The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Nov 1996
Randomized Controlled Trial Comparative Study Clinical TrialOperative treatment of fractures of the tibial plafond. A randomized, prospective study.
We performed a randomized, prospective study to compare the results of two methods for the operative fixation of fractures of the tibial plafond. Surgeons were assigned to a group on the basis of the operation that they preferred (randomized-surgeon design). In the first group, which consisted of eighteen patients, open reduction and internal fixation of both the tibia and the fibula was performed through two separate incisions. ⋯ All of the patients, in both groups, who had had a type-II or III fracture had some degree of osteoarthrosis on plain radiographs at the time of the latest follow-up. With the numbers available, there was no significant difference between the two groups with regard to the osteoarthrotic changes. We concluded that external fixation is a satisfactory method of treatment for fractures of the tibial plafond and is associated with fewer complications than internal fixation.
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J Bone Joint Surg Am · Nov 1996
Randomized Controlled Trial Multicenter Study Clinical TrialPrimary anterior dislocation of the shoulder in young patients. A ten-year prospective study.
Two hundred and forty-five patients who had had 247 primary anterior dislocations of the shoulder were followed for ten years in a multicenter study at twenty-seven Swedish hospitals. The ages of the patients at the time of the dislocation ranged from twelve to forty years. The patients were assigned to one of three treatment groups: immobilization with the arm tied with a bandage to the torso for three to four weeks after reduction of the dislocation; use of a sling, which was discontinued after the patient was comfortable; or immobilization for various durations. ⋯ Radiographs made for 208 shoulders at the ten-year follow-up examination were evaluated for post-dislocation arthropathy. Twenty-three shoulders (11 per cent) had mild arthropathy and eighteen (9 per cent) had moderate or severe arthropathy. Some of the shoulders that had arthropathy had had no recurrence.
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J Bone Joint Surg Am · Nov 1996
Randomized Controlled Trial Clinical TrialEfficacy of injections of corticosteroids for subacromial impingement syndrome.
A prospective, randomized, controlled, double-blind clinical study was performed to determine the short-term efficacy of subacromial injection of corticosteroids for the treatment of subacromial impingement syndrome. Forty patients were randomized to receive either six milliliters of 1 per cent lidocaine without epinephrine (the control group) or two milliliters containing forty milligrams of triamcinolone acetonide per milliliter with four milliliters of 1 per cent lidocaine without epinephrine (the corticosteroid group). The patients were re-examined serially until completion of the study. ⋯ The mean active range of forward elevation and external rotation improved by 24 and 11 degrees, respectively, for the corticosteroid group and by 10 and 5 degrees, respectively, for the control group. We concluded that subacromial injection of corticosteroids is an effective short-term therapy for the treatment of symptomatic subacromial impingement syndrome. The use of such injections can substantially decrease pain and increase the range of motion of the shoulder.