The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · May 2010
Role of early surgical decompression of the intradural space after cervical spinal cord injury in an animal model.
The role of decompressing the intradural space through a durotomy as a treatment option for acute traumatic cervical spinal cord injury has not been explored in an animal model, to our knowledge. We sought to determine the role of durotomy and duraplasty in the treatment of acute cervical spinal cord injury and its effects on inflammation, scar formation, and functional recovery. ⋯ Functional recovery after acute cervical spinal cord injury was better in animals treated with decompression of the intradural space and placement of a dural allograft than it was in animals treated with decompression alone. These functional data correlated directly with histological evidence of a decrease in spinal cord cavitation, inflammation, and scar formation.
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J Bone Joint Surg Am · May 2010
Comparative Study Clinical TrialQuality of life after volar plate fixation of articular fractures of the distal part of the radius.
Outcome measurement following surgery is increasingly the focus of attention in current health-care debates because of the rising costs of medical care and the large variety of operative options. The purpose of the present study was to correlate quality of life after volar locked plate fixation of unstable intra-articular distal radial fractures with functional and radiographic results as well as with quality-of-life data from population norms. ⋯ The results of the present single-center study show that, following distal radial fracture fixation, wrist arthritis may affect the patient's subjective well-being, as documented with the Short Form-36, without influencing the functional outcome. Well-designed longitudinal clinical trials are needed to confirm the findings of the present investigation in terms of quality of life after surgical treatment of intra-articular distal radial fractures.
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J Bone Joint Surg Am · May 2010
A modified Risser grading system predicts the curve acceleration phase of female adolescent idiopathic scoliosis.
The Risser sign can be assessed with the United States method or the European method. The Tanner-Whitehouse method estimates skeletal age on the basis of hand radiography and digital skeletal age. Digital skeletal age scores between 400 and 425 are associated with the beginning of the curve acceleration phase or peak growth velocity in adolescent idiopathic scoliosis. The first objective of the present study was to evaluate the agreement between the two Risser grading systems. The second objective was to identify which grading system best predicts a digital skeletal age of between 400 and 425. The third objective was to explore a new system that could be used to replace the Risser method. ⋯ Two Risser grading systems coexist, and the agreement between them is moderate. No Risser stage was found to be a good clinical landmark for the beginning of the curve acceleration phase of adolescent idiopathic scoliosis. A new group, Risser 0 with closed triradiate cartilage and Risser 1, was the best predictor of the beginning of the curve acceleration phase. This new system is easy to implement and is based on findings that are available on spine radiographs. It should be used at the first visit and for scoliosis follow-up to assess skeletal maturity and correlation with the curve acceleration phase.
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J Bone Joint Surg Am · May 2010
Preoperative predictors of persistent impairments during stair ascent and descent after total knee arthroplasty.
Although total knee arthroplasty improves functional mobility in persons with end-stage knee osteoarthritis, many subjects have reported continued difficulty with stair ascent and descent after surgery. The purpose of the present study was to determine preoperative predictors of handrail use during stair ascent and descent following primary unilateral total knee arthroplasty. ⋯ Younger, stronger patients who do not use a handrail prior to unilateral total knee arthroplasty can expect the best outcomes in terms of ascending and descending stairs following surgery. This information may provide patients with more realistic expectations after surgery and allow them to make more appropriate discharge plans.
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J Bone Joint Surg Am · May 2010
Comparative StudyFemoral fractures in adolescents: a comparison of four methods of fixation.
The optimal management of femoral fractures in adolescents is controversial. This study was performed to compare the results and complications of four methods of fixation and to determine the factors related to those complications. ⋯ External fixation was associated with the highest rate of complications in our series of adolescents treated for a femoral fracture. Although the other three methods yielded comparable outcomes, we cannot currently recommend one method of fixation for all adolescents with a femoral fracture. The choice of fixation will remain influenced by surgeon preference based on expertise and experience, patient and fracture characteristics, and patient and family preferences.