The Journal of bone and joint surgery. American volume
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This prospective study was performed to determine which clinical and imaging tests were most helpful for diagnosing acromioclavicular joint pain. ⋯ The highly sensitive tests had low specificity, and the highly specific tests had low sensitivity. However, the combination of a positive Paxinos test and a positive bone scan predicted damage to the acromioclavicular joint as the cause of shoulder pain with a high degree of confidence.
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Management of compartment syndrome in the modern era involves not only avoiding the sequelae of a missed diagnosis but also minimizing the risk of a malpractice claim. Little information is available on the legal aspects of compartment syndrome. ⋯ While malpractice claims involving compartment syndrome were uncommon, they resulted in a high rate and amount of indemnity payments. Early fasciotomy not only improves patient outcome but is also associated with decreased indemnity risk.
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J Bone Joint Surg Am · Apr 2004
Case ReportsSelective neurotization of the median nerve in the arm to treat brachial plexus palsy. An anatomic study and case report.
The current method for treatment of median nerve palsy after a brachial plexus injury is unpredictable. On the basis of an anatomic study of the median nerve in the arm, we present a new method of selective neurotization of the median nerve. ⋯ The typical arrangement of the fascicular groups of the median nerve in the arm favors the technique of selective neurotization, which has been used effectively in one patient to date.
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J Bone Joint Surg Am · Apr 2004
Randomized Controlled Trial Comparative Study Clinical TrialTreatment of lumbar disc herniation: epidural steroid injection compared with discectomy. A prospective, randomized study.
Epidural steroid injection is a low-risk alternative to surgical intervention in the treatment of lumbar disc herniation. The objective of this study was to determine the efficacy of epidural steroid injection in the treatment of patients with a large, symptomatic lumbar herniated nucleus pulposus who are surgical candidates. ⋯ Epidural steroid injection was not as effective as discectomy with regard to reducing symptoms and disability associated with a large herniation of the lumbar disc. However, epidural steroid injection did have a role: it was found to be effective for up to three years by nearly one-half of the patients who had not had improvement with six or more weeks of noninvasive care.
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J Bone Joint Surg Am · Apr 2004
Comparative StudyLateral-entry pin fixation in the management of supracondylar fractures in children.
There has been controversy regarding the optimal pin configuration in the management of supracondylar humeral fractures in children. A crossed-pin configuration may be mechanically more stable than lateral pins in torsional loading, but it is associated with a risk of iatrogenic injury to the ulnar nerve. Previous clinical studies have suggested that lateral pins provide sufficient fixation of unstable supracondylar fractures. However, these studies were retrospective and subject to patient-selection bias. ⋯ In this large, consecutive series without selection bias, the use of lateral-entry pins alone was effective for even the most unstable supracondylar humeral fractures. There were no iatrogenic ulnar nerve injuries, and no reduction was lost. The important technical points for fixation with lateral-entry pins are (1) maximize separation of the pins at the fracture site, (2) engage the medial and lateral columns proximal to the fracture, (3) engage sufficient bone in both the proximal segment and the distal fragment, and (4) maintain a low threshold for use of a third lateral-entry pin if there is concern about fracture stability or the location of the first two pins.