The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Mar 2010
Serum after traumatic brain injury increases proliferation and supports expression of osteoblast markers in muscle cells.
Traumatic brain injury is associated with an increased rate of heterotopic ossification within skeletal muscle, possibly as a result of humoral factors. In this study, we investigated whether cells from skeletal muscle adopt an osteoblastic phenotype in response to serum from patients with traumatic brain injury. ⋯ Human serum supports the osteoblastic differentiation of cells derived from human skeletal muscle, and serum from patients with severe traumatic brain injury accelerates proliferation of these cells. These findings suggest the early presence of humoral factors following traumatic brain injury that stimulate the expansion of mesenchymal cells and osteoprogenitors within skeletal muscle.
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J Bone Joint Surg Am · Mar 2010
Epidemiology of shoulder dislocations presenting to emergency departments in the United States.
The epidemiology of traumatic shoulder dislocations is poorly understood. The aim of the current study was to determine the incidence of shoulder dislocations presenting to hospital emergency departments in the United States and define demographic risk factors for these injuries. ⋯ The estimated incidence rate of shoulder dislocations in the United States is 23.9 per 100,000 person-years, which is approximately twice the previously reported value. A young age and male sex are risk factors for shoulder dislocation in the United States population.
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J Bone Joint Surg Am · Mar 2010
Outcome of lumbar arthrodesis in patients sixty-five years of age or older. Surgical technique.
The value of lumbar spine arthrodesis in older patients is not well documented. As most of the literature regarding lumbar arthrodesis in older patients has focused on the prevalence of complications, the purpose of this study was to determine the clinical outcomes for older compared with younger patients undergoing lumbar arthrodesis. ⋯ This study demonstrates a substantial benefit for patients sixty-five years of age or older with degenerative disc disease who are treated with a single-level lumbar decompression and instrumented arthrodesis, and we conclude that lumbar arthrodesis is a viable and reasonable treatment option for appropriately selected patients sixty-five years of age or older.
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J Bone Joint Surg Am · Mar 2010
Assessment of the posterior ligamentous complex following acute cervical spine trauma.
Magnetic resonance imaging is commonly used to assess the integrity of the posterior ligamentous complex following cervical trauma, but its accuracy and reliability have not been documented, to our knowledge. The purpose of this study was to determine the diagnostic accuracy of magnetic resonance imaging in detecting injury to specific components of the posterior ligamentous complex of the cervical spine. ⋯ Magnetic resonance imaging is sensitive for the evaluation of injury to the posterior ligamentous complex in the setting of acute cervical trauma. However, it has a lower positive predictive value and specificity, suggesting that injury to the posterior ligamentous complex may be "over-read" on magnetic resonance images. If magnetic resonance imaging is used in isolation to guide treatment, the high rate of false-positive findings may lead to unnecessary surgery. Other factors, including the morphology of the injury and the neurological status, should be considered as well when devising a treatment plan.
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J Bone Joint Surg Am · Mar 2010
Comparative StudySubtalar fusion after displaced intra-articular calcaneal fractures: does initial operative treatment matter? Surgical technique.
Many patients with displaced intra-articular calcaneal fractures require subtalar arthrodesis for the treatment of posttraumatic arthritis. We hypothesized that patients who underwent initial operative treatment would have better functional outcomes as compared with those who underwent initial nonoperative treatment before undergoing a subtalar arthrodesis. ⋯ In our study population, better functional outcomes and fewer wound complications were associated with subtalar fusion for the treatment of symptomatic posttraumatic subtalar arthritis after initial open reduction and internal fixation of a displaced intra-articular calcaneal fracture as compared with subtalar arthrodesis for the treatment of symptomatic posttraumatic subtalar arthritis secondary to calcaneal malunion following initial nonoperative treatment.Initial open reduction and internal fixation restores calcaneal shape, alignment, and height, which facilitates the fusion procedure and establishes an opportunity to create a better long-term functional result. We recommend open reduction and internal fixation for the treatment of displaced intra-articular calcaneal fractures when appropriately indicated.