The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Sep 2013
Long-term outcome of pronation-external rotation ankle fractures treated with syndesmotic screws only.
There is sparse information in the literature on the outcome of Maisonneuve-type pronation-external rotation ankle fractures treated with syndesmotic screws. The primary aim of this study was to determine the long-term results of such treatment of these fractures as indicated by standardized patient-based and physician-based outcome measures. The secondary aim was to identify predictors of the outcome with use of bivariate and multivariate statistical analysis. ⋯ Long-term functional outcomes at a mean of twenty-one years after pronation-external rotation ankle fractures treated with one or two syndesmotic screws were good to excellent in the great majority of patients despite substantial radiographic evidence of osteoarthritis in one-half of the patients. The most important predictor of long-term functional outcome was patient-reported pain rather than physician-reported function or posttraumatic osteoarthritis. There was no significant association between radiographic signs of posttraumatic osteoarthritis and perceived pain in the present series.
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J Bone Joint Surg Am · Sep 2013
Patients with atrial fibrillation undergoing total joint arthroplasty increase hospital burden.
More than 3 million people in the United States have atrial fibrillation, most of whom are being managed with anticoagulation therapy for life. The goal of the present study was to examine the effect of chronic anticoagulation therapy on patients with atrial fibrillation who undergo total joint arthroplasty. ⋯ Patients with preoperative atrial fibrillation undergoing total joint arthroplasty had an increased length of hospital stay, increased transfusion requirements, and an increased risk of periprosthetic joint infection and unplanned hospital readmission.
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J Bone Joint Surg Am · Sep 2013
Comparative StudyInterobserver reliability of classification and characterization of proximal humeral fractures: a comparison of two and three-dimensional CT.
Interobserver reliability for the classification of proximal humeral fractures is limited. The aim of this study was to test the null hypothesis that interobserver reliability of the AO classification of proximal humeral fractures, the preferred treatment, and fracture characteristics is the same for two-dimensional (2-D) and three-dimensional (3-D) computed tomography (CT). ⋯ Proximal humeral fracture classifications may be helpful conceptually, but they have poor interobserver reliability even when 3-D rather than 2-D CT is utilized. This may contribute to the similarly poor interobserver reliability that was observed for selection of the treatment for proximal humeral fractures. The lack of a reliable classification confounds efforts to compare the outcomes of treatment methods among different clinical trials and reports.
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J Bone Joint Surg Am · Sep 2013
High-dose rhBMP-2 for adults: major and minor complications: a study of 502 spine cases.
Use of recombinant human bone morphogenetic protein-2 (rhBMP-2) has increased considerably since its introduction in 2002. The complications associated with high-dose rhBMP-2 (≥ 40 mg) are unknown. The purpose of our study was to determine outcomes and medical and surgical complications associated with high-dose rhBMP-2 at short-term and long-term follow-up evaluations. ⋯ This is the largest study of which we are aware that examines complications associated with high-dose rhBMP-2. Major surgical complications occurred in 11.6% of patients, and 11.6% experienced major medical complications. There was a cancer prevalence of 3.4%, but no correlation between increasing rhBMP-2 dosage and cancer, radiculopathy (seen in 1% of the patients), or seroma (seen in 0.6%) was found.
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J Bone Joint Surg Am · Sep 2013
Ipsilateral hamstring tendon graft reconstruction for chronic patellar tendon ruptures: average 5.8-year follow-up.
Patellar tendon reconstruction is technically demanding and is indicated in patients with chronic ruptures (i.e., still present more than six weeks after injury). The purpose of this study was to assess the effectiveness of this procedure in patients with impaired function following patellar tendon rupture. ⋯ On the basis of our review of nineteen patients, hamstring tendon reconstruction of chronic patellar tendon rupture provided good functional recovery and return to preinjury daily activities.