Obesity to Blame for Epidemic of Knee Dislocations, Complications

Obesity to Blame for Epidemic of Knee Dislocations, Complications

Need another reason to keep your weight under control?

Excess weight can cause dislocation of your knee and may even lead to a complication that results in amputation of your leg.

A new study attributes a surge in dislocated knees to the U.S. obesity epidemic.

“Obesity greatly increases the complications and costs of care,” said study lead author Dr. Joey Johnson, an orthopedic trauma fellow at Brown University’s Warren Alpert Medical School.

“As the rate of obesity increases, the rate of knee dislocations increases. The total number of patients who are obese is increasing, so we are seeing more of these problems,” Johnson explained.

Knee dislocations result from multiple torn ligaments. Vehicle crashes or contact sports, such as football, are common causes.

For the study, the researchers analyzed more than 19,000 knee dislocations nationwide between 2000 and 2012. Over that time, people who were obese or severely obese represented a growing share of knee dislocation patients — 19 percent in 2012, up from 8 percent in 2000.

Obesity is also linked to more severe knee dislocations, longer hospital stays and higher treatment costs, according to the study published recently in the Journal of Orthopaedic Trauma.

And the chances that a knee dislocation would also injure the main artery behind the joint and down the leg were twice as high for obese patients than for those whose weight was normal, the findings showed. This severe complication of knee dislocation — known as a vascular injury — can lead to leg amputation if not treated, the study authors said.

Patients with a vascular injury averaged 15 days in the hospital, compared with about one week for other patients. Their average hospitalization costs were just over $131,000 and $60,000, respectively.

The study authors said doctors should be especially watchful for vascular injury in obese patients whose knees are dislocated.

“That subset of obese patients who come in with complaint of knee pain need to be carefully evaluated so as not to miss a potentially catastrophic vascular injury,” said study co-author Dr. Christopher Born, a professor of orthopedics at Brown.

Reducing obesity rates could help reverse the growing number of knee dislocations, the researchers suggested.

More information

The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases has more on knee problems.

SOURCE: Brown University, news release, Nov. 3, 2017

Don’t Delay Hip Fracture Surgery. Here’s Why

Don’t Delay Hip Fracture Surgery. Here’s Why

Seniors with a fractured hip need surgery as soon as possible or they could suffer life-threatening complications, a new Canadian study concludes.

Having surgery within 24 hours decreases the risk of hip fracture-related death. It also lowers odds of problems such as pneumonia, heart attack and blocked arteries, the researchers found.

“We found that there appears to be a safe window, within the first 24 hours,” said lead researcher Daniel Pincus, a doctoral student with the University of Toronto.

“After 24 hours, risk began to clearly increase,” Pincus said.

U.S. and Canadian guidelines recommend hip fracture surgery within 48 hours of injury, but it’s likely that many people don’t receive care that quickly, he noted.

In the United Kingdom, guidelines call for surgery within 36 hours, but hospitals often fail to get patients promptly into the operating room, Pincus added. Rates range from 15 percent to 95 percent among U.K. hospitals, according to the report.

Oftentimes, there’s no operating room or surgeon available, or other patients are awaiting surgery, Pincus explained.

“There’s a triage system and these patients historically were not prioritized,” he said. “Sometimes there’s medical reason for the delay, but that’s very rare. We’re starting to realize there’s almost no reason why a patient should be delayed.”

Delay also likely occurs because doctors approach these elderly patients with a good deal of caution, said Dr. Harry Sax. He is executive vice chair of surgery for Cedars-Sinai Medical Center in Los Angeles.

“The perception is that if you’re old and you’ve broken your hip, that you’re going to have a lot of other [health problems],” said Sax, co-author of an editorial accompanying the new study. “Therefore, I need to spend several days running tests on you to try to make sure I can get you through the hip fracture surgery. ”

To see how this delay affects the health of patients, Pincus and his colleagues evaluated data on over 42,000 people treated for hip fracture at 72 hospitals in Ontario between April 2009 and March 2014. The patients’ average age was 80.

The investigators compared patients based on whether they had surgery before or after 24 hours.

Overall, about 12 percent of hip fracture patients died within the month following their surgery.

However, patients who got surgery within 24 hours were 21 percent less likely to die during the following month, compared with those who had a delay in surgery, the findings showed.

Those patients also had lower complication rates. They were 82 percent less likely to develop a blood clot in the leg veins (deep vein thrombosis); 61 percent less likely to have a heart attack; and 49 percent less likely to suffer a blood clot in the lung (pulmonary embolism). They were also 5 percent less likely to develop pneumonia during the month following surgery.

“The problem is the longer you sit in bed, the more likely you are to get pneumonia and blood clots. The unfixed bone is continuing to flick off little bits of fat, which can go to the lungs,” Sax said. “The delay doesn’t necessarily make things better. It could make things worse.”

People with an elderly relative facing hip fracture surgery should ask the health care team to get their loved one into surgery as soon as possible, with as little additional testing as possible, Pincus and Sax said.

“A prompt evaluation to make sure there’s nothing quickly correctable should be done, but otherwise the patient should move to the operating room as quickly as possible,” Sax said.

Families should ask doctors about every test, scan or screen that delays the surgery, Sax said.

“The question needs to be, what is the information that you’re going to gain and how would that change your management of this patient,” Sax said. “There are very few things you find with all this expensive testing that you can do anything about.”

The patient would be best off in a hospital that has a specific program to manage elderly people with hip fractures, Sax added. These programs have a team of surgeons, geriatricians, anesthesiologists and other professionals well-versed in the procedure.

“If you can find a hospital that does that, the chances are your outcomes are going to be better,” Sax said.

The study was published Nov. 28 in the Journal of the American Medical Association.

More information

For more on hip fractures, visit the American Academy of Orthopaedic Surgeons.

SOURCES: Daniel Pincus, doctoral student, University of Toronto, Ontario, Canada; Harry Sax, M.D., executive vice chair, surgery, Cedars-Sinai Medical Center, Los Angeles; Nov. 28, 2017, Journal of the American Medical Association

Exercise, Not Vitamin D, Recommended to Prevent Falls

Exercise, Not Vitamin D, Recommended to Prevent Falls

WEDNESDAY, Sept. 27, 2017 (HealthDay News) — Falls and fractures are a major cause of disability in old age. An influential U.S. medical task force is recommending exercise and, in some cases, medical evaluation to help seniors stay on their feet.

But the new draft recommendations from the U.S. Preventive Services Task Force (USPSTF) say there isn’t enough evidence at this time to either endorse or advise against taking vitamin D or calcium supplements to prevent broken bones.

And based on current evidence, the panel recommends against taking vitamin D solely to prevent falls.

For Americans 65 and older, falls are the leading cause of injuries and injury-related deaths, according to the U.S. Centers for Disease Control and Prevention. On average, one older person falls every second in the United States, the CDC says.

“Fortunately, there are things we can do to help prevent falls,” said Dr. Alexander Krist, a task force member.

However, “we found that it is unclear whether vitamin D and calcium can help prevent fractures at higher doses,” said Krist, an associate professor of family medicine and population health at Virginia Commonwealth University. “They do not prevent fractures at lower doses.”

More research is needed to evaluate the potential benefit of high-dose calcium and vitamin D supplementation for fracture prevention after menopause, the task force noted.

“We hope that you talk to your primary care provider about exercise to prevent falls if you have any concerns about falling, as well as vitamin D or calcium supplementation if you have any questions about your personal risk of fractures,” Krist added.

The USPSTF, an independent panel of experts, provides guidance to physicians about how to prevent medical problems.

The proposed guidelines are intended to help prevent falls and fractures in generally healthy adults aged 65 and older who live at home and don’t have medical problems such as osteoporosis, vitamin D deficiency, Parkinson’s disease or dementia.

After reviewing the available studies, “we found that exercise had a moderate benefit in preventing falls in older adults at increased risk for falls,” Krist said.

The task force didn’t suggest any particular type of exercise. Still, “supervised exercise that improves balance, the way someone walks, and helps with completing common tasks are helpful,” Krist said.

“These can be done in group or individual classes and either at home or in the community. Patients should talk with their clinician about what exercise programs are best for them,” he added.

The task force also recommends that health care providers “selectively check older adults’ risks for falls, and then offer tailored interventions that address those specific risks.”

However, one expert doubts that such risk assessments will become common.

“Medical offices are businesses. Anything that adds time to the office visit, without adding revenue, is unlikely to be added to the majority of visits,” said Dr. Chris Sciamanna, a professor of medicine and public health sciences at Penn State College of Medicine. He wasn’t involved in writing the draft recommendations.

Sciamanna suggested that seniors test themselves: “If you can’t stand on either leg for 10 seconds without grabbing onto something, you’re at risk and should talk to your doctor,” he said.

But, he added, “the reality is that there’s little for doctors to do other than to refer you to an exercise program or, in some cases, reduce the dose of a medicine that may be hurting your balance, like a blood pressure medicine.”

In a perfect world, Sciamanna said, he would have his patients enroll in a strength and balance program three times each week, and also “get aerobic exercise, preferably something that would be fun and build their agility.”

Although the task force recommends against taking vitamin D to prevent falls, there’s no recommendation regarding whether seniors should take vitamin D for general health.

As for other ideas, the task force said there’s not enough evidence to show the value of single strategies like managing medications or making the home environment safer.

The task force released its draft recommendations Sept. 26 and is accepting comments about them on their website until Oct. 23.

More information

For more about preventing falls, see the U.S. National Institutes of Health.

SOURCES: Alexander Krist, M.D., MPH, associate professor of family medicine and population health, Virginia Commonwealth University, Richmond, Va.; Chris Sciamanna, M.D., MPH, professor, medicine and public health sciences and vice chair, research, department of medicine, Penn State College of Medicine, Hershey, Pa.; U.S. Preventive Services Task Force, draft recommendations, Sept. 26, 2017

Arthritis Diagnosis

Arthritis Diagnosis

Diagnosing arthritis may be difficult. There are more than 100 different types of arthritis. Many symptoms are similar among the different conditions affecting the joints. Arthritis may be generally categorized into the following groups: degenerative arthritis, inflammatory arthritis, metabolic arthritis, and infectious arthritis. Osteoarthritis (also known as degenerative arthritis) is the most common type. Rheumatoid arthritis and gout are two other more common types. To make an accurate diagnosis, a healthcare provider may need to:

  • Review your medical history and current symptoms.
  • Examine you, paying close attention to your joints.
  • Order laboratory tests, X-rays, and other imaging tests (such as an ultrasound or MRI).
  • Perform an arthrocentesis (the procedure of removing fluid from a joint).

What is involved in reviewing your medical history and your current symptoms?

When reviewing your medical history, your healthcare provider may ask the following questions:

  • Have you had any illnesses or injuries that may explain the pain?
  • Is there a family history of arthritis or other rheumatic diseases?
  • What medication(s) are you currently taking?

Your healthcare provider may also ask:

  • What symptoms are you having? For example, pain, stiffness, difficulty with movement, or swelling.
  • About your pain:
    • Where is it?
    • How long have you had it?
    • When do you have pain and how long does it last?
    • Describe your pain. (Constant, dull, throbbing, stabbing)
    • How intense is it? (on a scale of 1 to 10, with 1 being no pain, and 10, the worst pain)
    • What lessons the pain?
    • What makes it worse?

What is involved in laboratory testing?

In addition to a complete medical history and physical examination, the following are common laboratory tests:

  • Antinuclear antibody. This test measures blood levels of various antibodies, which may be present in persons with some types of arthritis.
  • Arthrocentesis (also called joint aspiration). This is an exam of joint fluid. A thin needle is inserted into the joint. Synovial fluid is removed with a syringe and examined for cell counts, crystal analysis, culture, and other tests.
  • Complement tests. This test measures the level of complement, a group of proteins in the blood. It is used to help diagnose and monitor systemic lupus erythematosus (SLE) and rheumatoid arthritis.
  • Complete blood count. Measures the number of white blood cells, red blood cells, and platelets present in a sample of blood. A low white blood count (leukopenia), low red blood count (anemia), or low platelet count (thrombocytopenia) are associated with some forms of arthritis or the medications to treat them.
  • Creatinine. A blood test to monitor for underlying kidney disease.
  • C-reactive protein. This is a protein that is elevated when there is inflammation in the body as in some types of arthritis.
  • Erythrocyte sedimentation rate (also called ESR or sed rate). This measures how quickly red blood cells fall to the bottom of a test tube. It is also elevated when there is inflammation in the body. This occurs in some types of arthritis.
  • Hematocrit (PCV, packed cell volume). Measures the number of red blood cells present in a sample of blood. Low levels of red blood cells (anemia) are common in people with some types of arthritis.
  • Rheumatoid factor. Checks for an antibody that is present in most people with rheumatoid arthritis.
  • Urinalysis. Laboratory examination of urine to check for kidney disease that may be associated with several types of arthritis.
  • Uric acid. It is elevated in gout.

What imaging techniques may be used to diagnose arthritis?

Imaging techniques may give your healthcare provider a clearer picture of what is happening to your joint(s). Imaging techniques may include the following:

  • X-ray. X-rays may show joint changes and bone damage found in some types of arthritis. Other imaging tests may also be done.
  • Ultrasound. Ultrasound uses sound waves (not radiation) to see the quality of synovial tissue, tendons, ligaments, and bones.
  • Magnetic resonance imaging (MRI). MRI images are more detailed than X-rays. They may show damage to joints, including muscles, ligaments, and cartilage.
  • Arthroscopy. This procedure uses a thin tube containing a light and camera (arthroscope) to look inside the joint. The arthroscope is inserted into the joint through a small incision. Images of the inside of the joint are projected onto a screen. It is used to evaluate any degenerative and/or arthritic changes in the joint; to detect bone diseases and tumors; to determine the cause of bone pain and inflammation, and to treat certain conditions.

Stress Fractures in Young Athletes

Teen girl holding ice pack on shinCompetitive sports can give some young athletes an edge over their peers. When fun, teamwork, and good sportsmanship are the top goals, sports can improve young kids’ physical and emotional health, self-esteem, and even their relationship skills. Unfortunately, young athletes must also compensate for still-growing bones, tendons, and muscles. Sometimes sports injuries happen.

The most common type of sports injury is an overuse injury such as a stress fracture. Overuse injuries are becoming more common in young athletes Playing sports year-round without time off doesn’t give young bodies enough time to rest and recover.

How stress fractures happen

Stress fractures happen when muscles are too tired to take on the impact of exercise, and the bones absorb the added stress. When those bones become too strained, they develop a tiny break known as a stress fracture.


Most stress fractures affect the bones in the lower leg. Stress fractures are also common in the feet.

These are the most common causes of stress fractures:

  • Increasing the frequency or intensity of exercise too quickly
  • Suddenly changing the workout surface
  • Getting sudden and significantly more playing time
  • Using or wearing gear that doesn’t offer enough support, such as shoes that are worn out
  • Insufficient periods of rest between practice or events

Stress fractures can happen during any number of sports, but they tend to be most frequent in young athletes who participate in sports that involve running and jumping, such as basketball, gymnastics, and track and field. These sports involve repetitive movements that strain the muscles and bones. This increases the risk for a stress fracture.

Preventing stress fractures

Parents and coaches can do many things to help reduce the risk for stress fractures in growing bones. Make sure that your young athletes follow these guidelines:

  • Eat a balanced, nutritious diet rich in calcium and vitamin D for strong, healthy bones.
  • Participate in conditioning practice for sports.
  • Do cross-training (alternating types of physical activities).
  • Stick to sports that are age-appropriate.
  • Always warm up before practice or games and cool down afterward.
  • Get a complete physical exam before participating in sports.
  • Wear athletic shoes (and any other needed gear) that are appropriate for the sport and that offer plenty of protection and cushioning.
  • See a healthcare provider for any persistent pain or limp.
  • Drink plenty of fluids and stay hydrated for practices and games.
  • Don’t resume sports or exercise too quickly after a stress fracture or other injury.

Also, make sure that your child’s coach is aware of the signs of stress fracture. This may be milder in nature than a more severe sports injury. Pain, particularly pain that gets better when the child is allowed to rest, is the most common symptom of a stress fracture.

Stress fractures typically heal with rest alone, but injured athletes may need to take off from their sport for as long as 6 to 8 weeks to properly recover. If your child complains of any pain that persists during sports, schedule a visit with your child’s healthcare provider.



What is a dislocation?

A dislocation happens when extreme force is put on a ligament, allowing the ends of two connected bones to separate. Ligaments are flexible bands of fibrous tissue that connect various bones and cartilage.

Ligaments also bind the bones in a joint together. Stress on joint ligaments can lead to dislocation of the joint. The hip and shoulder joints, for example, are called “ball and socket” joints. Extreme force on the ligaments in these joints can cause the head of the bone (ball) to partially or completely come out of the socket.

Illustration of types of joints
Click Image to Enlarge

The most commonly dislocated joint is the shoulder.

Dislocations are uncommon in younger children because their growth plates (area of bone growth located in the ends of long bones) are weaker than the muscles or tendons. Instead, children are more prone to a fracture than a dislocation.

What are the symptoms of a dislocation?

The following are the most common symptoms of a dislocation. However, each child may experience symptoms differently. Symptoms may include:

  • Pain in the injured area
  • Swelling in the injured area
  • Difficulty using or moving the injured area in a normal manner
  • Deformity of the dislocated area
  • Bruising or redness in the injured area
  • Numbness or weakness in the injured area

The symptoms of a dislocation may resemble other medical conditions. Always talk with your child’s healthcare provider for a diagnosis.

How is a dislocation diagnosed?

The healthcare provider makes the diagnosis with a physical exam. During the exam, the healthcare provider obtains a complete medical history of the child and asks how the injury happened.

Diagnostic procedures may help to evaluate the problem. Diagnostic procedures may include:

  • X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  • Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. An MRI is only likely to be done if your healthcare provider is considering surgery.

Treatment for dislocation

Specific treatment for a dislocation will be discussed with you by your child’s healthcare provider based on:

  • Your child’s age, overall health, and medical history
  • The extent of the injury
  • The type of injury
  • Your child’s tolerance for specific medicines, procedures, or therapies
  • Expectations for the course of the condition
  • Your opinion or preference

All dislocations need immediate medical attention since fractures can also happen with dislocations and neglected dislocations can lead to serious problems.

Initial treatment of a dislocation includes R.I.C.E. (rest, ice, compression, and elevation). Dislocations may reduce spontaneously, meaning the bone ends may go back into place by themselves. However, for those dislocations that do not go back into place, your child’s healthcare provider will need to place the joint back into its proper position so it will heal. Your child will receive sedation to help him or her remain comfortable before the procedure. Sedation will also help the muscles around the dislocated joint relax, so the joint can be put back into place more easily.

Your child’s healthcare provider may recommend any of the following to help reduce the dislocation or promote healing afterwards:

  • Splint or cast, which immobilizes the dislocated area to promote alignment and healing. It protects the injured area from motion or use
  • Medicine (for pain control)
  • Traction is the application of a force to stretch certain parts of the body in a specific direction. Traction consists or pulleys, strings, weights, and a metal frame attached over or on the bed. The purpose of traction is to stretch the muscles and tendons around the bone ends to help reduce the dislocation.
  • Surgery (especially for dislocations that happen again and again, or if a muscle, tendon, or ligament is badly torn)

Additional recommendations may include:

  • Activity restrictions (while the dislocation heals)
  • Crutches or wheelchair (to enable your child to move around during healing)
  • Physical therapy (to stretch and strengthen the injured muscles, ligaments, and tendons)

Long-term outlook after a dislocation

While dislocations are rare in younger children, they do happen more often among adolescents. It is important that the child stick to the activity restrictions and/or stretching and strengthening rehabilitation programs to prevent reinjury.