The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Sep 2012
Randomized Controlled Trial Comparative StudySling compared with plate osteosynthesis for treatment of displaced midshaft clavicular fractures: a randomized clinical trial.
Few randomized controlled trials have compared operative with nonoperative treatment of clavicular fractures. ⋯ One year after a displaced midshaft clavicular fracture, nonoperative treatment resulted in a higher nonunion rate but similar function and disability compared with operative treatment.
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J Bone Joint Surg Am · Sep 2012
ReviewResident duty-hour restrictions-who are we protecting?: AOA critical issues.
As advocated by Nasca, our teaching programs must nurture professionalism and the effacement of self interest that is the core of the practice of medicine and the profession. The evidence to date suggests that work-hour restrictions based solely on clock-defined time limits discourage, rather than promote, the professional behavior that we desire in tomorrow's physicians. Notwithstanding any issues related to duty hours or fitness for duty, a competency-based system of medical education is both desirable and necessary in the current environment of medical education. In the absence of evidence to suggest that duty-hour limits reduce medical errors and enhance patient safety, and until we have evolved to a competency-based system of resident education, a misguided and overzealous focus on limiting work hours should not be allowed to exert the unintended consequence of eroding the ethos of professionalism that we, and our patients, have come to expect of a physician.
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J Bone Joint Surg Am · Sep 2012
Comparative StudyClinical and structural results of arthroscopic repair of isolated subscapularis tear.
Even though the frequency of arthroscopic repair of isolated lesions of the subscapularis tendon has increased, few studies have presented clinical and anatomical outcomes of this treatment. We hypothesized that, after an arthroscopic repair, structural outcomes in the muscle have an influence on functional results. ⋯ Arthroscopic repair of isolated subscapularis tears was associated with improved shoulder function and improved results on clinical testing. The tendon-healing rate was high but resulted in incomplete correction of the results of clinical testing. Progression of fatty infiltration in the subscapularis muscle was observed on magnetic resonance imaging but did not influence the clinical outcomes.
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J Bone Joint Surg Am · Sep 2012
Multicenter Study Comparative StudyWound complications following rivaroxaban administration: a multicenter comparison with low-molecular-weight heparins for thromboprophylaxis in lower limb arthroplasty.
The oral anticoagulant rivaroxaban is recommended for venous thromboembolic prophylaxis following lower limb arthroplasty. Concerns regarding high rates of wound complications following its use have prompted this multicenter comparison with low-molecular-weight heparins. ⋯ The rivaroxaban group had a higher wound complication rate and a lower deep venous thrombosis rate; there were no differences in symptomatic pulmonary embolism or all-cause mortality. Longer follow-up is needed to assess any potential relationship between wound complications and joint stiffness, latent infection, and limb consequences of deep venous thrombosis.