The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Mar 2009
Randomized Controlled Trial Comparative StudySlower recovery after two-incision than mini-posterior-incision total hip arthroplasty. Surgical technique.
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.
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J Bone Joint Surg Am · Mar 2009
Association between decreased bone mineral density and severity of distal radial fractures.
The role of osteoporosis and osteopenia in the etiology of fractures of the distal part of the radius is well established, but any link between osteoporosis and the severity of the distal radial fracture has not been extensively investigated. The aim of this study was to investigate the association between the degree of osteoporosis and the severity of distal radial fractures. ⋯ There is a definite correlation between bone mineral density and the severity of distal radial fractures.
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J Bone Joint Surg Am · Mar 2009
Proximal humeral fracture as a risk factor for subsequent hip fractures.
With the aging of the world's population, the social and economic implications of osteoporotic fractures are at epidemic proportions. This study was performed to test the hypothesis that a proximal humeral fracture is an independent risk factor for a subsequent hip fracture and that the risk of the subsequent hip fracture is highest within the first five years after the humeral fracture. ⋯ In this cohort of older white women, a proximal humeral fracture independently increased the risk of a subsequent hip fracture more than five times in the first year after the humeral fracture but was not associated with a significant increase in the hip fracture risk in subsequent years.
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Fractures of the lesser tuberosity are rare injuries, and little is known of their epidemiology. Operative treatment is generally recommended for displaced fractures; however, the outcome of this method of treatment has not previously been studied. The aims of our study were to determine the approximate incidence of lesser tuberosity fractures, as well as the functional outcome following operative treatment in a consecutive series of patients. ⋯ A lesser tuberosity fracture, without an associated humeral head or greater tuberosity fracture, is a rare injury. Open reduction and internal fixation provides excellent restoration of function and range of shoulder movement, with a low risk of complications.
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J Bone Joint Surg Am · Mar 2009
A nonlocking end screw can decrease fracture risk caused by locked plating in the osteoporotic diaphysis.
Locking plates transmit load through fixed-angle locking screws instead of relying on plate-to-bone compression. Therefore, locking screws may induce higher stress at the screw-bone interface than that seen with conventional nonlocked plating. This study investigated whether locked plating in osteoporotic diaphyseal bone causes a greater periprosthetic fracture risk than conventional plating because of stress concentrations at the plate end. It further investigated the effect of replacing the locked end screw with a conventional screw on the strength of the fixation construct. ⋯ Under bending loads, the focused load transfer of locking plates through fixed-angle screws can increase the periprosthetic fracture risk in the osteoporotic diaphysis compared with conventional plates. Replacing the outermost locking screw with a conventional screw reduced the stress concentration at the plate end and significantly increased the bending strength of the plating construct compared with an all-locked construct (p = 0.001).