The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Nov 2011
Review Meta Analysis Comparative StudyPoor citation of prior evidence in hip fracture trials.
Failure to cite prior evidence in the medical literature may result in publication redundancy and inefficient use of research funding. We evaluated trials in which internal fixation was compared with arthroplasty for the treatment of hip fractures in order to determine the extent to which these randomized trials cited all relevant previous trials. ⋯ Our review of studies of hip fracture treatment suggests poor citation of the previous literature. Studies in higher-impact journals with positive results are more likely to be cited in subsequent studies. Therefore, redundancy in publication and unnecessary surgical trials often occur.
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J Bone Joint Surg Am · Nov 2011
Comparative StudyIntraoperative assessment of the stability of the distal tibiofibular joint in supination-external rotation injuries of the ankle: sensitivity, specificity, and reliability of two clinical tests.
This study was designed to assess the sensitivity, specificity, and interobserver reliability of the hook test and the stress test for the intraoperative diagnosis of instability of the distal tibiofibular joint following fixation of ankle fractures resulting from supination-external rotation forces. ⋯ Interobserver agreement for the hook test and the clinical stress test was excellent, but the sensitivity of these tests was insufficient to adequately detect instability of the syndesmosis intraoperatively.
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J Bone Joint Surg Am · Nov 2011
Comparative StudyComparison of intra-articular simple compression and extra-articular distal radial fractures.
The impact of a single well-reduced or stable intra-articular fracture oriented in the sagittal plane on the outcome of internal fixation of a distal radial fracture is uncertain. We tested the hypothesis that wrist motion and function scores would not differ between patients with an extra-articular fracture and those with a single sagittal intra-articular fracture following open fracture reduction and internal fixation with use of a volar locking plate. ⋯ Open reduction and volar locking plate and screw fixation of extra-articular fractures and of simple intra-articular fractures of the distal aspect of the radius are associated with comparable impairment and disability within two years of surgery.
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J Bone Joint Surg Am · Nov 2011
Comparative StudyA qualitative study of factors influencing the decision to have an elective amputation.
Some patients with a functionally impaired lower limb choose to have an elective amputation, whereas others do not. Functional outcomes do not favor either type of treatment, making this a complex decision. The experiences of patients who have chosen elective amputation were analyzed to identify the key factors in this decision-making process. ⋯ The severity of pain and the desire for improved function are strong drivers for patients deciding to undergo elective amputation of a functionally impaired lower extremity. While patients do not want others' opinions, information regarding life with an amputation helps to set realistic expectations regarding outcome.
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J Bone Joint Surg Am · Nov 2011
Comparative StudyChronic opioid use prior to total knee arthroplasty.
Chronic use of opioid medications may lead to dependence or hyperalgesia, both of which might adversely affect perioperative and postoperative pain management, rehabilitation, and clinical outcomes after total knee arthroplasty. The purpose of this study was to evaluate patients who underwent total knee arthroplasty following six or more weeks of chronic opioid use for pain control and to compare them with a matched group who did not use opioids preoperatively. ⋯ Patients who chronically use opioid medications prior to total knee arthroplasty may be at a substantially greater risk for complications and painful prolonged recoveries. Alternative non-opioid pain medications and/or earlier referral to an orthopaedic surgeon prior to habitual opioid use should be considered for patients with painful degenerative disease of the knee.