The Journal of bone and joint surgery. American volume
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Many surgical questions are not amenable to investigation with a randomized controlled trial; thus, investigators must select an appropriate observational study design. Case-control studies are relatively inexpensive and can be conducted in comparatively little time. ⋯ They are particularly useful when the outcome of interest is rare or when the time to development of the outcome is long. We present an overview of the case-control study, with a focus on trial design and interpretation of results.
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J Bone Joint Surg Am · May 2009
Randomized Controlled Trial Comparative StudyAugmented compared with nonaugmented surgical repair of a fresh total Achilles tendon rupture. A prospective randomized study.
Augmented and nonaugmented techniques have been used for the operative repair of a fresh complete Achilles tendon rupture. Augmented techniques have been favored for their stronger pullout strengths but have been avoided because of the risk of wound complications. If proven to be equally good, the nonaugmented technique would be the method of choice. In the present study, we hypothesized that augmentation with a down-turned gastrocnemius fascia flap would not provide better results than would end-to-end suture repair with use of the Krackow locking loop surgical technique. ⋯ Augmented repair of a fresh total Achilles tendon rupture does not have any advantage over simple end-to-end repair.
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J Bone Joint Surg Am · May 2009
Randomized Controlled Trial Comparative StudyPosterior short-segment fixation with or without fusion for thoracolumbar burst fractures. a five to seven-year prospective randomized study.
The impact of fusion as a supplement to short-segment instrumentation for the treatment of thoracolumbar burst fractures is unclear. We conducted a controlled clinical trial to define the effect of fusion on lumbar spine and patient-related functional outcomes. ⋯ Posterolateral bone-grafting is not necessary when a Denis type-B thoracolumbar burst fracture associated with a load-sharing score of
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J Bone Joint Surg Am · May 2009
Multicenter StudySix-year outcomes of anterior lumbar interbody arthrodesis with use of interbody fusion cages and recombinant human bone morphogenetic protein-2.
Twenty-four-month outcomes have been reported for patients with degenerative lumbar disc disease who were treated with stand-alone anterior lumbar interbody arthrodesis with use of dual tapered interbody fusion cages and recombinant human bone morphogenetic protein-2. This report represents an update of the clinical and radiographic results of this treatment at six years. ⋯ The use of dual tapered threaded fusion cages and recombinant human bone morphogenetic protein-2 on an absorbable collagen sponge obtained and maintained intervertebral spinal fusion, improved clinical outcomes, and reduced pain after anterior lumbar interbody arthrodesis in patients with degenerative lumbar disc disease.
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J Bone Joint Surg Am · May 2009
Complication rates following open reduction and internal fixation of ankle fractures.
Ankle fractures are among the most common injuries treated by orthopaedic surgeons. The purpose of the present investigation was to examine the risks of complications after open reduction and internal fixation of ankle fractures in a large population-based study. ⋯ By analyzing a large, diverse patient population, the present study clarifies the risks associated with open reduction and internal fixation of ankle fractures. Open injury, diabetes, and peripheral vascular disease were strong risk factors predicting a complicated short-term postoperative course. Fracture type was a strong predictor of reoperation for ankle fusion or replacement. Hospital volume did not play a significant role in the rates of short-term or intermediate-term complications.