The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Jan 2013
CommentThe dark side of amputation rehabilitation: commentary on an article by COL (Ret) William C. Doukas, MD, et al.: "The Military Extremity Trauma Amputation/Limb Salvage (METALS) study. outcomes of amputation versus limb salvage following major lower-extremity trauma".
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Local anesthetics are frequently delivered intra-articularly to provide perioperative pain control. Previous studies have shown that the commonly used drugs lidocaine, ropivacaine, and bupivacaine can be toxic to human chondrocytes. The present study was conducted to determine whether the toxic effects of local anesthetics on human chondrocytes also extend to human mesenchymal stem cells. ⋯ Mesenchymal stem cells likely play a key role in healing following surgical procedures such as microfracture and ligament reconstruction. If local anesthetics are used following joint surgery, selection of an agent with low toxicity toward mesenchymal stem cells, such as ropivacaine, may maximize tissue healing potential.
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J Bone Joint Surg Am · Jan 2013
The Military Extremity Trauma Amputation/Limb Salvage (METALS) study: outcomes of amputation versus limb salvage following major lower-extremity trauma.
The study was performed to examine the hypothesis that functional outcomes following major lower-extremity trauma sustained in the military would be similar between patients treated with amputation and those who underwent limb salvage. ⋯ Major lower-limb trauma sustained in the military results in significant disability. Service members who undergo amputation appear to have better functional outcomes than those who undergo limb salvage. Caution is needed in interpreting these results as there was a potential for selection bias.
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J Bone Joint Surg Am · Jan 2013
Current and future use of surgical skills training laboratories in orthopaedic resident education: a national survey.
Acquisition of surgical skills through laboratory-based training and simulation is appealing to surgical training programs. The purpose of this study was to provide baseline information on the current use of surgical skills training laboratories in orthopaedic resident education and to determine the interest in expansion of these facilities and training techniques. ⋯ There was strong agreement among both program directors and residents that surgical skills laboratories and simulation technology should be a required component of orthopaedic resident training. At the present time, the most substantial barrier to adoption of surgical skills laboratories and a formalized surgical skills curriculum is the lack of funding.
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J Bone Joint Surg Am · Jan 2013
Randomized Controlled Trial Multicenter StudyThe influence of obesity on the outcome of treatment of lumbar disc herniation: analysis of the Spine Patient Outcomes Research Trial (SPORT).
Questions remain as to the effect that obesity has on patients managed for symptomatic lumbar disc herniation. The purpose of this study was to determine if obesity affects outcomes following the treatment of symptomatic lumbar disc herniation. ⋯ Obese patients realized less clinical benefit from both operative and nonoperative treatment of lumbar disc herniation. Surgery provided similar benefit over nonoperative treatment in obese and nonobese patients.