JBJS reviews
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Ossification of the posterior longitudinal ligament (OPLL) is defined as ectopic bone formation within the posterior longitudinal ligament. Although various OPLL features (including the extent, shape, and thickness of the OPLL as well as the presence of dural ossification) have been defined in the literature, we are not aware of any systematic reviews that have summarized the associations between these features and clinical outcomes following surgery. The objective of the present study was to conduct a systematic review of the literature to determine whether OPLL characteristics are predictive of outcome in patients undergoing surgery for the treatment of cervical myelopathy. ⋯ Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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In the physiologically compromised elderly patient with an acetabular fracture, nonoperative treatment is associated with functional outcomes (as indicated by the Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] scores) similar to those seen in healthier patients who undergo open reduction and internal fixation, with similar mortality and lesser need for late conversion to total hip arthroplasty. Open reduction and internal fixation of displaced acetabular fractures in patients older than 60 years of age is an excellent option provided that the patient does not have risk factors for failure such as acetabular dome (roof) impaction, femoral-head impaction, or a posterior-wall component. Specific techniques to treat quadrilateral plate involvement and dome impaction are necessary to ensure a durable result. ⋯ Total hip arthroplasty should be considered for patients who are >=60 years of age and have posterior-wall acetabular fractures and perhaps even in younger patients when there are multiple injury factors that predict a poor outcome. The published clinical results of the use of acetabular reconstruction rings, bone graft, and revision arthroplasty techniques appear to be similar to the results of combined internal fixation and insertion of uncemented acetabular components. Surgeons should choose an operative plan that is appropriate to their particular training and skills, the patient's particular fracture, and hospital resources.
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Low-intensity pulsed ultrasound (LIPUS) is frequently used to enhance or to accelerate fracture-healing, but its clinical role and effectiveness as a treatment modality remain uncertain. We performed a systematic review and meta-analysis of randomized controlled trials to determine the efficiency of LIPUS on bone-healing and/or fracture union, as well as on functional recovery. ⋯ Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Review
Nonsteroidal Anti-Inflammatory Drugs and Bone-Healing: A Systematic Review of Research Quality.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are often avoided by orthopaedic surgeons because of their possible influence on bone-healing. This belief stems from multiple studies, in particular animal studies, that show delayed bone-healing or nonunions associated with NSAID exposure. The purpose of this review was to critically analyze the quality of published literature that evaluates the impact of NSAIDs on clinical bone-healing. ⋯ This systematic review highlights the limitations in the current understanding of the effects of NSAIDs on bone healing. Thus, withholding these medications does not have any proven scientific benefit to patients and may even cause harm by increasing narcotic requirements in cases in which they could be beneficial for pain management. This review should encourage further basic-science and clinical studies to clarify the risks and benefits of anti-inflammatory medications in the postoperative period, with the aim of improving patient outcomes.