The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Jun 2008
Risk factors in redisplacement of distal radial fractures in children.
The causes of redisplacement following closed treatment of distal metaphyseal radial fractures in children are still controversial. Various risk factors and radiographic indices have been suggested to predict redisplacement. The aims of this study were to prospectively identify the causes of redisplacement and to test the accuracy of previously described radiographic indices and our new method, the "three-point index." ⋯ Initial complete displacement and the degree of obliquity of the fracture line are the dominant factors affecting redisplacement. Our new radiographic index, the three-point index, should be used to predict redisplacement and assess the quality of the cast treatment of these fractures.
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J Bone Joint Surg Am · Jun 2008
Comparative StudyLong-term health-related quality of life after surgery for adolescent idiopathic scoliosis and spondylolisthesis.
The aim of surgical treatment for adolescent idiopathic scoliosis is primarily to prevent progression and secondarily to correct the deformity, whereas the goal of surgical treatment of pediatric spondylolisthesis is mainly to relieve pain and, in patients with a high-grade slip, to prevent progression. The aim of this study was to compare the long-term health-related quality of life after surgery for idiopathic scoliosis and spondylolisthesis in adolescence. ⋯ Patients have good long-term health-related quality of life after surgery for idiopathic scoliosis and spondylolisthesis in adolescence. Patients who have surgery for idiopathic scoliosis are likely to have better long-term outcomes than are patients who have surgery for spondylolisthesis. It is possible that back pain in adolescence may affect quality of life more than spinal deformity does.
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J Bone Joint Surg Am · Jun 2008
A coordinator program in post-fracture osteoporosis management improves outcomes and saves costs.
The orthopaedic unit at a university teaching hospital hired an osteoporosis coordinator to identify patients with a fragility fracture and to coordinate their education, assessment, referral, and treatment of underlying osteoporosis. We report the results of an analysis of the cost-effectiveness of the use of a coordinator (in comparison with the use of no coordinator) in avoiding future costs of subsequent hip fracture. ⋯ Employment of an osteoporosis coordinator to manage outpatients and inpatients who have fragility fractures is predicted to reduce the incidence of future hip fractures and to save money (a dominant strategy). A probabilistic sensitivity analysis showed a high probability of cost-effectiveness of this intervention from the hospital cost perspective.
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J Bone Joint Surg Am · Jun 2008
The use of long cemented stems for femoral impaction grafting in revision total hip arthroplasty.
Following revision total hip arthroplasty involving femoral impaction grafting, fractures usually have occurred distal to a standard-length stem in an area of weakened bone that was left inadequately supported. The purpose of the present study was to determine whether the use of a long stem decreases the rate of femoral fracture after revision hip surgery. We hypothesized that the use of a long-stem femoral component would decrease the risk of these fractures. ⋯ The use of a long stem for femoral impaction grafting did not completely resolve the problem of postoperative fractures in these patients with substantial loss of bone stock undergoing revision hip surgery. Poor bone stock, technical errors, and other patient-related factors continue to account for the high postoperative fracture rate.
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J Bone Joint Surg Am · Jun 2008
Pulmonary function following early thoracic fusion in non-neuromuscular scoliosis.
While early spinal fusion may halt progressive deformity in young children with scoliosis, it does not facilitate lung growth and, in certain children, it can result in thoracic insufficiency syndrome. The purpose of this study was to determine pulmonary function at intermediate-term follow-up in patients with scoliosis who underwent thoracic fusion before the age of nine years. ⋯ Patients with proximal thoracic deformity who require fusion of more than four segments, especially those with rib anomalies, are at the highest risk for the development of restrictive pulmonary disease. Pulmonary function tests should be performed for all patients who have an early fusion. The pursuit of alternative procedures to treat early spinal deformity is merited.