The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Sep 2011
Safety syringes and anti-needlestick devices in orthopaedic surgery.
The American Academy of Orthopaedic Surgery (AAOS), The Joint Commission, the Occupational Safety and Health Administration (OSHA), and the Needlestick Safety and Prevention Act encourage the integration of safety-engineered devices to prevent needlestick injuries to health-care workers and patients. We hypothesized that safety syringes and needles could be used in outpatient orthopaedic injection and aspiration procedures. ⋯ The most effective and reliable safety devices for orthopaedic syringe procedures are shielded safety needles, mechanical syringes, manual retractable syringes, and shielded syringes, but not automatic retractable syringes. Even when adopting safety-engineered devices for an orthopaedic clinic, conventional syringes larger than 20 mL and conventional needles longer than 1.5 in (3.8 cm) are necessary.
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J Bone Joint Surg Am · Sep 2011
Randomized Controlled Trial Multicenter Study Comparative StudyPulsed electromagnetic field stimulation for acute tibial shaft fractures: a multicenter, double-blind, randomized trial.
Tibial shaft fractures are sometimes complicated by delayed union and nonunion, necessitating further surgical interventions. Pulsed electromagnetic field stimulation is an effective treatment for delayed unions and nonunions, but its efficacy in preventing healing complications in patients with acute fractures is largely untested. The purpose of this pragmatic trial was to determine whether adjuvant pulsed electromagnetic field therapy for acute tibial shaft fractures reduces the rate of surgical revision because of delayed union or nonunion. ⋯ Adjuvant pulsed electromagnetic field stimulation does not prevent secondary surgical interventions for delayed union or nonunion and does not improve radiographic union or patient-reported functional outcomes in patients with acute tibial shaft fractures.
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J Bone Joint Surg Am · Sep 2011
Comparative StudyClinical outcomes of corrective osteotomy for distal radial malunion: a review of opening and closing-wedge techniques.
Radial corrective osteotomy is an established but challenging treatment for distal radial malunion. There is ongoing discussion over whether an opening or closing-wedge osteotomy should be employed. The purpose of the present study was to retrospectively compare the clinical and radiographic results of conventional opening-wedge osteotomy with those of our closing-wedge technique. ⋯ The closing-wedge osteotomy technique is an effective reconstructive procedure for the treatment of extra-articular distal radial malunion. It is significantly better than the opening-wedge osteotomy technique in terms of the restoration of ulnar variance, the extension-flexion arc of wrist motion, and the Mayo wrist score.
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J Bone Joint Surg Am · Sep 2011
Risk factors for postoperative infection following posterior lumbar instrumented arthrodesis.
Surgical site infection in the spine is a serious postoperative complication. Factors such as posterior surgical approach, arthrodesis, use of spinal instrumentation, age, obesity, diabetes, tobacco use, operating-room environment, and estimated blood loss are well established in the literature to affect the risk of infection. The goal of this study was to analyze and identify independent risk factors for surgical site infection among spine patients undergoing posterior lumbar instrumented arthrodesis. ⋯ This analysis confirms previously demonstrated risk factors for postoperative infection while reporting on new potential independent risk factors of osteoporosis, chronic obstructive pulmonary disease, and dural tears in the setting of posterior lumbar instrumented arthrodesis. Areas of new research can focus on the roles these novel factors may play in the pathogenesis of surgical site infections in the spine.
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J Bone Joint Surg Am · Sep 2011
Risk factors for immediate postoperative complications and mortality following spine surgery: a study of 3475 patients from the National Surgical Quality Improvement Program.
This investigation sought to identify risk factors for immediate postoperative morbidity and mortality among a large series of patients undergoing spine surgery who were prospectively entered into a national registry. ⋯ Patient age, female sex, longer procedural times, and several types of medical comorbidities influenced the risk of postoperative complications or mortality. This information enhances estimates of morbidity and mortality following spine surgery and may improve patient selection for spine surgery as well as preoperative discussions related to the risks of spine surgery.