The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Dec 2012
Randomized Controlled TrialEffects of tourniquet use on blood loss and soft-tissue damage in total knee arthroplasty: a randomized controlled trial.
Although tourniquets are widely used in total knee arthroplasty, their effectiveness in reducing blood loss and their influence on the postoperative course remain unclear. Tourniquet-related soft-tissue damage is a related concern. We performed a prospective, randomized, controlled trial to clarify the effect of tourniquets in total knee arthroplasty. ⋯ The use of a tourniquet during total knee arthroplasty was effective for reducing blood loss and avoiding excessive postoperative inflammation and muscle damage. The use of a tourniquet was related to slightly more postoperative pain but did not affect postoperative recovery.
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J Bone Joint Surg Am · Dec 2012
Forceps reduction of the syndesmosis in rotational ankle fractures: a cadaveric study.
Recent studies have shown that it is difficult to accurately reduce and assess the reduction of the syndesmosis after ankle injury. The syndesmosis is most commonly reduced with use of reduction clamps to compress across the tibia and fibula. However, intraoperative techniques to optimize forceps reductions to restore syndesmotic relationships accurately have not been systematically studied. The purpose of the present study was to evaluate the accuracy of syndesmosis reduction with different rotational vectors of clamp placement. ⋯ Clamp placement in the neutral anatomical axis reduced the syndesmosis most accurately in our cadaveric model, although slight overcompression was frequently observed. Placing the clamp obliquely malreduced the unstable syndesmosis.
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J Bone Joint Surg Am · Dec 2012
Meta AnalysisPatellar resurfacing in primary total knee replacement: a meta-analysis.
Treatment of the patella during total knee replacement is an area of continuing debate. We performed a meta-analysis of randomized controlled trials to address the hypothesis that patellar resurfacing in primary total knee replacement improved patient outcome. ⋯ Patients who underwent patellar resurfacing experienced anterior knee pain and satisfaction with the arthroplasty procedure that were equivalent to those experienced by patients whose patella was not resurfaced; however, these patients underwent significantly fewer additional surgical procedures. Further long-term follow-up of modern prostheses in randomized studies measuring outcome with a patella-specific score is needed.
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J Bone Joint Surg Am · Dec 2012
Amputation for long-standing, therapy-resistant type-I complex regional pain syndrome.
Some patients with long-standing, therapy-resistant type-I complex regional pain syndrome consider an amputation. There is a lack of evidence regarding the risk of recurrence of the pain syndrome and patient outcomes after amputation. The goal of the present study was to evaluate the impact of an amputation on pain, participation in daily life activities, and quality of life as well as the use of a prosthesis and the risk of recurrence of the pain syndrome in patients with long-standing, therapy-resistant type-I complex regional pain syndrome. ⋯ Amputation may positively contribute to the lives of patients with long-standing, therapy-resistant type-I complex regional pain syndrome. Patients were likely to use a prosthesis after a lower-limb amputation. The risk of recurrence of the type-I complex regional pain syndrome was 24%.
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J Bone Joint Surg Am · Dec 2012
CommentToward a new standard in autogenous bone graft?: commentary on an article by H. Claude Sagi, MD, et al.: "qualitative and quantitative differences between bone graft obtained from the medullary canal (with a Reamer/Irrigator/Aspirator) and the iliac crest of the same patient".