The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Feb 2013
CommentPrinciples and evidence: The optimal treatment of pertrochanteric hip fractures: Commentary on an article by Kjell Matre, MD, et al.: "TRIGEN INTERTAN intramedullary nail versus sliding hip screw. A prospective, randomized multicenter study on pain, function, and complications in 684 patients with an intertrochanteric or subtrochanteric fracture and one year of follow-up".
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Local anesthetics are frequently delivered intra-articularly to provide perioperative pain control. Previous studies have shown that the commonly used drugs lidocaine, ropivacaine, and bupivacaine can be toxic to human chondrocytes. The present study was conducted to determine whether the toxic effects of local anesthetics on human chondrocytes also extend to human mesenchymal stem cells. ⋯ Mesenchymal stem cells likely play a key role in healing following surgical procedures such as microfracture and ligament reconstruction. If local anesthetics are used following joint surgery, selection of an agent with low toxicity toward mesenchymal stem cells, such as ropivacaine, may maximize tissue healing potential.
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J Bone Joint Surg Am · Jan 2013
CommentThe dark side of amputation rehabilitation: commentary on an article by COL (Ret) William C. Doukas, MD, et al.: "The Military Extremity Trauma Amputation/Limb Salvage (METALS) study. outcomes of amputation versus limb salvage following major lower-extremity trauma".
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J Bone Joint Surg Am · Jan 2013
The Military Extremity Trauma Amputation/Limb Salvage (METALS) study: outcomes of amputation versus limb salvage following major lower-extremity trauma.
The study was performed to examine the hypothesis that functional outcomes following major lower-extremity trauma sustained in the military would be similar between patients treated with amputation and those who underwent limb salvage. ⋯ Major lower-limb trauma sustained in the military results in significant disability. Service members who undergo amputation appear to have better functional outcomes than those who undergo limb salvage. Caution is needed in interpreting these results as there was a potential for selection bias.
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J Bone Joint Surg Am · Jan 2013
Contribution of kinesophobia and catastrophic thinking to upper-extremity-specific disability.
Upper-extremity-specific disability correlates with mood and coping strategies. The aim of this study was to determine if two psychological factors, kinesiophobia (fear of movement) and perceived partner support, contribute significantly to variation in upper-extremity-specific disability in a model that included factors known to contribute to variation such as depression, pain anxiety, and catastrophic thinking. ⋯ In this sample, kinesiophobia and catastrophic thinking were the most important predictors of upper-extremity-specific disability in a model that accounted for symptoms of depression, anxiety, and pathophysiology (diagnosis) and explained more than half of the variation in disability. Perceived partner support was not a significant factor. The consistent and predominant role of several modifiable psychological factors in disability suggests that patients may benefit from a multidisciplinary approach that optimizes mindset and coping strategies.