The National Library of Medicine has accepted JBJS Reviews for indexing in MEDLINE/PubMed.
Launched in November 2013 and edited by Thomas A. Einhorn, MD and a distinguished editorial board, JBJS Reviews is an innovative, continuously published online review journal from the publishers of The Journal of Bone & Joint Surgery.
Each weekly posting of JBJS Reviews content updates the orthopaedic community on important topics in a concise, time-saving manner. Comprehensive reviews, special features, and integrated CME provide musculoskeletal clinicians with valuable perspectives on surgical practice and the latest advances in the field within twelve subspecialty areas.
If you are not already a JBJS Reviews subscriber, click here to learn more.
In the July 6, 2016 issue of The Journal, Weinberg at al. carefully measure the rotational profile of 600 cadaveric human forearm bones. The precision of these measurements is outstanding and sets a new standard for this type of investigation. The authors put real numbers on the rotational relationships between the radius and ulna that Evans first proposed in JBJS in 1945—and that many surgeons have relied on for intraoperative assessments of forearm rotational alignment since then.
What this investigation documents is the wide range of rotational profiles in the human forearm, with broad standard deviations. It confirms what all clinicians experience every day—each patient’s anatomy is different. There is commonality in hard- and soft-tissue structure overall, but the range of size, shape, density, length, and rotation is patient-specific and highly variable.
Whether closed, percutaneous, or open methods are applied, the skill and experience of the surgeon trump radiographic rules/tips/guidelines. As is often said with fracture reduction, the surgeon is responsible for 80% of the outcome. Studies comparing different casting methods or fixation devices provide useful information that address the remaining 20%, but surgical technique and surgeon experience/judgment are the major determinants.
We must always remember that each patient is not only emotionally and socially unique, but also anatomically unique. Our job is to restore their individual anatomy to the best of our clinical ability. I am therefore not sure that repeating high-precision measurements of other osseous structures—only to re-confirm anatomic variability—will have much ultimate value for our community.
Marc Swiontkowski, MD
The Editors of The Journal of Bone & Joint Surgery are pleased to announce the launch of JBJS Open Access. This new online-only journal gives authors an open-access option bolstered by the outstanding service and brand of excellence that JBJS has delivered for more than 125 years. And readers worldwide will benefit from expanded access to the best clinical and basic-science content about musculoskeletal health and injury care.
JBJS Open Access Co-editors Dr. Eng Lee and Dr. Robin Richards are not only expert basic-science and clinical researchers, but together they have more than 60 years of experience in scholarly publishing.
Click here for more information about this latest step in our continuing effort to meet the evolving needs of authors and readers.
Marc Swiontkowski, MD
BMJ recently published two studies of interest to orthopaedists:
- After analyzing data from more than 200 cardiovascular, orthopaedic, and neurologic devices approved in both the US and European Union (EU), Hwang et al. found that those approved in the EU first were nearly three times as likely to trigger a safety alert or experience a recall than those first approved in the US. Finding further that trial results were published for fewer than half of approved devices considered “major innovations,” the authors call for “greater regulatory transparency” so physicians and patients can make better-informed decisions. Interestingly, Figure 2 in this study showed that the FDA approval time for orthopaedic devices was faster than ortho-device approval times in the EU. However, a JBJS study earlier this year found that devices approved via the FDA’s “quick” 510(k) process were 11.5 times more likely to be recalled than those cleared through the longer and more stringent FDA pathway.
- In the second BMJ article, a registry-based case-control study, Abrahamsen et al. found that the long-term use of the bisphosphonate alendronate does not increase the risk for atypical femoral fractures (either subtrochanteric or femoral shaft), while protecting against hip fractures. After applying some sophisticated statistical analyses, the authors estimated that 38 patients with ≥5 years of alendronate adherence would need to be treated for an additional 5 years to prevent one hip fracture, while 1449 similar patients would need to be treated to cause an atypical femoral fracture. Click here for more OrthoBuzz coverage of the relationship between bisphosphonates and atypical femoral fractures.