The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · May 2008
Randomized Controlled Trial Multicenter StudyTreatment of persistent shoulder pain with sodium hyaluronate: a randomized, controlled trial. A multicenter study.
Presently, there are no approved nonoperative therapies for the ongoing treatment of persistent shoulder pain. Preliminary data suggest that intra-articular sodium hyaluronate injections may be beneficial for the treatment of persistent shoulder pain resulting from various etiologies. The present study evaluated the efficacy and safety of sodium hyaluronate (Hyalgan; molecular weight, 500 to 730 kDa) for these patients. ⋯ Although the primary end point of this study (that is, improvement in terms of shoulder pain at thirteen weeks) was not achieved, the overall findings, including secondary end points, indicate that sodium hyaluronate (500 to 730 kDa) is effective and well tolerated for the treatment of osteoarthritis and persistent shoulder pain that is refractory to other standard nonoperative interventions.
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J Bone Joint Surg Am · May 2008
Randomized Controlled TrialImproving evaluation and treatment for osteoporosis following distal radial fractures. A prospective randomized intervention.
Fragility fractures are associated with a significant increase in the risk of future fracture, but the rates of evaluation to identify osteoporosis after such injuries are low. The purpose of this study was to determine the rates of evaluation and treatment of osteoporosis following distal radial fractures and to test two interventions in the outpatient clinic to improve evaluation and treatment rates. ⋯ Rates of evaluation and treatment for osteoporosis after fragility fractures remain low (21.3% and 27.5%, respectively). Patients who undergo a bone mineral density examination are more likely to receive treatment. Ordering a bone mineral density examination in the orthopaedic clinic can dramatically improve osteoporosis evaluation and treatment rates following fragility fractures of the distal part of the radius.
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J Bone Joint Surg Am · May 2008
Randomized Controlled TrialTime-dependent contamination of opened sterile operating-room trays.
There are no clear guidelines for how long a sterile operating-room tray can be exposed to the open environment before the contamination risk becomes unacceptable. The purpose of this study was to determine the time until first contamination and the rate of time-dependent contamination of sterile trays that had been opened in a controlled operating-room environment. We also examined the effect of operating-room traffic on the contamination rate. ⋯ Culture positivity correlated directly with the duration of open exposure of the uncovered operating-room trays. Light traffic in the operating room appeared to have no impact on the contamination risk. Coverage of surgical trays with a sterile towel significantly reduced the contamination risk.
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J Bone Joint Surg Am · May 2008
Review Comparative StudyThe relationship between the outcome of operatively treated calcaneal fractures and institutional fracture load. A systematic review of the literature.
It has been assumed that outcome after open reduction and internal fixation of displaced intra-articular calcaneal fractures may be affected by the presence of institutional trauma care and the institution's fracture volume. The purpose of this systematic review was to investigate whether a relationship exists between institutional fracture load and the rates of serious infection and subtalar arthrodesis following the treatment of these fractures. ⋯ A significant relationship between the deep infection rate, traumatic subtalar arthritis, and the fracture load may indicate a need for specialized institutional trauma care to improve outcomes associated with the operative treatment of calcaneal fractures.
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J Bone Joint Surg Am · May 2008
Randomized Controlled Trial Comparative StudySlower recovery after two-incision than mini-posterior-incision total hip arthroplasty. A randomized clinical trial.
It has been claimed that the two-incision total hip arthroplasty technique provides quicker recovery than other methods do. To date, however, there have been no studies that have directly compared the two-incision technique with another method in similar groups of patients managed with the same advanced anesthetic and rehabilitation protocol. We posed the hypothesis that patients managed with two-incision total hip arthroplasty would recover faster than those managed with mini-posterior-incision total hip arthroplasty and designed a randomized controlled trial specifically (1) to determine if patients recovered faster after two-incision total hip arthroplasty than after mini-posterior-incision total hip arthroplasty as measured on the basis of the attainment of functional milestones that reflect activities of daily living, (2) to determine if the general health outcome after two-incision total hip arthroplasty was better than that after mini-posterior-incision total hip arthroplasty as measured with Short Form-12 (SF-12) scores, and (3) to evaluate the surgical complexity of the two procedures on the basis of the operative time and the prevalence of early complications. ⋯ Our hypothesis that the two-incision technique for total hip arthroplasty would substantially improve the short-term recovery after total hip arthroplasty compared with the mini-posterior incision technique was not proved; instead, the patients managed with the mini-posterior-incision technique had the quicker recovery.