The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Apr 2014
Randomized Controlled TrialPercutaneous pin removal in the outpatient clinic--do children require analgesia?: a randomized controlled trial.
Percutaneous pins used in the surgical fixation of fractures in children are often removed in the outpatient clinic without the administration of analgesia. Pin removal can be a cause of anxiety for children, parents, and caregivers. Relatively little is known about the requirement of analgesia for this procedure. In a randomized controlled trial, we evaluated whether oral acetaminophen or ibuprofen reduced the pain experienced during pin removal. ⋯ Neither acetaminophen nor ibuprofen significantly reduced the pain score or heart rate associated with percutaneous pin removal in children as compared with the placebo. The oral analgesics administered were clinically equivalent to the placebo. These results suggest that non-narcotic analgesia use does not significantly reduce pain or heart rate associated with percutaneous pin removal in children.
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J Bone Joint Surg Am · Apr 2014
ReviewLack of diversity in orthopaedic trials conducted in the United States.
Several orthopaedic studies have suggested patient race and ethnicity to be important predictors of patient functional outcomes. This issue has also been emphasized by federal funding sources. However, the reporting of race and ethnicity has gained little attention in the orthopaedic literature. The objective of this study was to determine the percentage of orthopaedic randomized controlled clinical trials in the United States that included race and ethnicity data and to record the racial and ethnic distribution of patients enrolled in these trials. ⋯ Few orthopaedic randomized controlled trials performed in the United States reported data on race or ethnicity. Among trials that did report demographic race or ethnicity data, the inclusion of minority patients was substantially lower than would be expected on the basis of census demographics. Failure to represent the true racial diversity may result in decreased generalizability of trial conclusions across clinical populations.
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J Bone Joint Surg Am · Apr 2014
Dynamic radiographic criteria for detecting pseudarthrosis following anterior cervical arthrodesis.
While interspinous motion analysis is commonly used to determine the status of an anterior cervical fusion, the accuracy of this technique is unclear. We believed that three questions needed to be answered. What degree of image magnification is ideal? How much motion should be considered "adequate" for making dynamic radiographs? What is the optimal amount of interspinous motion for detecting pseudarthrosis? ⋯ Use of interspinous motion of ≥ 1 mm as the cutoff for detection of anterior cervical pseudarthrosis on radiographs magnified 150% and made with superjacent interspinous motion of ≥ 4 mm yielded accuracies comparable with those of CT.
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J Bone Joint Surg Am · Apr 2014
Multicenter StudyIs there a "July effect" in surgery for adolescent idiopathic scoliosis?
Prior studies in various medical and surgical specialties have suggested that the changeover of medical trainees in the United States at the end of the academic year, or so-called "July effect," negatively impacts the quality of patient care, including increasing morbidity and decreasing efficiency. We analyzed whether the outcomes of surgery for adolescent idiopathic scoliosis involving physicians-in-training as first assistants were affected by the time of year the surgery was performed. ⋯ Overall, the data did not provide evidence to support a July effect. Our results suggest that surgery for adolescent idiopathic scoliosis during July and August yields safety and outcomes equal to that of other months.
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➤ Despite being common, syndesmotic injuries are challenging to diagnose and treat.➤ Anatomic reduction of the ankle syndesmosis is critical for good clinical outcomes.➤ Intraoperative three-dimensional radiography and direct syndesmotic visualization can improve rates of anatomic reduction.➤ The so-called gold-standard syndesmotic screw fixation is being brought increasingly into question as new fixation techniques emerge.➤ Syndesmotic screw removal remains controversial, but may allow spontaneous correction of malreductions.