanastomosis protected by a 2 × 3 × 1-cm
muscle cuff before being placed in contact with the silicone. We assessed flow-through of the microanastomosis by selective
microangiography and histology at 1 and 3 weeks. All microanastomoses in Group 1 were occluded by postoperative thromboses,
whereas all microanastomoses in Group 2 had adequate flow-through. Histologic analysis revealed thromboses in Group 1 formed
from collagenous bundles of fiber securely attached to the intraluminal wall of the vessel. Three weeks after the procedure,
these thromboses were canalized by varying small vessels. In Group 2, a slight luminal stenosis with evidence of infiltration
of inflammatory cells at the microanastomosis line was observed histologically in all cases. Prefabricated flaps using silicone
sheets and muscular cuffs placed around the anastomoses appear to reduce the risk of thrombosis and enhance neovascularization.
Content Type Journal Article
Category Original Article
DOI 10.1007/s11999-008-0388-z
Authors
The Hoang Nguyen, Central University Hospital 108 Department of Hand Surgery and Microsurgery, Institute of Trauma and Orthopaedics Khoa B1-2, Benh vien 108, So 1 Tran Hung Dao Hanoi Vietnam
Marcus Kloeppel, University Hospital “rechts der Isar”, Technical University of Munich Department of Plastic and Reconstructive Surgery Munich Germany
Christoph Hoehnke, University Hospital “rechts der Isar”, Technical University of Munich Department of Plastic and Reconstructive Surgery Munich Germany
Rainer Staudenmaier, University Hospital “rechts der Isar”, Technical University of Munich ENT Department Munich Germany
Abstract Psychological illness influences the experience and expression of pain and disability. We tested three null hypotheses: (1)
patients with nonspecific pain (medically unexplained and idiopathic) and patients with specific pain (discrete and verifiable)
are equally likely to screen for psychiatric illnesses based on a validated screening questionnaire; (2) the presence of psychiatric
illness (from a screening questionnaire) will not predict whether patients have specific or nonspecific pain type; and (3)
across all patients and regardless of whether they have specific or nonspecific pain, psychiatric illness will not predict
disability as measured by the Disabilities of the Arm Shoulder and Hand (DASH) questionnaire. We rejected all null hypotheses.
The 41 patients with nonspecific arm pain were more likely than the 40 patients with specific arm pain to screen for a somatoform
disorder (34% versus 7.5%), posttraumatic stress disorder (24% versus 7.5%), and panic disorder (12.2% versus 5%). The presence
of anxiety and somatoform disorders predicted pain type (nonspecific versus specific) and arm-specific disability (DASH).
Somatoform disorder was the strongest predictor of pain type and DASH scores. Based on a screening questionnaire, a comorbid
psychiatric illness, a somatoform disorder in particular, is associated with nonspecific arm pain and arm-specific disability.
Level of Evidence: Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Content Type Journal Article
Category Original Article
DOI 10.1007/s11999-008-0378-1
Authors
Ana-Maria Vranceanu, Massachusetts General Hospital and Harvard Medical School Behavioral Medicine Services, Department of Psychiatry Boston MA USA
Steven Safren, Massachusetts General Hospital and Harvard Medical School Behavioral Medicine Services, Department of Psychiatry Boston MA USA
Meijuan Zhao, Massachusetts General Hospital and Harvard Medical School Hand & Upper Extremity Services, Department of Orthopedic Surgery Yawkey 2100, 55 Fruit Street Boston MA 02114 USA
James Cowan, Massachusetts General Hospital and Harvard Medical School Hand & Upper Extremity Services, Department of Orthopedic Surgery Yawkey 2100, 55 Fruit Street Boston MA 02114 USA
David Ring, Massachusetts General Hospital and Harvard Medical School Hand & Upper Extremity Services, Department of Orthopedic Surgery Yawkey 2100, 55 Fruit Street Boston MA 02114 USA
Abstract Malawi has a population of about 13 million people, 85% of whom live in rural areas. The gross national income per capita
is US$620, with 42% of the people living on less than US$1 per day. The government per capita expenditure on health is US$5.
Malawi has 266 doctors, of whom only nine are orthopaedic surgeons. To address the severe shortage of doctors, Malawi relies
heavily on paramedical officers to provide the bulk of healthcare. Specialized orthopaedic clinical officers have been trained
since 1985 and are deployed primarily in rural district hospitals to manage 80% to 90% of the orthopaedic workload in Malawi.
They are trained in conservative management of most common traumatic and nontraumatic musculoskeletal conditions. Since the
program began, 117 orthopaedic clinical officers have been trained, of whom 82 are in clinical practice. In 2002, Malawi began
a local orthopaedic postgraduate program with an intake of one to two candidates per year. However, orthopaedic clinical officers
will continue to be needed for the foreseeable future. Orthopaedic clinical officer training is a cost-effective way of providing
trained healthcare workers to meet the orthopaedic needs of a country with very few doctors and even fewer orthopaedic surgeons.
Content Type Journal Article
Category Symposium: ABJS/C.T. Brighton Workshop on Trauma in the Developing World
DOI 10.1007/s11999-008-0366-5
Authors
Nyengo Mkandawire, University of Malawi Department of Surgery, College of Medicine P/Bag 360 Chichiri Blantyre Malawi
Christopher Ngulube, Queen Elizabeth Central Hospital Department of Surgery Blantyre Malawi
Christopher Lavy, Oxford University Department of Orthopaedics Oxford UK
Abstract Trauma is becoming a leading cause of death in most of the low-income and middle-income countries worldwide. The growing number
of motor vehicles far surpasses the development and upkeep of the road and highway networks, traffic laws, and driver training
and licensing. In Thailand, road traffic injuries have become the second leading cause of death and morbidity overall since
1990. The lack of improvement to existing roadways, implementation of traffic safety and ridership laws including seatbelt
regulations, and poor emergency medical assistance support systems all contribute to these statistics. An insufficient number
and inequitable distribution of healthcare professionals is also a national problem, especially at the district level. Prehospital
care of trauma patients remains insufficient and improvements at the national level are suggested.
Content Type Journal Article
Category Symposium: ABSJ/C.T. Brighton Workshop on Trauma in the Developing World
DOI 10.1007/s11999-008-0385-2
Authors
Banchong Mahaisavariya, Mahidol University Department of Orthopaedic Surgery and Rehabilitation, Faculty of Medicine, Siriraj Hospital Bangkok 10700 Thailand
Abstract Femoral neck fracture is one of the most common complications of hip resurfacing and considered by some to be related to reduced
blood flow as a consequence of the surgical approach. We measured oxygen concentration during hip resurfacing through the
trochanteric flip approach (n = 15 patients) and compared this approach with previous data for the posterior and anterolateral
approaches. With the trochanteric flip the average femoral oxygenation decreased during the procedure to approximately 50%
of that at the start, however it recovered to starting level by the end of the procedure. Preservation of oxygenation with
the trochanteric flip was similar to that observed with the anterolateral approach, but with less variation during the procedure.
Both of these approaches were superior in terms of oxygenation preservation to the posterior approach which resulted in a
dramatic reduction in oxygenation.
Content Type Journal Article
Category Original Article
DOI 10.1007/s11999-008-0390-5
Authors
Robert T. Steffen, University of Oxford OOEC/Nuffield Department of Orthopaedic Surgery, Nuffield Orthopaedic Centre Botnar 2 Oxford OX3 7LD UK
Darren Fern, Royal Cornwall Hospital Treliske Truro UK
Mark Norton, Royal Cornwall Hospital Treliske Truro UK
David W. Murray, University of Oxford OOEC/Nuffield Department of Orthopaedic Surgery, Nuffield Orthopaedic Centre Botnar 2 Oxford OX3 7LD UK
Harinderjit S. Gill, University of Oxford OOEC/Nuffield Department of Orthopaedic Surgery, Nuffield Orthopaedic Centre Botnar 2 Oxford OX3 7LD UK
Abstract Approximately 2000 lives are lost in Uganda annually through road traffic accidents. In Kampala, they account for 39% of all
injuries, primarily in males aged 16–44 years. They are a result of rapid motorization and urbanization in a country with
a poor economy. Uganda’s population is an estimated 28 million with a growth rate of 3.4% per year. Motorcycles and omnibuses,
the main taxi vehicles, are the primary contributors to the accidents. Poor roads and drivers compound the situation. Twenty-three
orthopaedic surgeons (one for every 1,300,000 people) provide specialist services that are available only at three regional
hospitals and the National Referral Hospital in Kampala. The majority of musculoskeletal injuries are managed nonoperatively
by 200 orthopaedic officers distributed at the district, regional and national referral hospitals. Because of the poor economy,
9% of the national budget is allocated to the health sector. Patients with musculoskeletal injuries in Uganda frequently fail
to receive immediate care due to inadequate resources and most are treated by traditional bonesetters. Neglected injuries
typically result in poor outcomes. Possible solutions include a public health approach for prevention of road traffic injuries,
training of adequate human resources, and infrastructure development.
Content Type Journal Article
Category Symposium: ABJS/C.T. Brighton Workshop on Trauma in the Developing World
DOI 10.1007/s11999-008-0369-2
Authors
E. K. Naddumba, Mulago Hospital Department of Orthopedics P.O. Box 7051 Kampala Uganda
Abstract China is a developing country with a population over 1.3 billion with the second largest group of people in poverty next to
India. There are about 159 million motor vehicles, with 163,887,372 drivers. From 2001 to 2004 over 100,000 people died each
year in traffic accidents. With law enforcement and public education, traffic accidents have decreased, and the death rate
is now less than 100,000 each year.
Content Type Journal Article
Category Symposium: ABSJ/C.T. Brighton Workshop on Trauma in the Developing World
DOI 10.1007/s11999-008-0382-5
Authors
Zhen-Sheng Ma, Xijing Hospital, Fourth Military Medical University Department of Orthopaedics 15th Changle West Road Xi’an 710032 China
Hong-Ju Zhang, Xijing Hospital, Fourth Military Medical University Department of Obstetrics and Gynecology Xi’an China
Wei Lei, Xijing Hospital, Fourth Military Medical University Department of Orthopaedics 15th Changle West Road Xi’an 710032 China
Li-Ze Xiong, Xijing Hospital, Fourth Military Medical University Department of Anesthesiology Xi’an China
Abstract Orthopaedic surgical training in Nepal began in 1998, and four major centers now produce between 15 and 20 graduates annually.
The duration of the training is four years in one center and three years in the remaining centers. Trainees have adequate
trauma exposure. The major challenges include: tailoring training to suit local needs, avoiding the dangers of market driven
orthopaedic surgery, adequately emphasizing and implementing time honored methods of closed fracture treatment, and ensuring
uniformity of exposure to the various musculoskeletal problems. Training in research methods needs to be implemented more
effectively. The evaluation process needs to be more uniform and all training programs need to complement one another and
avoid unhealthy competition. Training for nonorthopaedists providing musculoskeletal care is virtually nonexistent in Nepal.
Medical graduates have scant exposure to trauma and musculoskeletal diseases during their training. General surgeons provide
the majority of trauma care and in the rural areas, health assistants, auxiliary health workers and physiotherapy assistants
provide much needed basic services, but all lack formal training. Traditional “bone setters” in Nepal often cater to certain
faithful clientele with sprains, minor fractures etc. A large vacuum exists in Nepal for trained nonorthopaedists leading
to deficiencies in prehospital care, safe transport and basic, primary emergency care. The great challenges are yet to be
addressed.
Content Type Journal Article
Category Symposium: ABJS/C.T. Brighton Workshop on Trauma in the Developing World
DOI 10.1007/s11999-008-0370-9
Authors
Ashok K. Banskota, Hospital and Rehabilitation Center for Disabled Children Kathmandu Nepal
Abstract Serbia, a middle-income country, is located in southeastern Europe, with territory of 88,361 km2 and 9,400,000 inhabitants. Average month salary is US$542 and the registered unemployment rate is 22%. The country is administratively
divided into 30 districts (193 municipalities). The healthcare system is territorially organized. In the state capital there
are five clinical hospitals with musculoskeletal traumatology departments, as well as one in each of the four university centers.
In addition, there are orthopaedic departments in 40 smaller hospitals throughout the country and in three military hospitals,
along with several pediatric surgical departments involved in managing musculoskeletal trauma. There are 524 orthopaedic trauma
surgeons (1:18,000 people), with a minor number of additionally trained general and pediatric surgeons who care for musculoskeletal
problems. Bonesetters are neither recognized nor included in the healthcare system. Orthopaedic traumatology services are
well organized, with variable accessibility depending on the distance between injury site and nearest medical facility. Preventive
strategies are well developed and mainly consider agricultural, industrial, and traffic injuries. Distribution of medical
institutions is satisfactory. Future activities should include continuing medical education of specialists, exclusion of inappropriate
specialists, improvement of preventive strategies and medical transport facilities, as well as standardization of medical
equipment, diagnostics, and treatment protocols.
Content Type Journal Article
Category Symposium: ABJS/C.T. Brighton Workshop on Trauma in the Developing World
DOI 10.1007/s11999-008-0364-7
Authors
Zoran Vukašinović, Institute for Orthopaedic Surgery “Banjica” 28 Mihaila Avramovica 11000 Belgrade Serbia
Duško Spasovski, Institute for Orthopaedic Surgery “Banjica” 28 Mihaila Avramovica 11000 Belgrade Serbia
Zorica Živković, Institute for Orthopaedic Surgery “Banjica” 28 Mihaila Avramovica 11000 Belgrade Serbia
Abstract Radiographic evaluation of preoperative joint space width is believed important to predict the long-term results of osteotomy.
We asked whether joint space width differs in the supine and standing positions in patients with Crowe Type-1 osteoarthritis
(OA) secondary to developmental dysplasia of the hip (DDH). Joint space width was measured in the supine and standing positions
in 146 women and 16 men (231 hips) with OA. Subjects had a mean age of 46.7 years (range, 22–59 years). Differences were seen
on radiographs in joint space width between supine (2.35 ± 1.65 mm; range, 0.1–6.2 mm) and standing (2.04 ± 1.78 mm; range,
0.0–5.9 mm). In 27 of 172 hips with greater than 1 mm joint space in the supine position, joint space width was decreased
by greater than 1 mm in the standing position. To evaluate preoperative joint space width in patients scheduled for osteotomy,
radiographs should be obtained with the patient in the standing position.
Level of Evidence: Level IV, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Content Type Journal Article
Category Original Article
DOI 10.1007/s11999-008-0372-7
Authors
Kunihiko Okano, Nagasaki University Department of Orthopedic Surgery, Graduate School of Biomedical Science 1-7-1 Sakamoto Nagasaki 852-8501 Japan
Natsumi Kawahara, Nagasaki University Department of Orthopedic Surgery, Graduate School of Biomedical Science 1-7-1 Sakamoto Nagasaki 852-8501 Japan
Ko Chiba, Nagasaki University Department of Orthopedic Surgery, Graduate School of Biomedical Science 1-7-1 Sakamoto Nagasaki 852-8501 Japan
Hiroyuki Shindo, Nagasaki University Department of Orthopedic Surgery, Graduate School of Biomedical Science 1-7-1 Sakamoto Nagasaki 852-8501 Japan
Abstract There is currently an escalating epidemic of trauma-related injuries due to road traffic accidents and armed conflicts. This
trauma occurs predominantly in rural areas where most of the population lives. Major ways to combat this epidemic include
prevention programs, improved healthcare facilities, and training of competent providers. Mozambique and Sri Lanka have many
common features including size, economic system, and healthcare structure but have significant differences in their medical
education systems. With six medical schools, Sri Lanka graduates 1000 new physicians per year while Mozambique graduates less
than 50 from their singular school. To supplement the low number of physicians, a training course for surgical technicians
has been implemented. Examination of district hospital staffing and the medical education in these two countries might provide
for improving trauma care competence in other developing countries. Musculoskeletal education is underrepresented in most
medical school curricula around the world. District hospitals in developing countries are commonly staffed by recently graduated
general medical officers, whose last formal education was in medical school. There is an opportunity to improve the quality
of trauma care at the district hospital level by addressing the musculoskeletal curriculum content in medical schools.
Content Type Journal Article
Category Symposium: ABJS/C.T. Brighton Workshop on Trauma in the Developing World
DOI 10.1007/s11999-008-0365-6
Authors
Richard C. Fisher, University of Colorado Health Sciences Center Department of Orthopaedics Denver CO USA
Abstract Potential advantages of minimally invasive total knee arthroplasty (TKA) include decreased pain, faster recovery, and increased
quadriceps muscle strength. Computer-assisted navigation has been associated with more accurate component alignment. We evaluated
two groups of 50 patients who had minimally invasive TKAs performed with and without navigation by two surgeons. A comparison
of 50 previous TKAs by each of the two surgeons showed similar results. The mean operative times for the navigation and nonnavigation
groups were 112 minutes (range, 63–297 minutes) and 54 minutes (range, 35–86 minutes), respectively. The mean estimated blood
losses, mean Knee Society pain as well as functional scores and mean component alignments were similar. The number of knees
that deviated by more than 3° from the normal anatomic axis was three and one in the navigated and nonnavigated groups, respectively.
Complication rates were 6% and 4% in the navigated and nonnavigated groups, respectively. Our data demonstrate no distinct
advantage of navigation when combined with a minimally invasive approach.
Level of Evidence: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Content Type Journal Article
Category Symposium: Papers Presented at the Annual Meetings of the Knee Society
DOI 10.1007/s11999-008-0359-4
Authors
Peter M. Bonutti, Bonutti Clinic Effingham IL USA
Daniel A. Dethmers, Bonutti Clinic Effingham IL USA
Mike S. McGrath, Sinai Hospital of Baltimore Rubin Institute for Advanced Orthopedics 2401 West Belvedere Avenue Baltimore MD 21215 USA
Slif D. Ulrich, Sinai Hospital of Baltimore Rubin Institute for Advanced Orthopedics 2401 West Belvedere Avenue Baltimore MD 21215 USA
Michael A. Mont, Sinai Hospital of Baltimore Rubin Institute for Advanced Orthopedics 2401 West Belvedere Avenue Baltimore MD 21215 USA
Abstract Traditional bonesetters (TBS) have been in Nigeria for centuries. Up to 85% of patients with fractures present first to the
traditional bonesetters before coming to the hospital and therefore this mode of care delivery cannot be overlooked in Nigeria.
We attempted to document the current practice of TBS in Ibadan and their methods of fracture treatment with a view to training
and improving the services offered by them. We carried out a literature search to review all previous studies on traditional
bonesetters’ practice and visited a few of them to document their current practice. The only change in the management of fractures
by the TBS over the past 28 years was the use of spiritual methods of healing to treat open comminuted fractures; a technique
for which no scientific basis was readily discernible. There is a need to educate and train the TBS in effective management
of both open and closed fractures. Such training should be provided by orthodox orthopedic surgeons with a view to minimizing
mismanagement of fractures. To this end, we propose a training algorithm.
Content Type Journal Article
Category Symposium: ABJS/C.T. Brighton Workshop on Trauma in the Developing World
DOI 10.1007/s11999-008-0371-8
Authors
A. B. Omololu, University College Hospital Department of Surgery Ibadan Nigeria
S. O. Ogunlade, University College Hospital Department of Surgery Ibadan Nigeria
V. K. Gopaldasani, University College Hospital Department of Surgery Ibadan Nigeria
Abstract There is a critical need to identify markers that can accurately identify existing or predict future metastatic disease in
patients with osteosarcoma since the majority of patients present with undetectable micrometastatic disease. We previously
reported S100A6 is overexpressed in human osteosarcoma and increased expression of S100A6 by immunohistochemistry correlated
with decreased clinical metastasis. We have established 11 primary cultures from biopsies of patients with osteosarcoma and
ten of the 11 primary cultures have increased expression of S100A6 relative to normal human osteoblasts. To further explore
possible mechanisms for metastasis suppression previously reported, we used in this report siRNA-mediated knockdown of S100A6
in four commonly used human osteosarcoma lines, then examined their cell adhesion, migration, and invasion properties. Knockdown
of S100A6 expression inhibited cell adhesion and promoted cell migration and invasion in these lines. Conversely, S100A6 overexpression
enhanced cell adhesion and inhibited cell invasion. Our data demonstrate S100A6 is commonly overexpressed in human osteosarcoma.
S100A6 may inhibit osteosarcoma metastasis by promoting cell adhesion and inhibiting cell motility and invasion. Thus, S100A6
may be considered a potential marker for human osteosarcoma with prognostic value for identifying patients without metastases.
Content Type Journal Article
Category Symposium: Molecular Genetics in Sarcoma
DOI 10.1007/s11999-008-0361-x
Authors
Xiaoji Luo, Chongqing Medical University The Children’s Hospital and Key Laboratory of Diagnostic Medicine Designated by the Chinese Ministry of Education Chongqing China
Katie A. Sharff, The University of Chicago Medical Center Molecular Oncology Laboratory, Department of Surgery, Section of Orthopaedics 5841 South Maryland Avenue, MC3079 Chicago IL 60637 USA
Jin Chen, Chongqing Medical University The Children’s Hospital and Key Laboratory of Diagnostic Medicine Designated by the Chinese Ministry of Education Chongqing China
Tong-Chuan He, Chongqing Medical University The Children’s Hospital and Key Laboratory of Diagnostic Medicine Designated by the Chinese Ministry of Education Chongqing China
Hue H. Luu, The University of Chicago Medical Center Molecular Oncology Laboratory, Department of Surgery, Section of Orthopaedics 5841 South Maryland Avenue, MC3079 Chicago IL 60637 USA
Abstract Inhibitors of specific tyrosine kinases are attractive lead compounds for development of targeted chemotherapies for many
tumors, including osteosarcoma. We asked whether inhibition of specific tyrosine kinases would decrease the motility, colony
formation, and/or invasiveness by human osteosarcoma cell lines (TE85, MNNG, 143B, SAOS-2, LM-7). An EGF-R inhibitor reduced
motility of all five cell lines by 50% to 80%. In contrast, an IGF-1R inhibitor preferentially reduced motility by 42% in
LM-7 cells and a met inhibitor preferentially reduced motility by 80% in MNNG cells. The inhibitors of EGF-R, IGF-1R, and met reduced colony formation by more than 80% in all tested cell lines (TE85, MNNG, 143B). The EGF-R inhibitor reduced invasiveness
by 62% in 143B cells. The JAK inhibitor increased motility of SAOS-2 and LM7 cells without affecting colony formation or invasiveness.
Inhibitors of HER-2, NGF-R, and PDGF-Rs did not affect motility, invasiveness, or colony formation. These results support
the hypothesis that specific tyrosine kinases regulate tumorigenesis and/or metastasis in osteosarcoma.
Content Type Journal Article
Category Symposium: Molecular Genetics in Sarcoma
DOI 10.1007/s11999-008-0338-9
Authors
Patrick J. Messerschmitt, University Hospitals Case Medical Center, Case Western Reserve University Department of Orthopaedic Surgery 11100 Euclid Avenue, 6th Floor Hanna House Cleveland OH 44118 USA
Ashley N. Rettew, University Hospitals Case Medical Center, Case Western Reserve University Department of Orthopaedic Surgery 11100 Euclid Avenue, 6th Floor Hanna House Cleveland OH 44118 USA
Robert E. Brookover, University Hospitals Case Medical Center, Case Western Reserve University Department of Orthopaedic Surgery 11100 Euclid Avenue, 6th Floor Hanna House Cleveland OH 44118 USA
Ryan M. Garcia, University Hospitals Case Medical Center, Case Western Reserve University Department of Orthopaedic Surgery 11100 Euclid Avenue, 6th Floor Hanna House Cleveland OH 44118 USA
Patrick J. Getty, University Hospitals Case Medical Center, Case Western Reserve University Department of Orthopaedic Surgery 11100 Euclid Avenue, 6th Floor Hanna House Cleveland OH 44118 USA
Edward M. Greenfield, University Hospitals Case Medical Center, Case Western Reserve University Department of Orthopaedic Surgery 11100 Euclid Avenue, 6th Floor Hanna House Cleveland OH 44118 USA
Abstract We present the case of a patient with malignant transformation of a liposclerosing myxofibrous tumor. The patient had a histologically
confirmed liposclerosing myxofibrous tumor that, during a course of 22 months, spontaneously transformed into a lesion appearing
like a benign giant cell reactive lesion and subsequently into a high-grade bone sarcoma. Few such cases of spontaneous malignant
transformation of liposclerosing myxofibrous tumor have been reported. We report what we believe to be the first case documenting
spontaneous transformation of a liposclerosing myxofibrous tumor into an intermediate lesion with benign-appearing histologic
features and then into a high-grade malignant tumor.
Content Type Journal Article
Category Case Report
DOI 10.1007/s11999-008-0362-9
Authors
Kirk Campbell, New York University School of Medicine New York NY USA
Felasfa Wodajo, Inova Fairfax Hospital Department of Orthopedic Surgery Fairfax VA USA
Abstract Excision of the accessory bipartite fragment is widely used, but its long-term outcome is not known. We evaluated the outcome
after surgical excision of a symptomatic accessory bipartite or multipartite patella fragment in young adult men performing
their compulsory military service and determined the incidence of painful bipartite patellae in this group of skeletally mature
adults. We followed 25 of 32 patients for a minimum of 10 years (mean, 15 years; range, 10–22 years). The incidence of painful,
surgically treated bipartite patella was 9.2 per 100,000 recruits. Patients’ median age at surgery was 20 years. There were
19 superolateral and six lateral bipartite fragments. Other radiographic findings were rare. At followup, the Kujala score
mean was 95 points (range, 75–100 points), and osteoarthrotic changes (Kellgren-Lawrence Grade 1) were seen in two knees.
No reoperations related to bipartite patella occurred during the followup. Symptomatic bipartite patella is rare and does
not seem primarily associated with anatomic deviations, but when incapacitating pain persists despite nonoperative treatment,
surgical excision seems to yield reasonable functional outcome and quick recovery with no apparent adverse sequelae. Our data
suggest there is no reason to avoid this technically undemanding procedure for treating persistent symptoms of bipartite patella
in young adults.
Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Content Type Journal Article
Category Original Article
DOI 10.1007/s11999-008-0367-4
Authors
Maria Weckström, Centre for Military Medicine, Research Department P.O. Box 2 15701 Lahti Finland
Mickael Parviainen, Central Military Hospital Department of Orthopaedic Surgery Helsinki Finland
Harri K. Pihlajamäki, Central Military Hospital Department of Orthopaedic Surgery Helsinki Finland
Devoted to disseminating new and important orthopaedic knowledge,Clinical Orthopaedics and Related Research (CORR) is a leading peer-reviewed orthopaedic journal and a publication of The Association of Bone and Joint Surgeons. CORR brings readers the latest clinical and basic research and informed opinions that shape today's orthopaedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. 
