The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Dec 2012
Comparative StudyErect radiographs to assess clinical instability in patients with blunt cervical spine trauma.
Computed tomography (CT) and magnetic resonance imaging (MRI) are sensitive modalities for the assessment of the spine, but certain injuries remain poorly assessed with supine radiographs. We describe four cases in which cervical spine injuries were proven as unstable with erect radiographs after being previously evaluated with supine radiographs and CT scans. ⋯ Despite major advances in imaging, these cases highlight the importance of physiological loading and radiographs. The controlled use of erect radiographs to test for clinical instability in patients with cervical spine injuries should be considered except in cases in which instability is already evident on other imaging modalities and/or surgical treatment is already indicated.
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J Bone Joint Surg Am · Dec 2012
Comparative StudyThe influence of insurance status on access to and utilization of a tertiary hand surgery referral center.
The purpose of this study was to systematically examine the impact of insurance status on access to and utilization of elective specialty hand surgical care. We hypothesized that patients with Medicaid insurance or those without insurance would have greater difficulty accessing care both in obtaining local surgical care and in reaching a tertiary center for appointments. ⋯ Economically disadvantaged patients face barriers to accessing specialty surgical care. Among patients with Medicaid coverage or no insurance, local surgical care is less likely to be offered and yet personal resources may limit a patient's ability to reach distant centers for non-emergency care.
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J Bone Joint Surg Am · Dec 2012
Combined glenoid anteversion osteotomy and tendon transfers for brachial plexus birth palsy: early outcomes.
In the setting of severe glenohumeral dysplasia secondary to brachial plexus birth palsy, external rotation osteotomy of the humerus has traditionally been used to transpose the existing arc of shoulder motion to a more functional position. Here we introduce a surgical alternative, the aim of which is to gain stable reduction of the shoulder and restore active external rotation. ⋯ In patients with severe glenohumeral dysplasia, glenoid realignment osteotomy in conjunction with soft-tissue rebalancing permits maintenance of joint reduction and functional improvement in the short term. In our view, external rotation osteotomy of the humerus is no longer the only surgical option for these cases.
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J Bone Joint Surg Am · Nov 2012
Comparative StudyLong-term follow-up of shoulder hemiarthroplasty for glenohumeral osteoarthritis.
There is major controversy surrounding the use of hemiarthroplasty as compared with total shoulder arthroplasty for glenohumeral osteoarthritis, and long-term clinical outcomes of hemiarthroplasty are lacking. ⋯ Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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J Bone Joint Surg Am · Nov 2012
Comparative StudyDo traction radiographs of distal radial fractures influence fracture characterization and treatment?
Our center evaluates all distal radial fractures with traction radiographs before splinting. Although investigations of various imaging modalities to evaluate distal radial fractures have been presented in the literature, to our knowledge the use of traction radiographs has not been well described. We hypothesized that the addition of traction radiographs to standard radiographs increases interobserver and intraobserver reliability for injury descriptions, affects the choice of treatment plan, and decreases the perceived need for computed tomography. ⋯ The addition of traction radiographs appeared to affect surgeons' interobserver reliability in the evaluation of distal radial fractures. In addition, traction radiographs changed the rate of detection of intra-articular fragments requiring reduction and the perceived need for computed tomography. These data indicate that traction radiographs may provide some of the same information as computed tomographic scans at a lower cost and argue for additional research comparing computed tomographic scans and traction radiographs of the distal part of the radius.