Making Autologous Cells Home in to Fracture Sites
A former president of the Orthopaedic Trauma Association (OTA) is working to make it possible for healing cells to migrate to a fracture site. J. Tracy Watson, M.D. professor of orthopedic traumatology, fellowship director, and chief of the orthopedic trauma service at St. Louis University School of Medicine, tells OTW, “We just recently presented some our lab’s work on cellular therapy at the recent OTA meeting in Minneapolis and are submitting this for publication. The project involves injecting stem cells, which have been harvested from intra-medullary reamings in humans. These bone forming cells were first collected, then isolated via a genetic marker which selects out for bone forming cells. These were then expanded in tissue culture and immuno-labeled. These cells were injected into the blood stream of an animal model femur fracture. We then analyzed the migration of these cells to determine to what extent theses allograft stem cells migrated to the site of injury. Which they did…and they subsequently augmented the fracture healing of the femoral shaft fractures. Clearly we have demonstrated that we can modulate cell populations to migrate to a site of injury. Our studies have also evaluated the healing potential utilizing placental cord blood cells as well.”
“Such work holds a lot of promise. Imagine being able to harvest a patient’s own cells…perhaps by plasmapheresis techniques, isolate and expand the bone forming cells and simply inject them back to the patient, much like a blood transfusion to help treat a severe fracture of a fracture that hasn’t adequately healed. Currently we are simply trying to determine which cell lines exhibit the best migratory and osteogenic capabilities as this is just the first step in understanding this as a treatment modality to augment our surgical capabilities. It is hoped that eventually we can develop this technology to make it a reality for human use.”
It Is OK to Give Preoperative Antibiotics!
Well, one million dollar question seems to have been answered. Should you be withholding prophylactic antibiotics prior to revision surgery? No, says a recent study that won the Knee Society Ranawat Award. Craig Della Valle, M.D. is an orthopedic surgeon at Midwest Orthopaedics at Rush and associate professor at Rush University Medical Center in Chicago. He tells OTW, “Our prospective randomized study sought to determine if prophylactic antibiotics affect intraoperative culture results in patients undergoing revision hip or knee arthroplasty surgery. Many of us—myself included—were taught in residency to withhold preoperative antibiotics. Despite evidence that these drugs may be our most powerful weapon to prevent postoperative infections, many surgeons remain concerned that prophylactic preoperative antibiotics may alter intraoperative culture results and cloud the diagnosis of periprosthetic joint infection.”
“I’m pleased to be able to provide evidence that—in the vast majority of cases—we can safely give preoperative prophylactic antibiotics without it affecting the cultures. This work, which builds on similar research by Robert Barrack, M.D., is making people reevaluate the practice of routinely holding antibiotics before revision. In the majority of cases the surgeon will probably know prior to the revision procedure whether or not there is an infection, and hence the decision to give the patient prophylactic antibiotics should be clear. However, in the rare case where the diagnosis is unclear preoperatively, the surgeon might consider holding them. However, our data suggests that they will not affect intraoperative culture results. This work has been presented at both the open and closed meetings of the Knee Society, and has just been accepted for publication by Clinical Orthopaedics and Related Research.”
Military, Civilian Orthopedic Surgeons Collaborate for Disaster Response
Col. James Ficke, M.D. was the Orthopaedic Surgery Consultant to the U.S. Army Surgeon General until April 2013. He co-chaired the Extremity War Injuries symposium for six years. Here, Dr. Ficke gives OTW an update on the collaborative work being done between military and civilian orthopedic surgeons. “Along with Lieutenant Colonel Warren Kadrmas from the Air Force and Navy Captains Daniel Unger and Eric Hofmeister, we have facilitated a coordinated military and civilian disaster response program. We learned much from the Haitian earthquake disaster, and are learning how to cut through the red tape and streamline processes so that doctors can help in an organized fashion. The military has recently completed test credentialing for two orthopedic surgeons at Keesler Air Force Base, where the commander there is an orthopedic surgeon. It has been a success.”
“Thus far, two civilian surgeons have gone through the program and several others have travelled overseas to help with either disasters or care of our wounded warriors. The intent of this program is to facilitate federal response in cooperation with these doctors. This effort concerns primarily major international events where U.S. government assistance is requested, but hopefully also across state boundaries when domestic events take place. We encourage all surgeons to get involved in disaster response, whether with non-governmental organizations, or to have them completely ready to board hospital ships or other military facilities at the centers of international disasters. Having all of the required training, certification, paperwork and preliminary credentialing procedures out of the way when disaster strikes saves time and lives.”
“At present the federal government is working towards having an accepted, standardized credentialing process. They are doing fingerprinting and background checks on doctors interested in being credentialed during the Disaster Response Course, sponsored jointly by Society of Military Orthopaedic Surgeons (SOMOS) and the AAOS [American Academy of Orthopaedic Surgeons]. This course, directed jointly by Drs. Theodore Parsons, Chris Born, and Tad Gerlinger has sold out four times and has a standing waiting list for future courses. The next step is to have these volunteers privileged through the military. A year from now we hope to have the privileging process up and running; some issues remain, such as cross state recognition of surgeons, and medical liability. My message to anyone involved the process: You never know when a disaster will happen in your state, so it’s in your best interest to help this program succeed.”
Worldwide Push for Smallest Orthopedic Patients
In 2008 Kaye Wilkins, M.D. received the Humanitarian Award from AAOS. Since receiving this honor he has continued his focus on trying to establish the availability of quality pediatric orthopedic services for children in countries with limited resources. This former president of the Pediatric Orthopaedic Society of North America (POSNA) is leaving a big mark on musculoskeletal care for the most vulnerable patients. Dr. Wilkins tells OTW, “I am continuing to focus primarily on providing outreach education in pediatric orthopedics. My philosophy is to, ‘leave skills not just scars.’ During the past two years, I have worked on assisting selected orthopedic surgeons to establish pediatric orthopedic programs in Bangladesh, Nepal, and Sri Lanka. These orthopedic surgeons had previously traveled to established pediatric orthopedic training centers in North America where they observed the manner in which pediatric orthopedics was practiced and taught. Following these observerships, they then returned to their home orthopedic programs to implement what they had learned. I was especially proud in a return visit to Dhaka, Bangladesh, in 2012 to see that they had progressed to the point where they had established the Bangladesh Pediatric Orthopaedic Society, with its first meeting in late 2012. There were close to 20 individuals in attendance at that meeting.”
“I have continued to visit Haiti to attempt to expose doctors there to pediatric orthopedic education. I arranged for seven members of their orthopedic society to travel to San Antonio and other pediatric orthopedic centers in North America to observe how the practice of pediatric orthopedics is now conducted. This was an effort to build some enthusiasm for their orthopedic surgeons to develop some expertise in pediatric orthopedics in their country. Prior to the 2010 earthquake there were no orthopedic surgeons with any pediatric orthopedic expertise. Two years ago they had their first fellowship trained orthopedic surgeon return to start his practice at the Adventist Hospital in a suburb of Port au Prince. A second orthopedic surgeon is now starting her training and will be ready to treat pediatric orthopedic conditions in Haiti in 2014. One of the few positive effects of the 2010 earthquake was that it opened up to the outside world the dire insufficiency of quality orthopedic care in Haiti. As a result, there is now an increased interest on the part of pediatric orthopedists from North America to travel to Haiti to participate in outreach educational projects.”
Dr. Wilkin’s also helped rebuild the orthopedic residency program at the State University Hospital in Port au Prince. “Fortunately, the residents have returned to the University Hospital and I am now able to resume the teaching conference in pediatric orthopedics. Overall, I think ‘giving’ is catching on…and I’m glad to find that POSNA’s committee on outreach education is now one of the more popular committees.”
Matthew Scott New VP at ConforMIS
ConforMIS Inc. has announced the appointment of Matthew Scott as the company’s senior vice president of operations. Most recently the director of operations for Zimmer Dental, Scott oversaw all aspects of the operation and managed the rapid growth of the dental implant manufacturing facilities during his tenure. He also held several roles at Zimmer Orthopedics, where he started as the production manager for the knee femoral business, which led to leadership roles on teams responsible for lean process redesign, cost efficiencies and technology transfer, according to a company press release. Scott also helped establish a global network of manufacturing facilities to support the hip and knee implant business. He developed the business case for several overseas facilities, planned and executed the build out of the sites and served as interim general manager of a new production facility in Ireland before moving to Zimmer Dental.
