The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · May 2003
Randomized Controlled Trial Comparative Study Clinical TrialOperative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit. A prospective, randomized study.
To our knowledge, a prospective, randomized study comparing operative and nonoperative treatment of a thoracolumbar burst fracture in patients without a neurological deficit has never been performed. Our hypothesis was that operative treatment would lead to superior long-term clinical outcomes. ⋯ We found that operative treatment of patients with a stable thoracolumbar burst fracture and normal findings on the neurological examination provided no major long-term advantage compared with nonoperative treatment.
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J Bone Joint Surg Am · May 2003
Multicenter StudyFoot and ankle fractures in elderly white women. Incidence and risk factors.
Although foot and ankle fractures are among the most common nonspinal fractures occurring in older women, little is known about their epidemiology. This study was designed to determine the incidence of and risk factors for foot and ankle fractures in a cohort of 9704 elderly, nonblack women enrolled in the multicenter Study of Osteoporotic Fractures. ⋯ Overall, foot fractures appeared to be typical osteoporotic fractures, whereas ankle fractures occurred in younger women with a relatively high body mass index.
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J Bone Joint Surg Am · May 2003
Multicenter StudyGradual femoral lengthening with the Albizzia intramedullary nail.
Gradual limb lengthening with currently used external fixation techniques can result in less than optimal outcomes, with complications including infection, stiffness of adjacent joints, and secondary axial deviation of the extremity. We describe a totally implantable lengthening device designed to provide results similar to those achieved with external fixation devices, with fewer complications and improved outcomes. ⋯ Femoral lengthening with use of the minimally invasive Albizzia technique provides a reasonable alternative to external fixation that is well tolerated by patients and results in excellent function with little or no distortion of body image.
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Despite the good results that are usually reported after fixation at the sites of olecranon fractures and osteotomies, problems such as loss of fixation, nonunion, and the need for revision surgery are still encountered. Various types of fixation have been recommended, but few have been evaluated with use of clinically relevant cyclic load testing at appropriate levels of stress. The purpose of the present study was to test multiple olecranon fixation techniques under physiologic cyclic loads. ⋯ The use of a 7.3-mm screw in conjunction with a tension band provided better fixation of simulated displaced transverse fractures than did the use of Kirschner wires in conjunction with a tension band or the use of a screw only. The AO principle of converting posterior tensile forces to articular compressive forces was not demonstrated in this study. We therefore question the validity of the tension band concept in olecranon fracture fixation and recommend passive rather than active range of motion in the immediate postoperative period to limit fracture distraction.
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Plantar fasciitis is one of the more common soft-tissue disorders of the foot, yet little is known about its etiology. The purpose of the present study was to use an epidemiological design to determine whether risk factors for plantar fasciitis could be identified. Specifically, we examined the risk factors of limited ankle dorsiflexion with the knee extended, obesity, and time spent weight-bearing. ⋯ The risk of plantar fasciitis increases as the range of ankle dorsiflexion decreases. Individuals who spend the majority of their workday on their feet and those whose body-mass index is >30 kg/m (2) are also at increased risk for the development of plantar fasciitis. Reduced ankle dorsiflexion, obesity, and work-related weight-bearing appear to be independent risk factors for plantar fasciitis. Reduced ankle dorsiflexion appears to be the most important risk factor.