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Clinical Implications of Basic Research
Stem Cells and Spinal Cord Repair
For the past couple of decades, clinicians have watched the stem-cell field with a mixture of anticipation and skepticism. No group of patients has been more expectant than those with spinal cord injuries. Therapies for spinal cord injury have been promised almost since the dawning of the stem-cell…
- May 17, 2012
- Snyder E.Y. and Teng Y.D.
- N Engl J Med 2012; 366:1940-1942
For the past couple of decades, clinicians have watched the stem-cell field with a mixture of anticipation and skepticism. No group of patients has been more expectant than those with spinal cord injuries. Therapies for spinal cord injury have been ...
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Images in Clinical Medicine
Vertebra Plana with Spontaneous Healing
Figure 1.
- May 10, 2012
- Tsai P.-Y. and Tzeng W.-S.
- N Engl J Med 2012; 366:e30
- Free Full Text
A 3-year-old girl presented with a 3-week history of low back pain. Physical examination revealed mild tenderness over the upper lumbar spine.
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Perspective
Continuing Bisphosphonate Treatment for Osteoporosis — For Whom and for How Long?
In the 21st century, osteoporosis, a disease once considered an inevitable consequence of aging, is both diagnosable and treatable. Large, randomized, controlled trials have shown that bisphosphonate therapy for 3 to 4 years is effective in reducing the risk of both nonvertebral and vertebral…
- May 9, 2012
- Black D.M., Bauer D.C., Schwartz A.V., Cummings S.R., Rosen C.J.
- 10.1056/NEJMp1202623
- Free Full Text
In the 21st century, osteoporosis, a disease once considered an inevitable consequence of aging, is both diagnosable and treatable. Large, randomized, controlled trials have shown that bisphosphonate therapy for 3 to 4 years is effective in reducing the ...
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Perspective
Bisphosphonates for Osteoporosis — Where Do We Go from Here?
Osteoporosis, a disease characterized by reduced bone mass and increased skeletal fragility, affects 10 million Americans; another 34 million are at risk for it. Bisphosphonates are widely prescribed for osteoporosis; more than 150 million prescriptions were dispensed to outpatients between 2005…
- May 9, 2012
- Whitaker M., Guo J., Kehoe T., Benson G.
- 10.1056/NEJMp1202619
- Free Full Text
Osteoporosis, a disease characterized by reduced bone mass and increased skeletal fragility, affects 10 million Americans; another 34 million are at risk for it. Bisphosphonates are widely prescribed for osteoporosis; more than 150 million prescriptions ...
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Images in Clinical Medicine
Deep Sulcus Sign
Figure 1.
- February 9, 2012
- Sabbar S. and Nilles E.J.
- N Engl J Med 2012; 366:552
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A 23-year-old man who been a passenger in a minivan was brought to the ER after a high-speed road accident. He had transient hypotension and tachycardia, which improved after the administration of intravenous fluids.
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Correspondence
Staphylococcus aureus Reactivation Osteomyelitis after 75 Years
To the Editor: In 1934, a 10-year-old girl was hospitalized at the Children's Hospital of Boston for 1 1/2 years for Staphylococcus aureus osteomyelitis of the left femur. This was the preantibiotic era, so she did not receive any antibiotic therapy at that time but, instead, underwent multiple…
- February 2, 2012
- N Engl J Med 2012; 366:481-482
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In this case report, Staphylococcus aureus was found to persist in an 85-year-old woman 75 years after the successful treatment of osteomyelitis during her childhood.
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Images in Clinical Medicine
Post-Traumatic Herniated Cervical Disk
Figure 1.
- February 2, 2012
- Diabira S. and Morandi X.
- N Engl J Med 2012; 366:462
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An 18-year-old man with no notable medical history had sudden transient tetraplegia after heading a soccer ball. Ten minutes later, he had recovered normal strength. On examination, he had intense cervical pain, paresthesias on his shoulders and arms, and no other neurologic deficits.
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Images in Clinical Medicine
Pulmonary Cement Embolism after Vertebroplasty
Figure 1.
- January 19, 2012
- Tourtier J.-P. and Cottez S.
- N Engl J Med 2012; 366:258
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A 61-year-old man with spinal cord compression underwent therapeutic laminectomy of the fifth vertebra and laminectomy and vertebroplasty of the fourth vertebra. During the vertebroplasty, polymethylmethacrylate cement leaked into the paravertebral vascular system.
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Original Article
Liberal or Restrictive Transfusion in High-Risk Patients after Hip Surgery
In the United States, more than 17 million red-cell units are collected annually, and 15 million units are transfused. Blood transfusions are frequently given to surgical patients and to the elderly. Yet, the indications for postoperative transfusion have not been adequately evaluated and remain…
- December 29, 2011
- Carson J.L., Terrin M.L., Noveck H., et al.
- N Engl J Med 2011; 365:2453-2462
- CME
This trial compared a restrictive hemoglobin threshold with a liberal threshold for blood transfusion among hip-surgery patients with risk factors for CVD. The liberal strategy resulted in more transfusions and did not reduce death or inability to walk independently.
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Editorial
Transfusion Thresholds in FOCUS
Even though red-cell transfusion is an accepted and widely used intervention, questions regarding which patients should receive transfusions and under what circumstances continue to spark debate. There has been limited evidence from clinical trials to inform policy. Meanwhile, concern about…
- December 29, 2011
- Barr P.J. and Bailie K.E.M.
- N Engl J Med 2011; 365:2532-2533
Even though red-cell transfusion is an accepted and widely used intervention, questions regarding which patients should receive transfusions and under what circumstances continue to spark debate. There has been limited evidence from clinical trials to ...
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Clinical Practice
Primary Hyperparathyroidism
Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations. Stage. A 62-year-old…
- December 22, 2011
- Marcocci C. and Cetani F.
- N Engl J Med 2011; 365:2389-2397
- CME
- Full Text Audio
This article reviews the differential diagnosis and management of primary hyperparathyroidism. For most patients, parathyroidectomy (usually by a minimally invasive approach) is recommended, but surveillance is an option for asymptomatic patients who meet certain criteria.
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Images in Clinical Medicine
Metastasis of Renal-Cell Carcinoma
Figure 1.
- November 3, 2011
- Pugliese F. and Pagliuca V.
- N Engl J Med 2011; 365:e38
- Free Full Text
Four years after a right nephrectomy for renal-cell carcinoma, an 89-year-old man was referred for evaluation of a pulsating mass on the fourth digit of the right hand. The mass had increased in size during the preceding 3 months after minor trauma to the finger.
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Case Records of the Massachusetts General Hospital
Case 33-2011 — A 56-Year-Old Man with Hypophosphatemia
Presentation of Case. Dr. Eric Hesse (Harvard School of Dental Medicine): A 56-year-old man was seen in the outpatient endocrinology and oral-surgery clinics of this hospital because of recurrent hypophosphatemia. The patient had been well until 19 years earlier, when rib pain developed and a left…
- October 27, 2011
- Bergwitz C., Collins M.T., Kamath R.S., Rosenberg A.E.
- N Engl J Med 2011; 365:1625-1635
- CME
A 56-year-old man presented with recurrent bone pain, stress fractures, and hypophosphatemia. A tumor of the jaw had been resected in the past, with resolution of symptoms. Studies of the jaw revealed no recurrent tumor. Diagnostic tests were performed.
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Perspective
Medical Device Innovation — Is “Better” Good Enough?
Last year, the United States spent $95 billion on medical devices, nearly half of the $200 billion spent on devices worldwide. Our investment in devices has yielded impressive gains in length and quality of life from products such as implantable cardioverter–defibrillators, pacemakers, and…
- October 20, 2011
- Suter L.G., Paltiel A.D., Rome B.N., et al.
- N Engl J Med 2011; 365:1464-1466
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The FDA approves many devices on the basis of similarity to precursors, possibly encouraging development of slightly improved, higher-cost devices. A modeling approach can illuminate interplay among efficacy and durability, patient characteristics, costs, and outcomes.
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Correspondence
Atypical Femoral Fractures and Bone Turnover
To the Editor: Epidemiologic studies and case series and reports suggest that there is a relation between the long-term use of bisphosphonates and the development of atypical femoral fractures. Although the cause of such fractures is unknown, the fact that bisphosphonates decrease bone resorption…
- September 29, 2011
- N Engl J Med 2011; 365:1261-1262
- Free Full Text
A bone biopsy performed in a woman treated with bisphosphonates who had bilateral atypical femoral fractures did not reveal decreased bone turnover, suggesting the possibility that fractures associated with bisphosphonate use are not due to oversuppression of bone turnover.
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Perspective
Medical Devices — Balancing Regulation and Innovation
Many Americans benefit from the implantation of medical devices, such as artificial joints and lifesaving defibrillators. Tragically, many also suffer or even die from complications related to medical devices that were never studied in clinical trials before being implanted in patients. As devices…
- September 15, 2011
- Curfman G.D. and Redberg R.F.
- N Engl J Med 2011; 365:975-977
- Free Full Text
The FDA approval system cannot assure the safety and effectiveness of increasingly complex medical devices. The Institute of Medicine has recommended eliminating a process that permits approval of a device based on its “substantial equivalence” to an existing device.
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Perspective
The Art of Doing Nothing
Near the end of medical school, I injured my knee running a marathon. What began as classic "runner's knee" during training worsened when I ran the race anyway. A month later, I still couldn't run comfortably but assumed that with ibuprofen and round-the-clock icing, I'd be back to my old routine…
- September 1, 2011
- Rosenbaum L.
- N Engl J Med 2011; 365:782-785
There are times when a knee injury requires not an MRI and specialized orthopedic care but simply rest. Our understanding of such facts and our appreciation of the wisdom and experience of our physicians sometimes seem to be relics of a past era.
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Correspondence
In Vivo Biomechanical Measurements of a Football Player's C6 Spine Fracture
To the Editor: During an investigation of concussion in American football players, we captured in vivo biomechanical data on a cervical spine fracture as it occurred in a male athlete (age, 18 years; height, 189.0 cm; weight, 79.4 kg) who was performing a head-down tackling maneuver. The…
- July 21, 2011
- N Engl J Med 2011; 365:279-281
- Free Full Text
- Video
Sports are a common cause of spine injuries. Video footage documented an 18-year-old football player who sustained a cervical spine fracture during a head-down tackling maneuver. A telemetry system in the player's helmet measured the location and magnitude of the impact that caused the injury.
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Images in Clinical Medicine
Radiographic Zebra Lines from Cyclical Pamidronate Therapy
Figure 1.
- July 21, 2011
- Sarraf K.M.
- N Engl J Med 2011; 365:e5
- Free Full Text
A 6-year-old boy with type IV osteogenesis imperfecta presented to the ER with pain in the right leg after a fall. Plain radiographs revealed an undisplaced, transverse fracture of the right tibia. The images also revealed the presence of radiographic zebra lines.
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Images in Clinical Medicine
Fat Embolism Syndrome
Figure 1.
- May 5, 2011
- Liu H.-K. and Chen W.-C.
- N Engl J Med 2011; 364:1761
- Free Full Text
A 48-year-old man who had a traumatic fracture of the left femoral shaft 20 hours earlier was referred for a deterioration of consciousness that began after the fracture occurred. He was unresponsive to verbal stimuli; no focal neurologic abnormalities were found.
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Medical Meetings Pediatrics Conferences and Meetings

2012 Certifying Examinations of the American Board of Pediatrics

The general pediatrics examination will be held in various cities, Oct. 16-18. Registration for first-time applicants is ongoing through May 3. Registration for re-registrants is ongoing through May 24. The following subspecialty examinations will be held in various cities: "Hospice and Palliative Medicine" (Oct. 4); "Pediatric Transplant Hepatology" (Oct. 11); "Pediatric Cardiology" (Nov. 7); "Pediatric Pulmonology" (Nov. 8); "Medical Toxicology" (Nov. 12); and "Pediatric Critical Care Medicine" (Nov. 14). Registration for first-time applicants is ongoing through April 30. Registration for re-registrants is ongoing through June 15.

Contact the American Board of Pediatrics, 111 Silver Cedar Court, Chapel Hill, NC 27514-1513; or call (919) 929-0461; or fax (919) 918-7114 or (919) 929-9255; or see http://www.abp.org .

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Browse Orthopedics General

Showing 1 to 20 of 207 Articles

Filter Results

Stem Cells and Spinal Cord Repair

Vertebra Plana with Spontaneous Healing

Continuing Bisphosphonate Treatment for Osteoporosis — For Whom and for How Long?

Bisphosphonates for Osteoporosis — Where Do We Go from Here?

Deep Sulcus Sign

Staphylococcus aureus Reactivation Osteomyelitis after 75 Years

Post-Traumatic Herniated Cervical Disk

Pulmonary Cement Embolism after Vertebroplasty

Liberal or Restrictive Transfusion in High-Risk Patients after Hip Surgery

Transfusion Thresholds in FOCUS

Primary Hyperparathyroidism

Metastasis of Renal-Cell Carcinoma

Case 33-2011 — A 56-Year-Old Man with Hypophosphatemia

Medical Device Innovation — Is “Better” Good Enough?

Atypical Femoral Fractures and Bone Turnover

Medical Devices — Balancing Regulation and Innovation

The Art of Doing Nothing

In Vivo Biomechanical Measurements of a Football Player's C6 Spine Fracture

Radiographic Zebra Lines from Cyclical Pamidronate Therapy

Fat Embolism Syndrome

Medical Meetings Pediatrics Conferences and Meetings

2012 Certifying Examinations of the American Board of Pediatrics

Trends: Most Viewed (Last Week)