The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Dec 2010
Treatment of slipped capital femoral epiphysis with a modified Dunn procedure.
Surgical procedures with use of traditional techniques to reposition the proximal femoral epiphysis in the treatment of slipped capital femoral epiphysis are associated with a high rate of femoral head osteonecrosis. Therefore, most surgeons advocate in situ fixation of the slipped epiphysis with acceptance of any persistent deformity in the proximal part of the femur. This residual deformity can lead to secondary osteoarthritis resulting from femoroacetabular cam impingement. ⋯ The treatment of slipped capital femoral epiphysis with the modified Dunn procedure allows the restoration of more normal proximal femoral anatomy by complete correction of the slip angle, such that probability of secondary osteoarthritis and femoroacetabular cam impingement may be minimized. The complication rate from this procedure in our series was low, even in the treatment of unstable slipped capital femoral epiphysis, compared with alternative procedures described in the literature for fixation of slipped capital femoral epiphysis.
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J Bone Joint Surg Am · Dec 2010
Comparative StudyPain and function in patients after primary unicompartmental and total knee arthroplasty.
Unicompartmental knee arthroplasty has received renewed interest; however, its short-term advantages over total knee arthroplasty should be weighed against a higher risk of reoperation. Information regarding pain and function after unicompartmental and total knee arthroplasty is therefore needed. ⋯ We found only small or no differences in pain and function between the scores, at least two years following surgery, of patients who underwent unicompartmental knee arthroplasty and those of patients who underwent total knee arthroplasty; however, patients with unicompartmental knee implants had fewer problems with activities that involved bending the knee.
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J Bone Joint Surg Am · Dec 2010
Comparative StudyComparison of surgical outcomes of intra-articular calcaneal fractures by age.
Internal fixation is an accepted treatment for displaced fractures of the calcaneus. Operative intervention in older patients, however, is traditionally discouraged in the literature. The purpose of this study was to compare the outcomes of internal fixation of intra-articular fractures of the calcaneus on the basis of patient age. ⋯ In this series, outcomes of older patients are at least equivalent to those of younger patients undergoing internal fixation for an intra-articular calcaneal fracture. Operative intervention appears to be a reasonable option for displaced calcaneal fractures in older patients. Physiologic age should be considered when evaluating older patients, and individualized treatment plans remain critical because patients with low physical demands or who have medical complications may be better candidates for nonoperative treatment. Prospective studies are needed in this area.
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J Bone Joint Surg Am · Dec 2010
ReviewReview of successful litigation against english health trusts in the treatment of adults with orthopaedic pathology: clinical governance lessons learned.
Reviewing litigation brought against health institutions is a clinical governance issue and can help to prevent further cases. While large-scale databases are rare, the British National Health Service Litigation Authority deals with claims brought against all public health trusts in England. ⋯ These findings highlight the fact that education and vigilance remain important components of orthopaedic training as many of the cases of successful litigation had a preventable cause.
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J Bone Joint Surg Am · Dec 2010
How displaced are "nondisplaced" fractures of the medial humeral epicondyle in children? Results of a three-dimensional computed tomography analysis.
The management of fractures of the medial humeral epicondyle is controversial, but the primary issue is the relationship of outcomes to the extent of fracture displacement. This study compares the use of radiographs and three-dimensional computed tomography for determining the amount of displacement in medial humeral epicondylar injuries deemed to be minimally displaced (<5 mm) or nondisplaced. ⋯ Standard radiographs (anteroposterior and lateral views) are not sufficient to measure anterior displacement nor accurate enough to measure medial displacement of medial humeral epicondylar fractures. Internal oblique radiographs of the elbow appear to approximate the true anterior displacement, but three-dimensional computed tomography is the most accurate method to assess true displacement. The results of this study demonstrate that fractures that are found to be minimally displaced or nondisplaced by radiographs may have >1 cm of anterior displacement, for which surgery is usually recommended.