The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Sep 2009
Multicenter Study Comparative Study Clinical TrialIs after-hours orthopaedic surgery associated with adverse outcomes? A prospective comparative study.
Treatment of fractures is sometimes performed after normal daytime operating hours and in such instances may be performed under less than ideal conditions. The consequence of performing operations under such conditions is largely unknown and was therefore studied in the context of intramedullary nail fixation of tibial and femoral shaft fractures. ⋯ Rates of nonunion, infectious complications, and radiation exposure are similar for after-hours and daytime surgery for intramedullary nail fixation of both femoral and tibial fractures. After-hours femoral nail fixation was associated with an increased frequency for removal of painful hardware, which may be related to technical errors associated with nonideal conditions and shorter operative times. An increase in the allocated amount of daytime operative time for orthopaedic trauma surgery has the potential to reduce minor complication rates for intramedullary nail fixation.
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J Bone Joint Surg Am · Sep 2009
Comparative StudyFulfillment of patients' expectations for total hip arthroplasty.
Fulfillment of patient expectations is an important outcome of total hip arthroplasty. The objective of the present study was to determine the proportion of expectations that were fulfilled following total hip arthroplasty as well as how the fulfillment of expectations relates to patient and clinical characteristics. ⋯ A better postoperative Lower Limb Core score was most closely associated with the fulfillment of expectations following total hip arthroplasty. Not having a postoperative limp was independent of the postoperative Lower Limb Core score, indicating that the impact of a limp is greater than its manifestation as a physical disability. Better preoperative status also was an independent predictor, indicating that patient expectations are more likely to be fulfilled if the patient is not the most severely impaired at the time of surgery.
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J Bone Joint Surg Am · Sep 2009
Intention-to-treat analysis and accounting for missing data in orthopaedic randomized clinical trials.
The intention-to-treat principle implies that all patients who are randomized in a clinical trial should be analyzed according to their original allocation. This means that patients crossing over to another treatment group and patients lost to follow-up should be included in the analysis as a part of their original group. This principle is important for preserving the randomization scheme, which is the basis for correct inference in any randomized trial. In this study, we examined the use of the intention-to-treat principle in recently published orthopaedic clinical trials. ⋯ In most of the randomized clinical trials published in the orthopaedic literature, the investigators did not adhere to the stringent use of the intention-to-treat principle, with the most conspicuous problem being a lack of accounting for patients lost to follow-up. This omission might introduce bias to orthopaedic randomized clinical trials and their analysis.
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J Bone Joint Surg Am · Sep 2009
Comparative StudyResident duty-hour reform associated with increased morbidity following hip fracture.
The Accreditation Council for Graduate Medical Education implemented resident duty-hour reform for orthopaedic resident surgeons in the United States on July 1, 2003. This study sought to determine whether the change in duty-hour regulations was associated with relative changes in mortality and morbidity for patients with a hip fracture treated in hospitals with and without resident teaching involved in the delivery of medical care. ⋯ Resident duty-hour reform was associated with an accelerated rate of increasing patient morbidity following treatment of hip fractures in teaching institutions. Further research into this concerning finding is needed.
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J Bone Joint Surg Am · Sep 2009
Three-dimensional kinematics of the rheumatoid wrist after partial arthrodesis.
Partial arthrodesis of the wrist, such as radiolunate and radioscapholunate arthrodesis, is intuitively more appealing for the treatment of the rheumatoid wrist than total arthrodesis is because it preserves some motion. However, wrist kinematics after partial arthrodesis are incompletely understood. The purpose of the present study was to evaluate the kinematics of the radiocarpal and midcarpal joints of rheumatoid wrists with use of three-dimensional computed tomography before and after partial arthrodesis. ⋯ The results of this kinematic analysis, which showed that midcarpal motion occurred in the dart-throwing motion plane, may support the use of radiolunate and radioscapholunate arthrodeses as an alternative to total wrist arthrodesis in patients with symptomatic rheumatoid arthritis of the wrist.