The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Oct 2006
Comparative StudyTwo-part surgical neck fractures of the proximal part of the humerus. A biomechanical evaluation of two fixation techniques.
Successful internal fixation of fractures of the surgical neck of the humerus can be difficult to achieve because of osteopenia of the proximal aspect of the humerus. The purpose of this study was to compare the biomechanical stability of a proximal humeral intramedullary nail and a locking plate for the treatment of a comminuted two-part fracture of the surgical neck in a human cadaver model. ⋯ The high failure rate in torsion of the proximal humeral nail-bone construct is concerning, and, with relatively osteoporotic bone and early motion, the results could be poor.
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J Bone Joint Surg Am · Oct 2006
Reconstruction of segmental bone defects due to chronic osteomyelitis with use of an external fixator and an intramedullary nail.
Callus distraction over an intramedullary nail is a rarely used technique for the reconstruction of intercalary defects of the femur and tibia after radical débridement of chronic osteomyelitic foci. The aim of this study was to summarize our experience with distraction osteogenesis performed with an external fixator combined with an intramedullary nail for the treatment of bone defects and limb-shortening resulting from radical débridement of chronic osteomyelitis. ⋯ This combined method may prove to be an improvement on the classic techniques for the treatment of a nonunion of a long bone associated with chronic osteomyelitis, in terms of external fixation period and consolidation index. The earlier removal of the external fixator is associated with increased patient comfort, a decreased complication rate, and a convenient and rapid rehabilitation.
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J Bone Joint Surg Am · Oct 2006
The influence of cognitive function on outcome after a hip fracture.
Previous studies have indicated that patients with a hip fracture who have impaired cognitive function have an increased risk for complications, poor long-term outcome, and an increased mortality rate. An assessment of cognitive function is often lacking in nursing and medical records. We investigated whether an assessment of cognitive function obtained with use of a validated instrument would be a useful patient management adjunct. ⋯ The systematic use of the Short Portable Mental Status Questionnaire upon admission to the orthopaedic ward identifies patients with a hip fracture who have severe cognitive dysfunction and effectively predicts their outcome with regard to the ability to walk, ability to perform the activities of daily living, and mortality, and it can be recommended for use in the care of elderly patients with a hip fracture.
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J Bone Joint Surg Am · Oct 2006
Comminuted radial head fractures treated with a modular metallic radial head arthroplasty. Study of outcomes.
Comminuted fractures of the radial head are challenging to treat with open reduction and internal fixation. Radial head arthroplasty is an alternative treatment with results that compare favorably with those reported after open reduction and internal fixation of similar fractures. The purpose of this study was to evaluate the two-year outcomes and the rate of recovery of a closely followed cohort of patients in whom an unreconstructible radial head fracture had been treated with a modular metallic prosthesis. ⋯ An arthroplasty with a modular metallic radial head is a safe and effective option for the treatment of unreconstructible radial head fractures associated with other elbow injuries. Recovery primarily occurs by six months, with minimal additional improvements over the next eighteen months.
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J Bone Joint Surg Am · Oct 2006
Are patients being transferred to level-I trauma centers for reasons other than medical necessity?
In the United States, the Emergency Medical Treatment and Active Labor Act defines broad guidelines regarding interhospital transfer of patients who have sought care in the emergency department. However, patient transfers for nonmedical reasons are still considered a common practice. The purpose of this study was to evaluate the possible risk factors for hospital transfer in a population of patients unlikely to require transfer to a level-I center for medical reasons. ⋯ These results suggest the need for prospective studies to further investigate the relationships between hospital transfer and medical and nonmedical factors.