The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Feb 2013
Randomized Controlled TrialEffectiveness of multimodal pain management after bipolar hemiarthroplasty for hip fracture: a randomized, controlled study.
Appropriate pain management affects outcome after hip fracture surgery. Although multimodal pain management is commonly used for pain control for patients undergoing elective surgery, few studies have evaluated its use in those undergoing hip fracture surgery. This prospective randomized study was designed to determine the clinical value of multimodal pain management with preemptive pain medication and intraoperative periarticular multimodal drug injections in patients undergoing bipolar hip hemiarthroplasty. ⋯ Multimodal pain management provides additional pain relief until the fourth postoperative day, improves patient satisfaction at discharge, and reduces total narcotic consumption for postoperative pain management after hip hemiarthroplasty for hip fractures.
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J Bone Joint Surg Am · Feb 2013
Functional outcome thirty years after median and ulnar nerve repair in childhood and adolescence.
Age at injury is believed to be a factor that strongly influences functional outcome after nerve injury. However, there have been few long-term evaluations of the results of nerve repair and reconstruction in children. Our aim was to evaluate the long-term functional outcome of nerve repair or reconstruction at the forearm level in patients with a complete median and/or ulnar nerve injury at a young age. ⋯ At a median of thirty-one years after a median or ulnar nerve repair at the level of the forearm, nerve function is significantly better in those injured in childhood than in those injured in adolescence, with almost full sensory and motor recovery in individuals injured in childhood.
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J Bone Joint Surg Am · Feb 2013
Thickness of subcutaneous fat as a risk factor for infection in cervical spine fusion surgery.
Surgical site infections increase the incidence of morbidity and mortality as well as health-care expenses. The cost of care increases threefold to fourfold as a consequence of surgical site infection after spinal surgery. The aim of the present study was to determine the role of subcutaneous fat thickness in the development of surgical site infection following cervical spine fusion surgery. ⋯ The study demonstrated that the thickness of subcutaneous fat at the surgical site is a factor in the development of surgical site infection following cervical spine fusion and deserves assessment in the preoperative evaluation.
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J Bone Joint Surg Am · Feb 2013
Lessons regarding the safety of orthopaedic patient care: an analysis of four hundred and sixty-four closed malpractice claims.
An orthopaedic malpractice claim alleges that the patient sustained a preventable iatrogenic injury. The analysis of a representative series of malpractice claims provides a unique view of alleged orthopaedic adverse events, revealing what can potentially go wrong across a spectrum of practice settings and anatomic locations. The goal of this study was to identify high-impact targets in order to institute measures to reduce claims through efforts focused on patient safety. ⋯ Regarding clinical relevance, this analysis suggests risk areas for targeted efforts to improve patient safety and reduce malpractice claims.