The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Oct 2004
Multicenter Study Comparative Study Clinical Trial Controlled Clinical TrialLegg-Calve-Perthes disease. Part II: Prospective multicenter study of the effect of treatment on outcome.
The treatment of Legg-Calve-Perthes disease has been based on uncontrolled retrospective studies with relatively small numbers of patients. This large, controlled, prospective, multicenter study was designed to determine the effect of treatment and other risk factors on the outcome in patients with this disorder. ⋯ The lateral pillar classification and age at the time of onset of the disease strongly correlate with outcome in patients with Legg-Calve-Perthes disease. Patients who are over the age of 8.0 years at the time of onset and have a hip in the lateral pillar B group or B/C border group have a better outcome with surgical treatment than they do with nonoperative treatment. Group-B hips in children who are less than 8.0 years of age at the time of onset have very favorable outcomes unrelated to treatment, whereas group-C hips in children of all ages frequently have poor outcomes, which also appear to be unrelated to treatment.
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J Bone Joint Surg Am · Oct 2004
Multicenter StudyPredicting the outcome of total knee arthroplasty.
The relief of pain and the restoration of functional activities are the main outcomes of primary total knee arthroplasty for the treatment of osteoarthritis. This paper examines the preoperative predictors of pain and functional outcome at one and two years following total knee arthroplasty. ⋯ Patients who have marked functional limitation, severe pain, low mental health score, and other comorbid conditions before total knee arthroplasty are more likely to have a worse outcome at one year and two years postoperatively. After adjusting for these predictors, it was found that patients from the United Kingdom had significantly worse functional outcomes but similar pain relief compared with those from the United States and Australia.
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J Bone Joint Surg Am · Oct 2004
Randomized Controlled Trial Comparative Study Clinical TrialAnterior cruciate ligament reconstruction: bone-patellar tendon-bone compared with double semitendinosus and gracilis tendon grafts. A prospective, randomized clinical trial.
The choice of graft for anterior cruciate ligament reconstruction is a matter of debate, with patellar and hamstring tendons being the two most popular autologous graft options. The objective of this study was to determine in a prospective, randomized clinical trial whether two grafts (bone-patellar tendon-bone or doubled hamstring tendons) fixed with modern devices affect the two-year minimum clinical and radiographic outcomes of anterior cruciate ligament reconstruction. ⋯ We believe that, with use of accurate and proven surgical and rehabilitation techniques, both grafts are an equivalent option for anterior cruciate ligament reconstruction.
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J Bone Joint Surg Am · Oct 2004
The relationship between required medical school instruction in musculoskeletal medicine and application rates to orthopaedic surgery residency programs.
Orthopaedic residency programs lack gender and race diversity. This study examines the hypothesis that exposure to a required course in musculoskeletal medicine in medical school is associated with a higher rate of application to orthopaedic surgery residency programs by underrepresented groups. ⋯ Required instruction in musculoskeletal medicine was associated with a 12% higher rate of application to orthopaedic surgery residency programs among all students (5.7% of those who received required instruction compared with 5.1% of those who did not). The relative difference was more pronounced among women (a 75% difference in the rate of application) and minorities (a 35% difference in the rate of application). This study suggests that required instruction in musculoskeletal medicine can help to promote diversity in orthopaedic surgery residency programs.
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J Bone Joint Surg Am · Oct 2004
Open reduction and stable fixation of isolated, displaced talar neck and body fractures.
The purpose of this retrospective review was to evaluate the long-term results of surgical treatment of isolated, displaced talar neck and/or body fractures with stable internal fixation. ⋯ Open reduction and internal fixation is recommended for the treatment of displaced talar neck and/or body fractures. A delay in surgical fixation does not appear to affect the outcome, union, or prevalence of osteonecrosis. Posttraumatic arthritis is a more common complication than osteonecrosis following operative treatment. Patients with a displaced fracture of the talus should be counseled that posttraumatic arthritis and chronic pain are expected outcomes even after anatomic reduction and stable fixation. This is especially true following open fractures.