The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Dec 2013
Randomized Controlled Trial Multicenter StudyEfficacy and safety of recombinant human bone morphogenetic protein-2/calcium phosphate matrix for closed tibial diaphyseal fracture: a double-blind, randomized, controlled phase-II/III trial.
Recombinant human bone morphogenetic protein-2 (rhBMP-2) applied on an absorbable collagen sponge improves open tibial fracture-healing as an adjunct to unreamed intramedullary nail fixation. We evaluated rhBMP-2 and a new, injectable calcium phosphate matrix (CPM) formulation in acute closed tibial diaphyseal fractures treated with reamed intramedullary nail fixation. ⋯ In patients with closed tibial fractures treated with reamed intramedullary nailing, the time to fracture union and pain-free full weight-bearing were not significantly reduced by rhBMP-2/CPM compared with standard of care alone. 24306696
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J Bone Joint Surg Am · Dec 2013
Review Comparative StudyLateral mass screw fixation in the cervical spine: a systematic literature review.
Lateral mass screw fixation with plates or rods has become the standard method of posterior cervical spine fixation and stabilization for a variety of surgical indications. Despite ubiquitous usage, the safety and efficacy of this technique have not yet been established sufficiently to permit "on-label" U.S. Food and Drug Administration approval for lateral mass screw fixation systems. The purpose of this study was to describe the safety profile and effectiveness of such systems when used in stabilizing the posterior cervical spine. ⋯ The risks of complications were low and the fusion rate was high when lateral mass screw fixation was used in patients undergoing posterior cervical subaxial fusion. Nerve root injury attributed to screw placement occurred in only 1% of 1041 patients. No cases of vertebral artery injury were identified in 758 patients. Screw or rod pullout, screw or plate breakage, and screw loosening occurred in <1% of the screws inserted.
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J Bone Joint Surg Am · Dec 2013
ReviewThe surgical anatomy of the infrapatellar branch of the saphenous nerve in relation to incisions for anteromedial knee surgery.
Iatrogenic injury to the infrapatellar branch of the saphenous nerve is a common complication of surgical approaches to the anteromedial side of the knee. A detailed description of the relative anatomic course of the nerve is important to define clinical guidelines and minimize iatrogenic damage during anterior knee surgery. ⋯ These findings suggest that iatrogenic damage of the infrapatellar branch of the saphenous nerve can be minimized in anteromedial knee surgery when both the location and the location-dependent direction of the nerve are considered when making the skin incision.
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J Bone Joint Surg Am · Dec 2013
Comparative StudyEOS low-dose radiography: a reliable and accurate upright assessment of lower-limb lengths.
Children with lower-limb-length discrepancy require repeated radiographic assessment for monitoring and as a guide for management. The need for accurate assessment of length and alignment is balanced by the need to minimize radiation exposure. We compared the accuracy, reliability, and radiation dose of EOS, a novel low-dose upright biplanar radiographic imaging system, at two different settings, with that of conventional radiographs (teleoroentgenograms) and computed tomography (CT) scanograms, for the assessment of limb length. ⋯ This study assesses the reliability and accuracy of a diagnostic test used for clinical decision-making.
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J Bone Joint Surg Am · Nov 2013
Randomized Controlled TrialEfficacy and safety of fibrin glue and tranexamic acid to prevent postoperative blood loss in total knee arthroplasty: a randomized controlled clinical trial.
Postoperative blood loss in patients after total knee arthroplasty may cause local and systemic complications and influence clinical outcome. The aim of this study was to assess whether fibrin glue or tranexamic acid reduced blood loss compared with routine hemostasis in patients undergoing total knee arthroplasty. ⋯ Neither type of fibrin glue was more effective than routine hemostasis in reducing postoperative bleeding and transfusion requirements, and we no longer use them. However, this trial supports findings from previous studies showing that intravenous tranexamic acid can decrease postoperative blood loss.