The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Nov 2013
Randomized Controlled TrialTopical (intra-articular) tranexamic acid reduces blood loss and transfusion rates following total hip replacement: a randomized controlled trial (TRANX-H).
Approximately one-third of patients undergoing total hip replacement surgery require one to three units of blood postoperatively. Tranexamic acid is a synthetic antifibrinolytic agent that has been successfully used intravenously to control bleeding after total hip replacement. A topical application is easy to administer, provides a maximum concentration of tranexamic acid at the bleeding site, and is associated with little or no systemic absorption of the tranexamic acid. ⋯ Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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J Bone Joint Surg Am · Nov 2013
Randomized Controlled TrialLocal infiltration analgesia followed by continuous infusion of local anesthetic solution for total hip arthroplasty: a prospective, randomized, double-blind, placebo-controlled study.
We studied the efficacy of local infiltration analgesia in surgical wounds with 0.2% ropivacaine (50 mL), ketorolac (15 mg), and adrenaline (0.5 mg) compared with that of local infiltration analgesia combined with continuous infusion of 0.2% ropivacaine as a method of pain control after total hip arthroplasty. We hypothesized that as a component of multimodal analgesia, local infiltration analgesia followed by continuous infusion of ropivacaine would result in reduced postoperative opioid consumption and lower pain scores compared with infiltration alone, and that both of these techniques would be superior to placebo. ⋯ Therapeutic level I. See Instructions for Authors for a complete description of levels of evidence.
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J Bone Joint Surg Am · Nov 2013
The perfused, pulseless supracondylar humeral fracture: intermediate-term follow-up of vascular status and function.
This study provides intermediate-term follow-up data on the vascular status of a cohort of children with a perfused, pulseless supracondylar humeral fracture who were managed with closed reduction, percutaneous pinning, and observation. ⋯ Therapeutic level IV. See Instructions for Authors for a complete description of levels of evidence.
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J Bone Joint Surg Am · Nov 2013
Management of the pediatric pulseless supracondylar humeral fracture: is vascular exploration necessary?
Radically different conclusions exist in the pediatric orthopaedic and vascular literature regarding the management of patients with a pink hand but no palpable radial pulse in association with a supracondylar humeral fracture. ⋯ Prognostic level III. See Instructions for Authors for a complete description of levels of evidence.
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J Bone Joint Surg Am · Nov 2013
Complications, reoperation rates, and health-care cost following surgical treatment of lumbar spondylolisthesis.
Surgery remains the mainstay for management of lumbar spondylolisthesis and is considered an effective therapeutic modality following unsuccessful nonoperative treatment. Surgical procedures include decompression, decompression with instrumented arthrodesis, and decompression with noninstrumented arthrodesis. The purpose of this study was to examine the complications, reoperation rates, and health-care costs associated with each of these procedures. ⋯ Therapeutic level III. See Instructions for Authors for a complete description of levels of evidence.