The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · May 2014
Randomized Controlled TrialTrapeziometacarpal arthrodesis or trapeziectomy with ligament reconstruction in primary trapeziometacarpal osteoarthritis: a randomized controlled trial.
Both trapeziectomy with ligament reconstruction and tendon interposition and trapeziometacarpal arthrodesis are commonly performed procedures for the treatment of trapeziometacarpal osteoarthritis. The purpose of this study was to compare the outcomes of both treatments for symptomatic osteoarthritis of the thumb trapeziometacarpal joint in a randomized trial. ⋯ Women who are forty years or older with trapeziometacarpal osteoarthritis have fewer moderate and severe complications after trapeziectomy with ligament reconstruction and tendon interposition and are more likely to consider the surgery again under the same circumstances than are those who undergo arthrodesis. Twelve months after surgery, the PRWHE and DASH scores were similar in both groups. We do not recommend routine use of arthrodesis with plate and screws in the treatment of women who are forty years or older with stage-II or III trapeziometacarpal osteoarthritis.
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J Bone Joint Surg Am · May 2014
Intraoperative three-dimensional imaging in the treatment of calcaneal fractures.
Displaced intra-articular calcaneal fractures are frequently treated by open reduction and internal fixation. The usual intraoperative monitoring by means of fluoroscopy does not always provide complete intraoperative information for the surgeon. The aims of this study were to analyze the percentage of patients for whom intraoperative three-dimensional imaging leads to intraoperative revision and whether the avoidance of an intra-articular step or gap influences the clinical outcome. ⋯ In many cases, intraoperative three-dimensional imaging identifies intra-articular incongruence and implants that are not detected by fluoroscopy. Due to the resulting options for better joint surface reconstruction, clinical outcomes may be improved, at times requiring repeat reduction, and posttraumatic osteoarthritis may be reduced.
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J Bone Joint Surg Am · May 2014
Development of a cast application simulator and evaluation of objective measures of performance.
Surgical simulation offers a low-risk learning environment with repetitive practice opportunities for orthopaedic residents. It is increasingly prevalent in many training programs, as acquisition of technical skills in the face of educational demands and reduced work hours becomes more challenging. In addition to surgical skills, orthopaedic residents must also learn the technique of cast application. Deficiencies in casting skill are risk factors for re-displacement of fractures and cast-specific complications. Formal educational models to instruct or to evaluate casting technique have not been well described or tested. The purposes of this study were to develop a cast application simulator and to validate a novel method of evaluating casting skill. ⋯ This casting simulation model and evaluation instrument is a reliable assessment of casting skill in applying a short arm cast. However, given the inability to stratify all three groups on the basis of the level of training, further work is needed to establish construct validity.
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J Bone Joint Surg Am · May 2014
Anatomical dissection and CT imaging of the posterior cruciate and lateral collateral ligaments in skeletally immature cadaver knees.
Understanding the relationship of the posterior cruciate ligament (PCL) and the lateral collateral ligament (LCL) to the femoral and tibial physes is important to reducing the risk of physeal injury during surgical reconstruction. The purpose of this study was to identify the location of the attachments of the PCL and LCL in skeletally immature cadaveric knee specimens and to determine their position relative to the physes. ⋯ A better understanding of the spatial relationship between the PCL and LCL attachments and their respective physes may help guide drill-hole placement during ligament reconstructions and reduce the risk for iatrogenic physeal injury in skeletally immature patients.
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J Bone Joint Surg Am · Apr 2014
Bracing for idiopathic scoliosis: how many patients require treatment to prevent one surgery?
Although the efficacy of bracing for adolescent idiopathic scoliosis has been debated, recent evidence indicates a strong dose-response effect with respect to preventing curve progression of ≥6°. The purpose of this study was to investigate whether bracing, prescribed with use of current criteria, prevents surgery and how many patients must be treated with bracing to prevent one surgery. ⋯ Within the limitations of a nonrandomized prospective study design, bracing for adolescent idiopathic scoliosis was found to substantially decrease the risk of curve progression to a range requiring surgery when patients were highly compliant with brace wear. Since many patients avoid surgery without wearing a brace, current indications appear to lead to marked overtreatment. Bracing appears to decrease the risk of curve progression to a magnitude requiring surgery, but current bracing indications include many curves that would not have progressed to a magnitude requiring surgery even if the patient had not worn the brace, and overall compliance with brace wear is low. Identifying these lower-risk patients and improving the compliance of those likely to have curve progression could substantially improve bracing results.