Background: Soldiers serving in the Israel Defense Force Military Working Dogs (MWD) Unit spend m... more Background: Soldiers serving in the Israel Defense Force Military Working Dogs (MWD) Unit spend many hours taming dogs' special skills, taking them on combat missions, and performing various dogkeeping activities. During this intensive work with the aggressive military dogs, bites are common, and some of them result in permanent disability. However, this phenomenon has not been quantified or reported as an occupational hazard. Methods: This was a retrospective cohort study based on self-administered questionnaires. Information was collected about soldiers' baseline demographics, duration of the experience of working with dogs, total number of bites they had, circumstances of bite events, and complications and medical treatment of each bite. Bite risk was quantified by incidence, mean time to first bite, and a Cox proportional hazards model. Rates of complications and the medical burden of bites were compared between combat soldiers and noncombat dogkeepers. Bite locations were presented graphically. Results: Seventy-eight soldiers participated and reported on 139 bites. Mean time of working with dogs was 16 months (standard deviation, ±9.4 months). Overall bite incidence was 11 bites per 100 person-months; the mean time to first bite event was 6.3 months. The Cox proportional hazards model showed that none of baseline characteristics significantly increased bite hazard. About 90% of bites occurred during routine activities, and 3.3% occurred on combat missions. Only in 9% of bite events did soldiers observed the safety precautions code. Bite complications included fractures, need for intravenous antibiotic treatment and surgical repair, prominent scarring, diminished sensation, and stiffness of proximal joints. Bite complications were similar between combat soldiers and dogkeepers. Most bites (57%) were located on hands and arms. Conclusion: MWD bites are an occupational hazard resulting in significant medical burden. Hands and arms were most common bite locations. Observance of safety precautions may be the most appropriate first-line preventive intervention. Barrier protection of upper extremities may reduce bite severity and complication rates.
Pulsed electromagnetic fields (PEMFs) have been considered a potential treatment modality for fra... more Pulsed electromagnetic fields (PEMFs) have been considered a potential treatment modality for fracture healing, however, the mechanism of their action remains unclear. Mammalian target of rapamycin (mTOR) signaling may affect osteoblast proliferation and differentiation. This study aimed to assess the osteogenic differentiation of mesenchymal stem cells (MSCs) under PEMF stimulation and the potential involvement of mTOR signaling pathway in this process. PEMFs were generated by a novel miniaturized electromagnetic device. Potential changes in the expression of mTOR pathway components, including receptors, ligands and nuclear target genes, and their correlation with osteogenic markers and transcription factors were analyzed. Involvement of the mTOR pathway in osteogenesis was also studied in the presence of proinflammatory mediators. PEMF exposure increased cell proliferation and adhesion and the osteogenic commitment of MSCs even in inflammatory conditions. Osteogenic-related genes ...
Background: Locked plating is one of the latest innovative options for treating supracondylar fem... more Background: Locked plating is one of the latest innovative options for treating supracondylar femur fractures with relatively low failure rates. Single lateral plating was often found to have a relative higher failure rate. No clinical studies of double-plating distal femur fixation have thus far been reported. The aim of this study is to present our clinical experience with this surgical approach. Patients and methods: Thirty-two patients (26 females and 6 males, mean age 76 years, range 44-101) were included in the study. Eight of them patients had a periprosthetic stable implant fracture and two patients were treated for a nonunion. Results: All fractures, excluding one that needed bone grafting and one refracture, healed within 12 weeks. One patient needed bone grafting for delayed union and one patient needed fixation exchange due to femur re-fracture at the site of the most proximal screw. Two patients developed superficial wound infection and one patient required medial plate removal after union due to deep infection. Conclusions: Based on these promising results, we propose that the double-plating technique should be considered in the surgeon's armamentarium for the treatment of supracondylar femur fractures, particularly in patients with poor bone quality, comminuted fractures and very low periprosthetic fractures.
Orthopedic injuries are predominant among combat casualties, and carry the potential for signific... more Orthopedic injuries are predominant among combat casualties, and carry the potential for significant morbidity. An expert consensus process (Prehospital care of military orthopedic trauma: A consensus meeting, Israel Defense Forces Medical Corps, May 2003) was used to create guidelines for the treatment of these injuries by military prehospital providers. The consensus treatment guidelines developed by experienced orthopedic trauma personnel from leading trauma centers in Israel are presented in this paper.For victims with open fractures, the first priority is hemorrhage control. Splinting, irrigation, and wound care should be performed while waiting for transport, or, in any scenario, in the case of an isolated limb injury. The use of traction splints was advocated for both the rapid transport scenario (up to one hour from the time of injury to arrival at the hospital) and the delayed transport scenario. In the urban setting, traction splints may not be necessary. Any victim experi...
The aim of this study was to analyze dynamic patterns for scanning femoroacetabular impingement (... more The aim of this study was to analyze dynamic patterns for scanning femoroacetabular impingement (FAI) radiographs in orthopedics, in order to better understand the nature of expertise in radiography. Seven orthopedics residents with at least two years of expertise and seven board-certified orthopedists participated in the study. The participants were asked to diagnose 15 anteroposterior (AP) pelvis radiographs of 15 surgical patients, diagnosed with FAI syndrome. Eye tracking data were recorded using the SMI desk-mounted tracker and were analyzed using advanced measures and methodologies, mainly recurrence quantification analysis. The expert orthopedists presented a less predictable pattern of scanning the radiographs although there was no difference between experts and nonexperts in the deterministic nature of their scan path. In addition, the experts presented a higher percentage of correct areas of focus and more quickly made their first comparison between symmetric regions of the pelvis. We contribute to the understanding of experts' process of diagnosis by showing that experts are qualitatively different from residents in their scanning patterns. The dynamic pattern of scanning that characterizes the experts was found to have a more complex and less predictable signature, meaning that experts' scanning is simultaneously both structured (i.e. deterministic) and unpredictable.
sidered the basic skills (specific knowledge, practical skills, assessment/planning of treatment)... more sidered the basic skills (specific knowledge, practical skills, assessment/planning of treatment) as less important in treating older adults 75+. Of the15 physical therapists who cited "geriatrics" or "education" as their main work domains, 10 considered assessments/planning of treatment to be less important. 28% of the sample considered treating older adults 75+ as rather difficult. They significantly expected poorer outcome (p < 0.001), had a higher salience of age (p = 0.0151) and considered communication with older adults as difficult (p < 0.001) compared with the control group. Conclusion(s): A small number of physical therapists showed beliefs that could lead to discriminating older patients. The results are not statistically significant but clinically relevant particularly as there are specialists in "geriatrics" and "education" among them. Implications: To meet the current health care needs in demographic changes, education and training in physiotherapy has to add comprehensive knowledge of ageing and older adults from the field of gerontology. Especially knowledge about stereotypes and priming should be facilitated. Particular attention should be paid to suitable assessments and training in communication.
authorities to recommend that NSAIDs be prescribed at the lowest dose. SoluMatrix diclofenac is a... more authorities to recommend that NSAIDs be prescribed at the lowest dose. SoluMatrix diclofenac is approved for the management of mild to moderate acute pain and osteoarthritis (OA) pain in adults. Based on previous studies that examined the efficacy and safety of SoluMatrix diclofenac, we evaluated the pooled safety of SoluMatrix diclofenac in older patients (65 years of age) across two phase 3 studies. Methods: A 12-week randomized, multicenter, double-blind, parallelgroup study enrolled 305 chronic NSAID and/or acetaminophen users, 41 to 90 years of age with symptomatic and radiographically documented (Kellgren-Lawrence grade II or III) OA of the hip or knee. Patients had baseline Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale scores 40 mm at baseline and a documented OA pain "flare" (increase in WOMAC pain subscale 15 mm) following NSAID/acetaminophen discontinuation. Patients received either SoluMatrix diclofenac capsules 35 mg two or three times daily (BID or TID) or placebo. A 12-month open-label, multicenter study treated 601 chronic NSAID/acetaminophen users, aged 40 to 86 years, with knee and/or hip OA. Patients initially received SoluMatrix diclofenac 35-mg capsules BID; that could be increased to TID and reduced as needed. Results: Similar proportions of patients reported AEs in the 65 years of age group (157/205 [76.6%]) compared with the < 65 years of age group (365/500 [73.0%]). In patients 65 years of age treated with SoluMatrix diclofenac, the most commonly reported AEs included nausea (18/205, 8.8%), diarrhea (17/205, 8.3%), and upper respiratory tract infection (17/205, 8.3%). In patients < 65 years of age treated with SoluMatrix diclofenac, the most commonly reported AEs were headache (40/500, 8.0%), upper respiratory tract infection (34/500, 6.8%), and diarrhea (32/500, 6.4%). Forty-six of the 205 patients 65 years of age (22.4%) withdrew from the study due to any AE, whereas 73/500 patients < 65 years of age (14.6%) withdrew from the study due to an AE. Few SoluMatrix diclofenac-treated patients experienced AEs reported in class labeling for NSAIDs, including stroke, myocardial infarction, gastrointestinal ulcers, perforation or hemorrhage, or liver function abnormalities and occurred with no major differences among the two age groups (Table). Two patients (< 65 years of age) reported myocardial infarctions, which were not considered to be treatment-related; there were no deaths.
The Israel Medical Association journal : IMAJ, 2000
Synovial cysts are a well-known phenomenon in rheumatoid arthritis, and have various locations an... more Synovial cysts are a well-known phenomenon in rheumatoid arthritis, and have various locations and symptoms [1-5]. We describe here a unique case of synovial cyst originating from the pes anserinus and presenting clinically as intermittent claudication.
We analysed the effects of commonly used medications on human osteoblastic cell activity in vitro... more We analysed the effects of commonly used medications on human osteoblastic cell activity in vitro, specifically proliferation and tissue mineralisation. A list of medications was retrieved from the records of patients aged > 65 years filed in the database of the largest health maintenance organisation in our country (> two million members). Proliferation and mineralisation assays were performed on the following drugs: rosuvastatin (statin), metformin (antidiabetic), metoprolol (β-blocker), citalopram (selective serotonin reuptake inhibitor [SSRI]), and omeprazole (proton pump inhibitor (PPI)). All tested drugs significantly stimulated DNA synthesis to varying degrees, with rosuvastatin 5 µg/ml being the most effective among them (mean 225% (SD 20)), compared with metformin 10 µg/ml (185% (SD 10)), metoprolol 0.25 µg/ml (190% (SD 20)), citalopram 0.05 µg/ml (150% (sd 10)) and omeprazole 0.001 µg/ml (145% (SD 5)). Metformin and metoprolol (to a small extent) and rosuvastatin (to...
The Israel Medical Association journal : IMAJ, 2011
Intraarticular injections for the local treatment of osteoarthritis are widely used in the office... more Intraarticular injections for the local treatment of osteoarthritis are widely used in the office or hospital setting. Septic arthritis is a potential catastrophic complication of intraarticular injection, as bacterial arthritis of any cause is associated with up to 15% mortality and residual impairment of joint function in up to 50% of survivors. There is lack of evidence regarding the precautions that should be taken to avoid such a complication, as well as how often it is encountered. To report our experience with the clinical presentation, diagnosis and treatment of knee septic arthritis following intraarticular injections. We followed six patients who were admitted to the hospital and underwent surgery for the treatment of pyogenic arthritis following injection to the knee joint in outpatient clinics. All but one patient were over 70 years old with comorbidities. Three patients were injected with steroid preparations and three with hyaluronic acid several days before admission....
The Israel Medical Association journal : IMAJ, 2009
Gunshot wounds impose a continuous burden on community and hospital resources. Gunshot injuries t... more Gunshot wounds impose a continuous burden on community and hospital resources. Gunshot injuries to the extremities might involve complex soft tissue, bone, vascular, musculotendinous, and nerve injuries. A precise knowledge of anatomy is needed to evaluate and treat those injuries. To review our experience with gunshot wounds to the extremities. We retrospectively reviewed all civilian cases of gunshot wounds to the limbs treated in our institution during 2003-2005. Altogether, we evaluated 60 patients with 77 injuries. Of the 60 patients 36 had fractures, 75% of them in the lower extremity and 81% in long bones. The most common fixation modality used was external fixation (33%), followed by intramedullary nailing (25%). This relatively high percentage of fracture treated with external fixation may be attributed to the comminuted pattern of the fractures, the general status of the patient, or the local soft tissue problems encountered in gunshot wounds. About one-fifth of the fractu...
The Israel Medical Association journal : IMAJ, 2002
Open reduction and internal fixation are the current trends of treatment for comminuted calcaneal... more Open reduction and internal fixation are the current trends of treatment for comminuted calcaneal fractures. Assessing treatment results is often difficult due to discrepancy between objective parameters such as range of movement, and subjective results such as pain. To test the reliability of footprint analysis as an adjuvant method of postoperative assessment of patients who sustained calcaneal fractures. Dynamic and static footprint analysis was used as an adjuvant additional method to objectively assess operative results. This method is simple and is independent of the patient's initiatives. This modality was used in 22 patients followed-up 9-90 months postoperatively. We found a good correlation between footprint analysis and objective and subjective parameters of results expressed by American Orthopedic Foot and Ankle Society hind foot score. In certain cases, this method can be used to distinguish between uncorrelated parameter results, such as malingering, and workmens&#...
Background: Biomechanical interventions for the management of knee osteoarthritis (OA) are emergi... more Background: Biomechanical interventions for the management of knee osteoarthritis (OA) are emerging. AposTherapy is one type of biomechanical therapy that was shown to reduce knee adduction moment and improve gait patterns and clinical symptoms. The purpose of the current study was to further investigate the changes in gait patterns following this biomechanical therapy and to define its possible clinical benefits for patients with knee OA. Methods: 988 patients with knee OA were evaluated using a computerized gait test as well as with the Western Ontario and McMaster Osteoarthritis Index (WOMAC) and SF-36 Health Survey self-evaluation questionnaires. Following these measurements, the Apos system was individually calibrated to each patient according to his or her gait patterns and clinical evaluation. All patients received exercise guidelines and underwent 4 months of therapy. A second evaluation of gait and clinical symptoms was conducted after four months of therapy. Results: After 4 months of therapy, a significant improvement was found in all gait parameters (all P < 0.01), as well as in the level of pain, function and quality of life (all P < 0.01). High correlations were found between the improvement in gait parameters and the improvement in self-evaluation questionnaires. Conclusions: The examined biomechanical therapy led to a significant reduction in pain and improvement in function, quality of life and gait patterns. These finding support previous findings and deepens the understanding of this new noninvasive biomechanical therapy in patients with knee OA.
The Israel Medical Association journal : IMAJ, 2005
Pelvic fracture poses a complex challenge to the trauma surgeon. It is associated with head, thor... more Pelvic fracture poses a complex challenge to the trauma surgeon. It is associated with head, thoracic and abdominal injuries. As pelvic fracture severity increases so does the number of associated injuries and the mortality rate. To report our experience in the treatment of pelvic fractures. Between October 1998 and September 2001, 78 patients with pelvic fractures were admitted to our hospital. The age range of the 56 male and 22 female patients was 16-92 (mean 42 years). The cause of injury was road accident in 52 patients, fall from a height in 15, a simple fall in 9, and gunshot wounds in 2 patients. The Glascow Coma Scale score on arrival at the hospital was 3-15 (average 12). Twenty-five patients (32%) were admitted to the intensive care unit, 38 (48%) to the orthopedic department, 5 (6.4%) to neurosurgery and the remainder to a surgical department. Twenty-six patients (33.3%) received blood transfusion in the first 24 hours. Of the 25 patients with associated head trauma, 6 h...
Objective: The purpose of this study was to evaluate the effect of a biomechanical therapy on the... more Objective: The purpose of this study was to evaluate the effect of a biomechanical therapy on the pain, function, quality of life and spatio-temporal gait patterns of patients with hip osteoarthritis (OA). Design: 60 patients with hip OA were examined before and after twelve weeks of a personalized biomechanical therapy (AposTherapy). Patients were evaluated using the WOMAC questionnaire for pain and function and the SF-36 Health Survey for quality of life, and underwent a computerized gait test. Results: After twelve weeks of treatment, a significant improvement was found in the patients' velocity, step length and cadence (P ≤ 0.001). WOMAC-pain, stiffness and function subscales were significantly improved compared to baseline (P ≤ 0.001). SF-36 physical score subscale improved significantly (P=0.007). Conclusions: Patients with bilateral hip OA treated with AposTherapy for twelve weeks showed statistically and clinically significant improvements in pain, function and gait patterns. assessed in patients with hip OA, although it may be assumed that the same biomechanical principles apply. The purpose of this current study was to examine the efficiency of this biomechanical therapy on the gait patterns and clinical symptoms in patients with hip OA. We hypothesize that patients who undergo this therapy will show improvement in gait patterns and function, as well as a relief in pain. Methods Participants This was a retrospective study. The protocol was approved by the Institutional Helsinki Committee Registry (Registration number NCT00767780). A search for eligible data was performed through the research database of AposTherapy Center. Eligibility for the study was defined as follows: 1. Patients suffering from symptomatic hip OA for at least six months and who fulfilled the American College of Rheumatology clinical criteria for OA of the hip [17]; 2. Patients who completed a gait test, the Western Ontario and McMaster Osteoarthritis Index WOMAC [18] questionnaire and the Short Form SF-36 Health Survey [19] at the start of therapy (study baseline) and after twelve weeks of therapy. Exclusion criteria were: 1. Neurological and rheumatic inflammatory diseases; 2. Corticosteroid injection within 3 months of the study; 3. Earlier hip surgery excluding arthroscopy; 4. Joint replacement of the hip or knee; 5. Instability of the hip due to traumatic ligament injury; 6.
Background: SSc is an autoimmune disease characterized by progressive fibrosis of the skin and in... more Background: SSc is an autoimmune disease characterized by progressive fibrosis of the skin and internal organs. Development of an activated population of fibroblasts and myofibroblasts in lesional tissue is likely to be central to pathogenesis. In this study, we identify stem cell factor (SCF) as a potential driving factor in this process and future therapeutic target. SCF is a cytokine which acts via c-Kit a tyrosine kinase receptor. In a phosphorylation array analysis of migrating fibroblasts c-Kit was found to be upregulated. Our aim was to examine the role of SCF in the migration and proliferation of fibroblasts in SSc and healthy controls. Methods: Primary skin fibroblast lines were cultured in vitro with varying concentrations of SCF, or neutralizing antibodies directed against its receptor c-Kit or SCF itself. Proliferation was assessed using the WST-1 assay and by direct cell counting. Migration was assessed using the scratch wound assay and area of wound invasion measured following treatment with either SCF or anti-Kit antibodies. The expression and quantity of SCF and c-Kit by SSc (n ¼ 6) and control skin (n ¼ 6) fibroblasts was assessed by western blotting. Epidermis was also harvested from healthy (n ¼ 5) and SSc (n ¼ 9) skin using the blister technique. SCF gene expression was assessed using quantitative PCR (qPCR). Results: SCF expression was enhanced in SSc epidermis samples by qPCR as compared with healthy controls (566 vs 336 copy numbers respectively). In the Western of fibroblasts, both c-KIT and SCF were strongly present in SSc skin derived fibroblasts and hardly detectable in healthy controls (normalized band intensity 2.14 vs 0.03 for c-KIT and 1.81 vs 0.07 in SSc vs normal skin respectively P < 0.002 in both). Human recombinant SCF (rSCF) promoted the migration of normal human fibroblasts. At both 24 and 48 h, cells treated with rSCF showed a much greater percentage wound coverage as compared treatment with media only-with greatest migration at the rSCF concentration of 2.5 ng/ml (wound invasion 86% compared with 52% at 48 h P < 0.002). Conversely, treatment with antibody to c-KIT resulted in a reduction of wound invasion (invasion 19% compared with 62% P < 0.04). Addition of rSCF to normal fibroblast cell induced proliferation as measured by the WST-1 assay (13% increase, not statistically significant). Conversely, adding anti-Kit or anti-SCF neutralizing antibodies to cell culture medium resulted in reduction of proliferation (30% reduction, P < 0.05 and 20% reduction P < 0.029 respectively). Conclusions: SCF is found at higher levels in the skin of SSc subjects compared with controls. We have demonstrated that in vitro, SCF promotes proliferation and migration of fibroblasts and that its blockade using specific antibodies results in reduction in both these processes. SCF appears to be a potential therapeutic target for future treatment in SSc. Disclosures: The authors have declared no conflicts of interest.
Purpose: Porous, resorbable scaffolds offer a new solution for symptomatic osteochondral and chon... more Purpose: Porous, resorbable scaffolds offer a new solution for symptomatic osteochondral and chondral articular defects in the knee and other joints. This paper reports on early results of this novel off-the-shelf product. Methods and Materials: 8 active sporting patients underwent cartilage repair using TruFit CB plugs (Smith and Nephew) for symptomatic defects on the medial or lateral femoral condyle. All had failed previous treatment (debridement in 6 and microfracture in 2). Postoperatively patients were touch weight bearing for 2 weeks and partial until 4 weeks. Data was collected prospectively. Results: The overall mean age was 34.3 (range 21-50) and 5 were male. Four lateral femoral condyle defects were treated, all associated with lateral meniscal tears. Four medial defects were associated with ACL injury (1), PCL injury (1) or isolated chondral injury (2). Single plugs were required in 6 (9mm in 4 and 7mm plugs in 2) while 2 patients required 2 plugs (9mm and 7mm). All 8 patients were improved at mean follow up of 8 months with 4 currently back to full pre-injury level of sport. Subjective IKDC scores improved from 44.6 preop to 79 post op (p<0.05). 2 nd look arthroscopy was undertaken in 2 showing well healed and well integrated surface. Conclusions: These preliminary results indicate that TruFit CB plugs offer a potential solution for small focal chondral defects, offering an alternative to microfracture or osteochondral grafting with advantages of low morbidity and rapid recovery without the need for prolonged non-weight bearing.
Background: Soldiers serving in the Israel Defense Force Military Working Dogs (MWD) Unit spend m... more Background: Soldiers serving in the Israel Defense Force Military Working Dogs (MWD) Unit spend many hours taming dogs' special skills, taking them on combat missions, and performing various dogkeeping activities. During this intensive work with the aggressive military dogs, bites are common, and some of them result in permanent disability. However, this phenomenon has not been quantified or reported as an occupational hazard. Methods: This was a retrospective cohort study based on self-administered questionnaires. Information was collected about soldiers' baseline demographics, duration of the experience of working with dogs, total number of bites they had, circumstances of bite events, and complications and medical treatment of each bite. Bite risk was quantified by incidence, mean time to first bite, and a Cox proportional hazards model. Rates of complications and the medical burden of bites were compared between combat soldiers and noncombat dogkeepers. Bite locations were presented graphically. Results: Seventy-eight soldiers participated and reported on 139 bites. Mean time of working with dogs was 16 months (standard deviation, ±9.4 months). Overall bite incidence was 11 bites per 100 person-months; the mean time to first bite event was 6.3 months. The Cox proportional hazards model showed that none of baseline characteristics significantly increased bite hazard. About 90% of bites occurred during routine activities, and 3.3% occurred on combat missions. Only in 9% of bite events did soldiers observed the safety precautions code. Bite complications included fractures, need for intravenous antibiotic treatment and surgical repair, prominent scarring, diminished sensation, and stiffness of proximal joints. Bite complications were similar between combat soldiers and dogkeepers. Most bites (57%) were located on hands and arms. Conclusion: MWD bites are an occupational hazard resulting in significant medical burden. Hands and arms were most common bite locations. Observance of safety precautions may be the most appropriate first-line preventive intervention. Barrier protection of upper extremities may reduce bite severity and complication rates.
Pulsed electromagnetic fields (PEMFs) have been considered a potential treatment modality for fra... more Pulsed electromagnetic fields (PEMFs) have been considered a potential treatment modality for fracture healing, however, the mechanism of their action remains unclear. Mammalian target of rapamycin (mTOR) signaling may affect osteoblast proliferation and differentiation. This study aimed to assess the osteogenic differentiation of mesenchymal stem cells (MSCs) under PEMF stimulation and the potential involvement of mTOR signaling pathway in this process. PEMFs were generated by a novel miniaturized electromagnetic device. Potential changes in the expression of mTOR pathway components, including receptors, ligands and nuclear target genes, and their correlation with osteogenic markers and transcription factors were analyzed. Involvement of the mTOR pathway in osteogenesis was also studied in the presence of proinflammatory mediators. PEMF exposure increased cell proliferation and adhesion and the osteogenic commitment of MSCs even in inflammatory conditions. Osteogenic-related genes ...
Background: Locked plating is one of the latest innovative options for treating supracondylar fem... more Background: Locked plating is one of the latest innovative options for treating supracondylar femur fractures with relatively low failure rates. Single lateral plating was often found to have a relative higher failure rate. No clinical studies of double-plating distal femur fixation have thus far been reported. The aim of this study is to present our clinical experience with this surgical approach. Patients and methods: Thirty-two patients (26 females and 6 males, mean age 76 years, range 44-101) were included in the study. Eight of them patients had a periprosthetic stable implant fracture and two patients were treated for a nonunion. Results: All fractures, excluding one that needed bone grafting and one refracture, healed within 12 weeks. One patient needed bone grafting for delayed union and one patient needed fixation exchange due to femur re-fracture at the site of the most proximal screw. Two patients developed superficial wound infection and one patient required medial plate removal after union due to deep infection. Conclusions: Based on these promising results, we propose that the double-plating technique should be considered in the surgeon's armamentarium for the treatment of supracondylar femur fractures, particularly in patients with poor bone quality, comminuted fractures and very low periprosthetic fractures.
Orthopedic injuries are predominant among combat casualties, and carry the potential for signific... more Orthopedic injuries are predominant among combat casualties, and carry the potential for significant morbidity. An expert consensus process (Prehospital care of military orthopedic trauma: A consensus meeting, Israel Defense Forces Medical Corps, May 2003) was used to create guidelines for the treatment of these injuries by military prehospital providers. The consensus treatment guidelines developed by experienced orthopedic trauma personnel from leading trauma centers in Israel are presented in this paper.For victims with open fractures, the first priority is hemorrhage control. Splinting, irrigation, and wound care should be performed while waiting for transport, or, in any scenario, in the case of an isolated limb injury. The use of traction splints was advocated for both the rapid transport scenario (up to one hour from the time of injury to arrival at the hospital) and the delayed transport scenario. In the urban setting, traction splints may not be necessary. Any victim experi...
The aim of this study was to analyze dynamic patterns for scanning femoroacetabular impingement (... more The aim of this study was to analyze dynamic patterns for scanning femoroacetabular impingement (FAI) radiographs in orthopedics, in order to better understand the nature of expertise in radiography. Seven orthopedics residents with at least two years of expertise and seven board-certified orthopedists participated in the study. The participants were asked to diagnose 15 anteroposterior (AP) pelvis radiographs of 15 surgical patients, diagnosed with FAI syndrome. Eye tracking data were recorded using the SMI desk-mounted tracker and were analyzed using advanced measures and methodologies, mainly recurrence quantification analysis. The expert orthopedists presented a less predictable pattern of scanning the radiographs although there was no difference between experts and nonexperts in the deterministic nature of their scan path. In addition, the experts presented a higher percentage of correct areas of focus and more quickly made their first comparison between symmetric regions of the pelvis. We contribute to the understanding of experts' process of diagnosis by showing that experts are qualitatively different from residents in their scanning patterns. The dynamic pattern of scanning that characterizes the experts was found to have a more complex and less predictable signature, meaning that experts' scanning is simultaneously both structured (i.e. deterministic) and unpredictable.
sidered the basic skills (specific knowledge, practical skills, assessment/planning of treatment)... more sidered the basic skills (specific knowledge, practical skills, assessment/planning of treatment) as less important in treating older adults 75+. Of the15 physical therapists who cited "geriatrics" or "education" as their main work domains, 10 considered assessments/planning of treatment to be less important. 28% of the sample considered treating older adults 75+ as rather difficult. They significantly expected poorer outcome (p < 0.001), had a higher salience of age (p = 0.0151) and considered communication with older adults as difficult (p < 0.001) compared with the control group. Conclusion(s): A small number of physical therapists showed beliefs that could lead to discriminating older patients. The results are not statistically significant but clinically relevant particularly as there are specialists in "geriatrics" and "education" among them. Implications: To meet the current health care needs in demographic changes, education and training in physiotherapy has to add comprehensive knowledge of ageing and older adults from the field of gerontology. Especially knowledge about stereotypes and priming should be facilitated. Particular attention should be paid to suitable assessments and training in communication.
authorities to recommend that NSAIDs be prescribed at the lowest dose. SoluMatrix diclofenac is a... more authorities to recommend that NSAIDs be prescribed at the lowest dose. SoluMatrix diclofenac is approved for the management of mild to moderate acute pain and osteoarthritis (OA) pain in adults. Based on previous studies that examined the efficacy and safety of SoluMatrix diclofenac, we evaluated the pooled safety of SoluMatrix diclofenac in older patients (65 years of age) across two phase 3 studies. Methods: A 12-week randomized, multicenter, double-blind, parallelgroup study enrolled 305 chronic NSAID and/or acetaminophen users, 41 to 90 years of age with symptomatic and radiographically documented (Kellgren-Lawrence grade II or III) OA of the hip or knee. Patients had baseline Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale scores 40 mm at baseline and a documented OA pain "flare" (increase in WOMAC pain subscale 15 mm) following NSAID/acetaminophen discontinuation. Patients received either SoluMatrix diclofenac capsules 35 mg two or three times daily (BID or TID) or placebo. A 12-month open-label, multicenter study treated 601 chronic NSAID/acetaminophen users, aged 40 to 86 years, with knee and/or hip OA. Patients initially received SoluMatrix diclofenac 35-mg capsules BID; that could be increased to TID and reduced as needed. Results: Similar proportions of patients reported AEs in the 65 years of age group (157/205 [76.6%]) compared with the < 65 years of age group (365/500 [73.0%]). In patients 65 years of age treated with SoluMatrix diclofenac, the most commonly reported AEs included nausea (18/205, 8.8%), diarrhea (17/205, 8.3%), and upper respiratory tract infection (17/205, 8.3%). In patients < 65 years of age treated with SoluMatrix diclofenac, the most commonly reported AEs were headache (40/500, 8.0%), upper respiratory tract infection (34/500, 6.8%), and diarrhea (32/500, 6.4%). Forty-six of the 205 patients 65 years of age (22.4%) withdrew from the study due to any AE, whereas 73/500 patients < 65 years of age (14.6%) withdrew from the study due to an AE. Few SoluMatrix diclofenac-treated patients experienced AEs reported in class labeling for NSAIDs, including stroke, myocardial infarction, gastrointestinal ulcers, perforation or hemorrhage, or liver function abnormalities and occurred with no major differences among the two age groups (Table). Two patients (< 65 years of age) reported myocardial infarctions, which were not considered to be treatment-related; there were no deaths.
The Israel Medical Association journal : IMAJ, 2000
Synovial cysts are a well-known phenomenon in rheumatoid arthritis, and have various locations an... more Synovial cysts are a well-known phenomenon in rheumatoid arthritis, and have various locations and symptoms [1-5]. We describe here a unique case of synovial cyst originating from the pes anserinus and presenting clinically as intermittent claudication.
We analysed the effects of commonly used medications on human osteoblastic cell activity in vitro... more We analysed the effects of commonly used medications on human osteoblastic cell activity in vitro, specifically proliferation and tissue mineralisation. A list of medications was retrieved from the records of patients aged > 65 years filed in the database of the largest health maintenance organisation in our country (> two million members). Proliferation and mineralisation assays were performed on the following drugs: rosuvastatin (statin), metformin (antidiabetic), metoprolol (β-blocker), citalopram (selective serotonin reuptake inhibitor [SSRI]), and omeprazole (proton pump inhibitor (PPI)). All tested drugs significantly stimulated DNA synthesis to varying degrees, with rosuvastatin 5 µg/ml being the most effective among them (mean 225% (SD 20)), compared with metformin 10 µg/ml (185% (SD 10)), metoprolol 0.25 µg/ml (190% (SD 20)), citalopram 0.05 µg/ml (150% (sd 10)) and omeprazole 0.001 µg/ml (145% (SD 5)). Metformin and metoprolol (to a small extent) and rosuvastatin (to...
The Israel Medical Association journal : IMAJ, 2011
Intraarticular injections for the local treatment of osteoarthritis are widely used in the office... more Intraarticular injections for the local treatment of osteoarthritis are widely used in the office or hospital setting. Septic arthritis is a potential catastrophic complication of intraarticular injection, as bacterial arthritis of any cause is associated with up to 15% mortality and residual impairment of joint function in up to 50% of survivors. There is lack of evidence regarding the precautions that should be taken to avoid such a complication, as well as how often it is encountered. To report our experience with the clinical presentation, diagnosis and treatment of knee septic arthritis following intraarticular injections. We followed six patients who were admitted to the hospital and underwent surgery for the treatment of pyogenic arthritis following injection to the knee joint in outpatient clinics. All but one patient were over 70 years old with comorbidities. Three patients were injected with steroid preparations and three with hyaluronic acid several days before admission....
The Israel Medical Association journal : IMAJ, 2009
Gunshot wounds impose a continuous burden on community and hospital resources. Gunshot injuries t... more Gunshot wounds impose a continuous burden on community and hospital resources. Gunshot injuries to the extremities might involve complex soft tissue, bone, vascular, musculotendinous, and nerve injuries. A precise knowledge of anatomy is needed to evaluate and treat those injuries. To review our experience with gunshot wounds to the extremities. We retrospectively reviewed all civilian cases of gunshot wounds to the limbs treated in our institution during 2003-2005. Altogether, we evaluated 60 patients with 77 injuries. Of the 60 patients 36 had fractures, 75% of them in the lower extremity and 81% in long bones. The most common fixation modality used was external fixation (33%), followed by intramedullary nailing (25%). This relatively high percentage of fracture treated with external fixation may be attributed to the comminuted pattern of the fractures, the general status of the patient, or the local soft tissue problems encountered in gunshot wounds. About one-fifth of the fractu...
The Israel Medical Association journal : IMAJ, 2002
Open reduction and internal fixation are the current trends of treatment for comminuted calcaneal... more Open reduction and internal fixation are the current trends of treatment for comminuted calcaneal fractures. Assessing treatment results is often difficult due to discrepancy between objective parameters such as range of movement, and subjective results such as pain. To test the reliability of footprint analysis as an adjuvant method of postoperative assessment of patients who sustained calcaneal fractures. Dynamic and static footprint analysis was used as an adjuvant additional method to objectively assess operative results. This method is simple and is independent of the patient's initiatives. This modality was used in 22 patients followed-up 9-90 months postoperatively. We found a good correlation between footprint analysis and objective and subjective parameters of results expressed by American Orthopedic Foot and Ankle Society hind foot score. In certain cases, this method can be used to distinguish between uncorrelated parameter results, such as malingering, and workmens&#...
Background: Biomechanical interventions for the management of knee osteoarthritis (OA) are emergi... more Background: Biomechanical interventions for the management of knee osteoarthritis (OA) are emerging. AposTherapy is one type of biomechanical therapy that was shown to reduce knee adduction moment and improve gait patterns and clinical symptoms. The purpose of the current study was to further investigate the changes in gait patterns following this biomechanical therapy and to define its possible clinical benefits for patients with knee OA. Methods: 988 patients with knee OA were evaluated using a computerized gait test as well as with the Western Ontario and McMaster Osteoarthritis Index (WOMAC) and SF-36 Health Survey self-evaluation questionnaires. Following these measurements, the Apos system was individually calibrated to each patient according to his or her gait patterns and clinical evaluation. All patients received exercise guidelines and underwent 4 months of therapy. A second evaluation of gait and clinical symptoms was conducted after four months of therapy. Results: After 4 months of therapy, a significant improvement was found in all gait parameters (all P < 0.01), as well as in the level of pain, function and quality of life (all P < 0.01). High correlations were found between the improvement in gait parameters and the improvement in self-evaluation questionnaires. Conclusions: The examined biomechanical therapy led to a significant reduction in pain and improvement in function, quality of life and gait patterns. These finding support previous findings and deepens the understanding of this new noninvasive biomechanical therapy in patients with knee OA.
The Israel Medical Association journal : IMAJ, 2005
Pelvic fracture poses a complex challenge to the trauma surgeon. It is associated with head, thor... more Pelvic fracture poses a complex challenge to the trauma surgeon. It is associated with head, thoracic and abdominal injuries. As pelvic fracture severity increases so does the number of associated injuries and the mortality rate. To report our experience in the treatment of pelvic fractures. Between October 1998 and September 2001, 78 patients with pelvic fractures were admitted to our hospital. The age range of the 56 male and 22 female patients was 16-92 (mean 42 years). The cause of injury was road accident in 52 patients, fall from a height in 15, a simple fall in 9, and gunshot wounds in 2 patients. The Glascow Coma Scale score on arrival at the hospital was 3-15 (average 12). Twenty-five patients (32%) were admitted to the intensive care unit, 38 (48%) to the orthopedic department, 5 (6.4%) to neurosurgery and the remainder to a surgical department. Twenty-six patients (33.3%) received blood transfusion in the first 24 hours. Of the 25 patients with associated head trauma, 6 h...
Objective: The purpose of this study was to evaluate the effect of a biomechanical therapy on the... more Objective: The purpose of this study was to evaluate the effect of a biomechanical therapy on the pain, function, quality of life and spatio-temporal gait patterns of patients with hip osteoarthritis (OA). Design: 60 patients with hip OA were examined before and after twelve weeks of a personalized biomechanical therapy (AposTherapy). Patients were evaluated using the WOMAC questionnaire for pain and function and the SF-36 Health Survey for quality of life, and underwent a computerized gait test. Results: After twelve weeks of treatment, a significant improvement was found in the patients' velocity, step length and cadence (P ≤ 0.001). WOMAC-pain, stiffness and function subscales were significantly improved compared to baseline (P ≤ 0.001). SF-36 physical score subscale improved significantly (P=0.007). Conclusions: Patients with bilateral hip OA treated with AposTherapy for twelve weeks showed statistically and clinically significant improvements in pain, function and gait patterns. assessed in patients with hip OA, although it may be assumed that the same biomechanical principles apply. The purpose of this current study was to examine the efficiency of this biomechanical therapy on the gait patterns and clinical symptoms in patients with hip OA. We hypothesize that patients who undergo this therapy will show improvement in gait patterns and function, as well as a relief in pain. Methods Participants This was a retrospective study. The protocol was approved by the Institutional Helsinki Committee Registry (Registration number NCT00767780). A search for eligible data was performed through the research database of AposTherapy Center. Eligibility for the study was defined as follows: 1. Patients suffering from symptomatic hip OA for at least six months and who fulfilled the American College of Rheumatology clinical criteria for OA of the hip [17]; 2. Patients who completed a gait test, the Western Ontario and McMaster Osteoarthritis Index WOMAC [18] questionnaire and the Short Form SF-36 Health Survey [19] at the start of therapy (study baseline) and after twelve weeks of therapy. Exclusion criteria were: 1. Neurological and rheumatic inflammatory diseases; 2. Corticosteroid injection within 3 months of the study; 3. Earlier hip surgery excluding arthroscopy; 4. Joint replacement of the hip or knee; 5. Instability of the hip due to traumatic ligament injury; 6.
Background: SSc is an autoimmune disease characterized by progressive fibrosis of the skin and in... more Background: SSc is an autoimmune disease characterized by progressive fibrosis of the skin and internal organs. Development of an activated population of fibroblasts and myofibroblasts in lesional tissue is likely to be central to pathogenesis. In this study, we identify stem cell factor (SCF) as a potential driving factor in this process and future therapeutic target. SCF is a cytokine which acts via c-Kit a tyrosine kinase receptor. In a phosphorylation array analysis of migrating fibroblasts c-Kit was found to be upregulated. Our aim was to examine the role of SCF in the migration and proliferation of fibroblasts in SSc and healthy controls. Methods: Primary skin fibroblast lines were cultured in vitro with varying concentrations of SCF, or neutralizing antibodies directed against its receptor c-Kit or SCF itself. Proliferation was assessed using the WST-1 assay and by direct cell counting. Migration was assessed using the scratch wound assay and area of wound invasion measured following treatment with either SCF or anti-Kit antibodies. The expression and quantity of SCF and c-Kit by SSc (n ¼ 6) and control skin (n ¼ 6) fibroblasts was assessed by western blotting. Epidermis was also harvested from healthy (n ¼ 5) and SSc (n ¼ 9) skin using the blister technique. SCF gene expression was assessed using quantitative PCR (qPCR). Results: SCF expression was enhanced in SSc epidermis samples by qPCR as compared with healthy controls (566 vs 336 copy numbers respectively). In the Western of fibroblasts, both c-KIT and SCF were strongly present in SSc skin derived fibroblasts and hardly detectable in healthy controls (normalized band intensity 2.14 vs 0.03 for c-KIT and 1.81 vs 0.07 in SSc vs normal skin respectively P < 0.002 in both). Human recombinant SCF (rSCF) promoted the migration of normal human fibroblasts. At both 24 and 48 h, cells treated with rSCF showed a much greater percentage wound coverage as compared treatment with media only-with greatest migration at the rSCF concentration of 2.5 ng/ml (wound invasion 86% compared with 52% at 48 h P < 0.002). Conversely, treatment with antibody to c-KIT resulted in a reduction of wound invasion (invasion 19% compared with 62% P < 0.04). Addition of rSCF to normal fibroblast cell induced proliferation as measured by the WST-1 assay (13% increase, not statistically significant). Conversely, adding anti-Kit or anti-SCF neutralizing antibodies to cell culture medium resulted in reduction of proliferation (30% reduction, P < 0.05 and 20% reduction P < 0.029 respectively). Conclusions: SCF is found at higher levels in the skin of SSc subjects compared with controls. We have demonstrated that in vitro, SCF promotes proliferation and migration of fibroblasts and that its blockade using specific antibodies results in reduction in both these processes. SCF appears to be a potential therapeutic target for future treatment in SSc. Disclosures: The authors have declared no conflicts of interest.
Purpose: Porous, resorbable scaffolds offer a new solution for symptomatic osteochondral and chon... more Purpose: Porous, resorbable scaffolds offer a new solution for symptomatic osteochondral and chondral articular defects in the knee and other joints. This paper reports on early results of this novel off-the-shelf product. Methods and Materials: 8 active sporting patients underwent cartilage repair using TruFit CB plugs (Smith and Nephew) for symptomatic defects on the medial or lateral femoral condyle. All had failed previous treatment (debridement in 6 and microfracture in 2). Postoperatively patients were touch weight bearing for 2 weeks and partial until 4 weeks. Data was collected prospectively. Results: The overall mean age was 34.3 (range 21-50) and 5 were male. Four lateral femoral condyle defects were treated, all associated with lateral meniscal tears. Four medial defects were associated with ACL injury (1), PCL injury (1) or isolated chondral injury (2). Single plugs were required in 6 (9mm in 4 and 7mm plugs in 2) while 2 patients required 2 plugs (9mm and 7mm). All 8 patients were improved at mean follow up of 8 months with 4 currently back to full pre-injury level of sport. Subjective IKDC scores improved from 44.6 preop to 79 post op (p<0.05). 2 nd look arthroscopy was undertaken in 2 showing well healed and well integrated surface. Conclusions: These preliminary results indicate that TruFit CB plugs offer a potential solution for small focal chondral defects, offering an alternative to microfracture or osteochondral grafting with advantages of low morbidity and rapid recovery without the need for prolonged non-weight bearing.
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Papers by Moshe Salai