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Bone morphogenetic protein-2 (BMP-2) is currently the only Food and Drug Administration (FDA)-approved osteoinductive growth factor used as a bone graft substitute. However, with increasing clinical use of BMP-2, a growing and well-documented side effect profile has emerged. This includes postoperative inflammation and associated adverse effects, ectopic bone formation, osteoclast-mediated bone resorption, and inappropriate adipogenesis. Several large-scale studies have confirmed the relative frequency of adverse events associated with the clinical use of BMP-2, including life-threatening cervical spine swelling. In fact, the FDA has issued a warning of the potential life-threatening complications of BMP-2. This review summarizes the known adverse effects of BMP-2, including controversial areas such as tumorigenesis. Next, select animal models that replicate BMP-2's adverse clinical effects are discussed. Finally, potential molecules to mitigate the adverse effects of BMP-2 are reviewed. In summary, BMP-2 is a potent osteoinductive cytokine that has indeed revolutionized the bone graft substitute market; however, it simultaneously has accrued a worrisome side effect profile. Better understanding of these adverse effects among both translational scientists and clinicians will help determine the most appropriate and safe use of BMP-2 in the clinical setting.

Background Surgical site infections (SSI) continue to be a significant source of morbidity despite the introduction of perioperative intravenous antibiotics. Our objective was to assess the efficacy of local vancomycin powder on lowering deep SSI rates in high-energy tibial plateau and pilon fractures. Materials and methods A retrospective review of all tibial plateau and pilon fractures treated in 2012 at our level I trauma center identified 222 patients. Of these, 107 patients sustained high-energy injuries that required staged fixation, and 93 had minimum 6 month follow-up. Ten patients received 1 gram vancomycin powder directly into the surgical wound at the time of definitive fixation, and the remaining 83 patients served as controls. SSI was defined according to criteria from the Centers for Disease Control. Demographic data, patient comorbidities, injury and treatment details, and infection details were recorded. Descriptive and comparative statistics were performed. Results Amongst the vancomycin powder group, 1 patient (10 %) developed a deep SSI; in the control group, 14 (16.7 %) developed deep SSI. The rate of deep SSI between the groups was not statistically significantly different ( P  = 1.0). The groups were statistically similar with regard to injuries, treatment, comorbidities, and infectious outcomes ( P values range = 0.06–1.0). Conclusions The application of local vancomycin powder into surgical wounds of high-energy tibial plateau and pilon fractures did not reduce the rate of deep SSI in this retrospective review. There is a need to find effective, cheap, and widely available methods for prevention of SSI. Basic science and larger prospective clinical studies are needed to further delineate the role of local vancomycin powder as a modality to reduce deep SSI in extremity trauma. Level of evidence Level III, therapeutic.

Introduction Superior labrum anterior to posterior (SLAP) tears are injuries of the shoulder's glenoid labrum involving biceps tendon insertion. We describe the scope of outcome measures used in the SLAP tear literature over the last decade and evaluate whether objective study metrics relate to level of evidence (LOE) and journal rank. Methods A comprehensive review of the literature was performed to identify all articles on the outcomes of the treatment of patients with SLAP tears published over the period of a decade (2007-2016). Studies were reviewed for LOE, SCImago Scientific Journal Ranking (SJR), study characteristics, and patient demographics. The utilization frequencies of outcome measures were recorded. Outcome measures were categorized as clinician-measured outcomes (CMOs), outcome scores/patient-reported outcomes (PROs), or other reported outcomes (OROs). Univariate analyses compared demographics and outcome-measure utilization among studies grouped by LOE (high: I/II vs. low: III/IV) and SJR (high: >2 vs. low: <2). Results The literature review identified 86 studies meeting inclusion criteria from an initial search of 582 articles. The mean study SJR was 2.02 and 0.85 +/- 0.79 CMOs were included. Twenty different outcome scores were utilized in the reviewed literature with a mean of 2.66 +/- 1.61 PROs/study. The most common outcome scores were ASES score, pain Visual Analog Scale (VAS), and constant score. High SJR studies had longer follow-up (p=0.036). High LOE studies utilized more CMOs (p=0.008) and more commonly included physical exam findings (p=0.0015). Revision surgery rate was less commonly reported in high LOE studies (p=0.036). None of the other outcome measures studied were associated with high study LOE or SJR. Conclusions Considerable variability exists in outcome-measure utilization within the recent SLAP tear literature. ASES score, pain VAS, and constant score are the most commonly reported PROs. CMOs and OROs are infrequently reported. There is little objectivity distinguishing higher and lower quality studies based on the proxy metrics used. Future SLAP tear research should focus on improving the consistency of outcome-measure reporting to enable more meaningful cross-study comparisons.

Cryptococcus neoformans is an encapsulated yeast responsible for disseminated meningitis in immunocompromised hosts. Controversies persist on the existence of primary cutaneous cryptococcosis (PCC) versus cutaneous cryptococcosis being only secondary to hematogenous dissemination. Thus, we reviewed cryptococcosis cases associated with skin lesions reported in the French National Registry. Patients with PCC (n = 28) differed significantly from those with secondary cutaneous cryptococcosis (n = 80) or other forms of the disease (n = 1866) by living area (mostly rural), age (older), ratio of men to women (∼1:1), and the lack of underlying disease. Evidence of PCC included the absence of dissemination and, predominantly, a solitary skin lesion on unclothed areas presenting as a whitlow or phlegmon, a history of skin injury, participation in outdoor activities, or exposure to bird droppings, and isolation of C. neoformans serotype D. Therefore, PCC is a distinct epidemiological and clinical entity with a favorable prognosis even for immunocompromised hosts.