The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Nov 2012
Comparative StudyRisk of sciatic nerve traction injury during hip arthroscopy—is it the amount or duration? An intraoperative nerve monitoring study.
Using intraoperative nerve monitoring we prospectively studied the prevalence, pattern, and predisposing factors for sciatic nerve traction injury during hip arthroscopy. ⋯ The prevalence of nerve changes seen with monitoring of SSEPs and tcMEPs is greater than what is clinically identified. The maximum traction weight, not the total traction time, is the greatest risk factor for sciatic nerve dysfunction during hip arthroscopy. This study did not identify a discrete threshold of traction weight or traction time that increased the odds of nerve dysfunction.
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J Bone Joint Surg Am · Nov 2012
Functional impact of tibial malrotation following intramedullary nailing of tibial shaft fractures.
Tibial malrotation is a complication that is seen in approximately 30% of patients following locked intramedullary nailing. In this cohort study, we evaluated the hypothesis that tibial malrotation would lead to impaired functional outcomes. ⋯ Despite high rates of tibial malrotation following locked intramedullary nailing of isolated tibial diaphyseal fractures, this finding does not have a significant intermediate-term functional impact.
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J Bone Joint Surg Am · Nov 2012
Review Comparative StudyLower-extremity peripheral nerve blocks in the perioperative pain management of orthopaedic patients: AAOS exhibit selection.
The utilization of peripheral nerve blocks in orthopaedic surgery has paralleled the rise in the number of ambulatory surgical procedures performed. Optimization of pain control in the perioperative orthopaedic patient contributes to improved patient satisfaction, early mobilization, decreased length of hospitalization, and decreased associated hospital and patient costs. Our purpose was to provide a concise, pertinent review of the use of peripheral nerve blocks in various orthopaedic procedures of the lower extremity, with specific focus on procedural anatomy, indications, patient outcome measures, and complications. ⋯ The use of peripheral nerve blocks in lower-extremity surgery is becoming a mainstay of perioperative pain management strategy.
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J Bone Joint Surg Am · Nov 2012
Randomized Controlled Trial Comparative StudyOutcomes of operative treatment of unstable ankle fractures: a comparison of metallic and biodegradable implants.
Biodegradable implants for internal fixation of ankle fractures may overcome some disadvantages of metallic implants, such as imaging interference and the potential need for additional surgery to remove the implants. The purpose of this study was to evaluate the outcomes after fixation of ankle fractures with biodegradable implants compared with metallic implants. ⋯ The outcomes after fixation of bimalleolar ankle fractures with biodegradable implants were inferior to those after fixation with metallic implants in terms of the score on the AOFAS scale and time to bone union. However, the difference in the final AOFAS score between the groups may not be clinically important. The outcomes associated with the use of biodegradable implants for the fixation of isolated lateral malleolar fractures were comparable with those for metallic implants.
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J Bone Joint Surg Am · Nov 2012
Comparative StudyRisk factors for wound complications after ankle fracture surgery.
The overall rate of complications after ankle fracture fixation varies between 5% and 40% depending on the population investigated, and wound complications have been reported to occur in 1.4% to 18.8% of patients. Large studies have focused on complications in terms of readmission, but few studies have examined risk factors for wound-related issues in the outpatient setting in a large number of patients. A review was performed to identify risk factors for wound complications tracked in the hospital and outpatient setting. ⋯ These results highlight the difficulty of treating medically complex and noncompliant patient populations. With careful preoperative monitoring of swelling, time to surgery does not affect wound outcome. The failure of the patient to adhere to postoperative instructions should be a concern to the treating surgeon.