The Journal of bone and joint surgery. American volume
-
J Bone Joint Surg Am · Apr 2013
Relationship of bicipital groove rotation with humeral head retroversion: a three-dimensional computed tomographic analysis.
Bicipital groove location has been used as a reference for humeral stem orientation in total shoulder arthroplasty to recreate humeral head retroversion. However, anatomic variability has rendered its use for prosthetic orientation problematic in cases of comminuted proximal fractures. We hypothesized that variability in groove rotation is directly related to variability in humeral head retroversion and that by defining the degree of groove rotation, humeral head retroversion can be predicted. ⋯ A previously unknown direct correlation between bicipital groove rotation and humeral head retroversion was found to exist. The ability to predict humeral head retroversion when mapping only the distal third of the groove has potentially important clinical implications because the distal third is often the only portion of the groove remaining in patients with a comminuted proximal humeral fracture. This is particularly relevant with computer-navigated surgery.
-
J Bone Joint Surg Am · Apr 2013
Multicenter StudyFunctional and quality-of-life outcomes in geriatric patients with type-II dens fracture.
Dens fractures are relatively common in the elderly. The treatment of Type-II dens fractures remains controversial. The aim of this multicenter prospective cohort study was to compare outcomes (assessed with use of validated clinical measures) and complications of nonsurgical and surgical treatment of Type-II dens fractures in patients sixty-five years of age or older. ⋯ We demonstrated a significant benefit with surgical treatment of dens fractures as measured by the NDI, a disease-specific functional outcome measure. As a result of the nonrandomized nature of the study, the results are vulnerable to the effects of possible residual confounding. We recommend that elderly patients with a Type-II dens fracture who are healthy enough for general anesthesia be considered for surgical stabilization to improve functional outcome as well as the union and fusion rates.
-
J Bone Joint Surg Am · Apr 2013
Center and surgeon volume influence the revision rate following unicondylar knee replacement: an analysis of 23,400 medial cemented unicondylar knee replacements.
Revision rates following unicondylar knee replacement vary among reporting institutions. Revision rates from institutions involved in the design of these implants and independent single-center series are comparable with those following total knee replacement, suggesting that higher operative volumes and surgical enthusiasm improve revision outcomes. ⋯ High-volume centers and surgeons specializing in such procedures had superior results following unicondylar knee replacement compared with their low-volume counterparts. These results suggest that centers and surgeons should undertake a minimum of thirteen such procedures per year to achieve results comparable with the high-volume operators.
-
J Bone Joint Surg Am · Apr 2013
The estimated sensitivity and specificity of compartment pressure monitoring for acute compartment syndrome.
The aim of our study was to document the estimated sensitivity and specificity of continuous intracompartmental pressure monitoring for the diagnosis of acute compartment syndrome. ⋯ The estimated sensitivity and specificity of continuous intracompartmental pressure monitoring for the diagnosis of acute compartment syndrome following tibial diaphyseal fracture are high; continuous intracompartmental pressure monitoring should be considered for patients at risk for acute compartment syndrome.
-
J Bone Joint Surg Am · Apr 2013
Long-term outcomes of anterior dual-rod instrumentation for thoracolumbar and lumbar curves in adolescent idiopathic scoliosis: a twelve to twenty-three-year follow-up study.
Anterior spinal fusion with instrumentation is used for the treatment of thoracolumbar/lumbar scoliosis. The aim of this long-term, retrospective, hospital-based cohort study was to determine the outcomes of anterior dual-rod instrumentation in a consecutive series of patients with thoracolumbar/lumbar adolescent idiopathic scoliosis managed by a single surgeon at a single institution. ⋯ Radiographic findings, pulmonary function, and clinical measures were satisfactory at the time of follow-up, at a minimum of twelve years. Anterior dual-rod instrumentation remains a useful surgical treatment for Lenke type-5C thoracolumbar/lumbar adolescent idiopathic scoliosis.