The Journal of bone and joint surgery. American volume
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Clinically evident neurologic injury of the involved limb after total shoulder arthroplasty is not uncommon, but the subclinical prevalence is unknown. The purposes of this prospective study were to determine the subclinical prevalence of neurologic lesions after reverse shoulder arthroplasty and anatomic shoulder arthroplasty, and to evaluate the correlation of neurologic injury to postoperative lengthening of the arm. ⋯ The occurrence of peripheral neurologic lesions following reverse shoulder arthroplasty is relatively common, but usually transient. Arm lengthening with a reverse shoulder arthroplasty may be responsible for these nerve injuries.
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J Bone Joint Surg Am · Jul 2011
Substantial variation in the interpretation of financial disclosure policies for orthopaedic society meetings.
Physician disclosure of potential conflicts of interest is currently controversial. To address this issue, orthopaedic societies have implemented a variety of guidelines related to potential conflict-of-interest disclosure. Transparency is crucial to address the concerns about potential conflict-of-interest disclosure. Nonetheless, prior studies have noted substantial discrepancies in disclosures to societies for individual authors who present their research work at multiple conferences. Our goal was to evaluate the ability of orthopaedic surgeons to interpret disclosure policy statements regarding project-specific or global disclosure instructions. ⋯ This study clearly demonstrated a discrepancy between what societies intend to identify with disclosure policies and what the orthopaedist interprets is intended. Almost half of those completing the survey did not correctly understand the intention of three or more of the policies, even with expected study intent bias. This study showed that the language used in disclosure policy statements and the lack of a uniform policy may be a cause of substantial discrepancies in potential conflict-of-interest disclosure.
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J Bone Joint Surg Am · Jul 2011
Comparative StudyAdjacent-level cervical ossification after Bryan cervical disc arthroplasty compared with anterior cervical discectomy and fusion.
Ossification of the anterior longitudinal ligament and the anulus adjacent to an anterior cervical arthrodesis has been termed adjacent-level ossification development. Initial studies suggested an association with the placement of plates <5 mm from an adjacent disc space. A follow-up study demonstrated that this ossification rarely occurs in association with arthrodeses without plate fixation. In the present study, our goal was to determine the incidence of adjacent-level ossification in patients who underwent cervical arthrodesis with plate fixation as compared with that in patients who underwent cervical arthroplasty. ⋯ Our data conclusively demonstrate that cervical intervertebral arthroplasty is associated with a significantly lower incidence of adjacent-level ossification than arthrodesis with plate fixation at both the two-year and the four-year follow-up. Arthroplasty has the advantage of not being associated with adjacent-level ossification, which may decrease cervical spine motion above and below the surgical level.
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J Bone Joint Surg Am · Jul 2011
Scaphoid fractures in children and adolescents: contemporary injury patterns and factors influencing time to union.
Historically, scaphoid fractures in children and adolescents have predominantly involved the distal pole, requiring neither surgical care nor extended follow-up. Changing patient characteristics, however, appear to be altering fracture epidemiology and treatment. The purpose of this investigation was to characterize contemporary fracture patterns in children and adolescents and to identify factors influencing time to healing following both nonoperative and operative treatment. ⋯ With changes in patient characteristics and activities, scaphoid fracture patterns in children and adolescents are now similar to the published patterns in adults. While 90% of acute nondisplaced fractures heal with nonoperative treatment, three months of cast immobilization or more may be required for more proximal injuries. Almost one-third of pediatric patients with scaphoid fractures will present late with chronic nonunions; in these instances, surgical reduction and internal fixation should be considered the primary treatment option.
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J Bone Joint Surg Am · Jul 2011
ReviewPediatric pedicle screws: comparative effectiveness and safety: a systematic literature review from the Scoliosis Research Society and the Pediatric Orthopaedic Society of North America task force.
Pedicle screws are widely used in spinal surgery. There is extensive published literature concerning the use of pedicle screw instrumentation for spinal surgery in adults. Now there is a trend to use pedicle screws in pediatric patients, including the very young. A systematic review of the current English-language literature on the use of pedicle screw instrumentation in the pediatric age group was performed to specifically determine (1) the pedicle screw placement accuracy in patients with spine deformity and (2) the effect size of all-pedicle screw constructs compared with other methods of spinal instrumentation in terms of the percentage of scoliosis correction. ⋯ The accuracy of pedicle screw placement in the pediatric spine exceeds the accuracy rate reported in adults. Pedicle screw instrumentation constructs are significantly more effective for scoliosis correction, as determined on the basis of Cobb angle measurements, than are hook constructs and hybrid constructs.