The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Jul 2007
Timely fracture-healing requires optimization of axial fixation stability.
Bone-healing is known to be sensitive to the mechanical stability of fixation. However, the influence on healing of the individual components of fixation stiffness remains unclear. The aim of this study was to investigate the relationship between the initial in vitro fixation stiffness and the strength and stiffness of the callus after nine weeks. We hypothesized that axial stiffness would determine the healing outcome. ⋯ In this study, a clear relationship between the stability of fixation and the mechanical strength of the healing tibia was seen. Moderate levels of axial stability were associated with the highest callus strength and stiffness.
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J Bone Joint Surg Am · Jul 2007
Are outcomes of bimalleolar fractures poorer than those of lateral malleolar fractures with medial ligamentous injury?
Recommendations for surgical treatment and expected outcomes differ for two unstable patterns of supination-external rotation ankle injuries. We compared the demographic characteristics and functional outcome following surgical stabilization between the two types of supination-external rotation type-4 fractures: distal fibular fracture with a deltoid ligament rupture and bimalleolar fracture. ⋯ At one year after surgical stabilization of an unstable ankle fracture, most patients experience little or mild pain and have few restrictions in functional activities. However, the functional outcome for those with a bimalleolar fracture is worse than that for those with a lateral malleolar fracture and disruption of the deltoid ligament, possibly because of the injury pattern and the energy expended.
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J Bone Joint Surg Am · Jul 2007
Complex posterior fracture-dislocation of the shoulder. Epidemiology, injury patterns, and results of operative treatment.
Complex posterior fracture-dislocations of the shoulder are rare and often associated with poor long-term function regardless of the choice of treatment. The purposes of this study were to evaluate the epidemiology and pathological anatomy of posterior fracture-dislocations of the shoulder and to assess the clinical and radiographic outcomes of a specific treatment protocol of open reduction and internal fixation. ⋯ Acute complex posterior fracture-dislocations of the shoulder are rare, but they occur in patients who are younger than the majority of other patients who sustain a proximal humeral fracture. The use of open reduction and internal fixation to treat these fractures is associated with a relatively low risk of postoperative complications, and the functional outcome is generally favorable.
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J Bone Joint Surg Am · Jul 2007
Randomized Controlled Trial Multicenter StudyCan vitamin C prevent complex regional pain syndrome in patients with wrist fractures? A randomized, controlled, multicenter dose-response study.
Complex regional pain syndrome type I is treated symptomatically. A protective effect of vitamin C (ascorbic acid) has been reported previously. A dose-response study was designed to evaluate its effect in patients with wrist fractures. ⋯ Vitamin C reduces the prevalence of complex regional pain syndrome after wrist fractures. A daily dose of 500 mg for fifty days is recommended.
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J Bone Joint Surg Am · Jul 2007
The outcome and structural integrity of arthroscopic rotator cuff repair with use of the double-row suture anchor technique.
The reported rate of failure after arthroscopic rotator cuff repair has varied widely. The influence of the repair technique on the failure rates and functional outcomes after open or arthroscopic rotator cuff repair remains controversial. The purpose of the present study was to evaluate the functional and anatomic results of arthroscopic rotator cuff repairs performed with the double-row suture anchor technique on the basis of computed tomography or magnetic resonance imaging arthrography in order to determine the postoperative integrity of the repairs. ⋯ Arthroscopic repair of a rotator cuff tear with use of the double-row suture anchor technique results in a much lower rate of failure than has previously been reported in association with either open or arthroscopic repair methods. Patients with an intact rotator cuff repair have better pain relief than those with a failed repair. After repair, large and massive rotator cuff tears result in more postoperative weakness than small tears do.