The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Sep 2012
Comparative StudyPost-splinting radiographs of minimally displaced fractures: good medicine or medicolegal protection?
Many institutions perform radiographic documentation following splint application even when no manipulation had been performed. The purpose of this study was to evaluate the utility of post-splinting radiographs of acute non-displaced or minimally displaced fractures that did not undergo manipulation. Our hypothesis was that post-splinting radiographs do not demonstrate changes in fracture alignment or impact the management of the patient. ⋯ Post-splinting radiographs of non-displaced and minimally displaced fractures that do not undergo manipulation before or during immobilization are associated with longer ER waits, additional radiation exposure, and increased health-care costs without providing helpful information. While certain circumstances call for additional imaging, routine performance of post-splinting radiography of non-displaced or minimally displaced fractures should be discouraged.
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J Bone Joint Surg Am · Sep 2012
Comparative StudyTalocalcaneal tarsal coalitions and the calcaneal lengthening osteotomy: the role of deformity correction.
Surgical resection of persistently painful talocalcaneal tarsal coalitions may not reliably relieve symptoms in patients with large coalitions associated with excessive hindfoot valgus deformity and subtalar posterior facet narrowing. Since 1991, calcaneal lengthening osteotomy, with or without coalition resection, has been used at our institution to relieve symptoms and to preserve motion at the talonavicular and calcaneocuboid joints. ⋯ It is generally accepted that resection is the treatment of choice for an intractably painful small talocalcaneal tarsal coalition that is associated with a wide, healthy posterior facet and minimal valgus deformity of the hindfoot. Although triple arthrodesis has been recommended for those who do not meet all three criteria, the present study suggests that an algorithmic treatment approach is justified. Treatment of the valgus deformity appears to be as important as that of the coalition. Calcaneal lengthening osteotomy with gastrocnemius or Achilles tendon lengthening is effective for correcting deformity and relieving pain in rigid flatfeet, just as it is in flexible flatfeet.
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J Bone Joint Surg Am · Sep 2012
Comparative StudyThe association between preoperative spinal cord rotation and postoperative C5 nerve palsy.
C5 nerve palsy is a known complication of cervical spine surgery. The development and etiology of this complication are not completely understood. The purpose of the present study was to determine whether rotation of the cervical spinal cord predicts the development of a C5 palsy. ⋯ Our evidence suggests that spinal cord rotation is a strong and significant predictor of C5 palsy postoperatively. Patients can be classified into three types, with Type 1 representing mild rotation (0° to 5°), Type 2 representing moderate rotation (6° to 10°), and Type 3 representing severe rotation (≥ 11°). The rate of C5 palsy was zero of 159 in the Type-1 group, eight of thirteen in the Type-2 group, and four of four in the Type-3 group. This information may be valuable for surgeons and patients considering anterior surgery in the C4 to C6 levels.
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J Bone Joint Surg Am · Sep 2012
Randomized Controlled Trial Comparative StudySling compared with plate osteosynthesis for treatment of displaced midshaft clavicular fractures: a randomized clinical trial.
Few randomized controlled trials have compared operative with nonoperative treatment of clavicular fractures. ⋯ One year after a displaced midshaft clavicular fracture, nonoperative treatment resulted in a higher nonunion rate but similar function and disability compared with operative treatment.
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J Bone Joint Surg Am · Sep 2012
ReviewResident duty-hour restrictions-who are we protecting?: AOA critical issues.
As advocated by Nasca, our teaching programs must nurture professionalism and the effacement of self interest that is the core of the practice of medicine and the profession. The evidence to date suggests that work-hour restrictions based solely on clock-defined time limits discourage, rather than promote, the professional behavior that we desire in tomorrow's physicians. Notwithstanding any issues related to duty hours or fitness for duty, a competency-based system of medical education is both desirable and necessary in the current environment of medical education. In the absence of evidence to suggest that duty-hour limits reduce medical errors and enhance patient safety, and until we have evolved to a competency-based system of resident education, a misguided and overzealous focus on limiting work hours should not be allowed to exert the unintended consequence of eroding the ethos of professionalism that we, and our patients, have come to expect of a physician.