The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Aug 2008
Trigger finger: prognostic indicators of recurrence following corticosteroid injection.
Corticosteroid injections are commonly used in the treatment of flexor tenosynovitis in adults. The present study was performed in an attempt to identify prognostic indicators of symptom recurrence one year after corticosteroid injection for the treatment of trigger digits. ⋯ At one year following injection, 56% of the digits had a recurrence of symptoms. Younger age, insulin-dependent diabetes mellitus, involvement of multiple digits, and a history of other tendinopathies of the upper extremity were associated with a higher rate of treatment failure. Symptoms often recurred several months after the injection.
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J Bone Joint Surg Am · Aug 2008
Comparative StudyComparison of thoracolumbar motion produced by manual and Jackson-table-turning methods. Study of a cadaveric instability model.
Patients who have sustained a spinal cord injury remain at risk for further neurologic deterioration until the spine is adequately stabilized. To our knowledge, no study has previously addressed the effects of different bed-to-operating room table transfer techniques on thoracolumbar spinal motion in an instability model. We hypothesized that the conventional logroll technique used to transfer patients from a supine position to a prone position on the operating room table has the potential to confer significantly more motion to the unstable thoracolumbar spine than the Jackson technique. ⋯ This study addresses in-hospital patient safety. Performing the Jackson turn requires approximately half as many people as required for a manual logroll. This study suggests that the Jackson technique should be considered for supine-to-prone transfer of patients with known or suspected instability of the thoracolumbar spine.
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J Bone Joint Surg Am · Aug 2008
Comparative StudyGeographic variation in epidural steroid injection use in medicare patients.
The rates of epidural steroid injections have increased dramatically over time, with conflicting evidence regarding the efficacy of epidural steroid injections for the treatment of various low-back pain disorders. Given the uncertainty about their role, we sought to evaluate the geographic variation in the use of epidural steroid injections for low back pain within the United States. We also sought to determine whether greater rates of epidural steroid injections are associated with lower rates of lumbar surgery. ⋯ There is substantial geographic variation in the rates of epidural steroid injections within the United States. Southern states tend to have the highest procedure rates, whereas northeastern states have the lowest. Injection rates are positively correlated with lumbar surgery rates; therefore, epidural steroid injections do not appear to be substituting for lumbar surgeries or reducing overall rates of lumbar surgery.
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J Bone Joint Surg Am · Aug 2008
The future of the orthopaedic clinician-scientist. Part I: The potential role of MD-PhD students considering orthopaedic surgery.
There is currently a severe shortage of clinician-scientists, who fill a vital role in musculoskeletal care. One way to address this shortage is to recruit more MD-PhD students into orthopaedics. We analyzed data from a national survey of MD-PhD students to assess this potential. ⋯ This study suggests that there is a relatively strong interest in orthopaedic surgery (patient care and research) among MD-PhD students nationally, creating the potential to recruit approximately 100 new orthopaedic clinician-scientists every eight years (the average MD-PhD training period). Extrapolation indicates that there is the ability to double the number of orthopaedic clinician-scientists in the United States over the next fifty years. Therefore, efforts should be made to attract these students (especially women and those in underrepresented minority groups) to orthopaedic surgery. The study further suggests recruiting broadly-we should not be biased toward students late in training and just those with surgical interests.
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J Bone Joint Surg Am · Aug 2008
Multicenter StudyCell count and differential of aspirated fluid in the diagnosis of infection at the site of total knee arthroplasty.
Although there is no absolute diagnostic test for periprosthetic infection, the synovial fluid leukocyte count and neutrophil percentage have been reported to have high sensitivity and specificity. However, the cutoff values for these tests are not agreed upon. We sought to identify definite cutoff values for both the fluid leukocyte count and the neutrophil percentage that may help to diagnose infection at the site of a prosthetic joint. ⋯ The synovial fluid leukocyte count and differential are useful adjuncts to the erythrocyte sedimentation rate and the C-reactive protein level in the preoperative workup of infection at the site of a total knee arthroplasty. The present study identified cutoff values for the leukocyte count (>1100 cells/10(-3)cm(3)) and neutrophil percentage (>64%) that can be used to diagnose infection. Combining the peripheral blood tests with the synovial fluid cell count and differential can improve their diagnostic value.