JBJS reviews
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Nonsteroidal anti-inflammatory drugs (NSAIDs) are being increasingly employed as a part of multimodal non-opioid strategies to treat postoperative pain. In the present study, we sought to review the effects of short-term NSAID use on musculoskeletal soft-tissue healing. ⋯ Current limited evidence demonstrates that selective COX-2 inhibitors can negatively affect healing of musculoskeletal soft tissue after surgical repair. In contrast, the majority of studies demonstrate that nonselective COX inhibitors have no negative effect on musculoskeletal soft-tissue healing. Additional high-quality human clinical trials are necessary to provide more definitive conclusions.
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We conducted a meta-analysis of randomized trials to determine the effect of the use of an orthosis (as compared with no orthosis) on clinical and radiographic outcomes in neurologically intact patients with thoracolumbar burst fractures. Optimal nonoperative treatment of thoracolumbar burst fractures in neurologically intact patients remains inconclusive. Conventional care prescribes spine precautions and a thoracolumbar orthosis. Recent studies have suggested that patients with stable burst fractures can obtain comparable outcomes with or without bracing. ⋯ Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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The minimum clinically important difference (MCID) was developed to ascertain the smallest change in an outcome that patients perceive as beneficial. The objectives of the present review were (1) to compare the MCIDs for pain assessments used among guidelines and meta-analyses investigating different nonsurgical therapies for knee osteoarthritis and (2) to compare the effect estimates of different nonsurgical interventions against a single commonly-utilized MCID threshold. ⋯ Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Reconstruction of segmental bone loss due to malignancy, infection, or trauma is a challenge for the reconstructive surgeon. The combination of a vascularized fibular flap with a cortical allograft provides a reliable reconstructive option in the lower extremity. In this systematic review, we describe the outcome of this technique for the treatment of segmental bone loss. ⋯ Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Obesity has been associated with a greater burden of symptomatic knee osteoarthritis. There is some evidence that patients with a very high body mass index (BMI) may have a higher risk of complications and poor outcomes following total knee replacement compared with non-obese patients or obese patients with a lower BMI. We hypothesized that increasing degrees of obesity would be associated with deteriorating outcomes for patients following total knee replacement. ⋯ Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.