The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Mar 2011
Randomized Controlled Trial Comparative StudyComparison of bipolar hemiarthroplasty with total hip arthroplasty for displaced femoral neck fractures: a concise four-year follow-up of a randomized trial.
We performed a four-year follow-up of a randomized controlled trial involving 120 elderly patients with an acute displaced femoral neck fracture who were randomized to treatment with either a bipolar hemiarthroplasty or a total hip arthroplasty. The difference in hip function (as indicated by the Harris hip score) in favor of the total hip arthroplasty group that was previously reported at one year persisted and seemed to increase with time (mean score, 87 compared with 78 at twenty-four months [p < 0.001] and 89 compared with 75 at forty-eight months [p < 0.001]). The health-related quality of life (as indicated by the EuroQol [EQ-5D(index)] score) was better in the total hip arthroplasty group at the time of each follow-up, but the difference was significant only at forty-eight months (p < 0.039). These results confirm the better results in terms of hip function and quality of life after total hip arthroplasty as compared with hemiarthroplasty in elderly, lucid patients with a displaced fracture of the femoral neck.
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J Bone Joint Surg Am · Mar 2011
Comparative StudyA comparison of five treatment protocols for contaminated bone grafts in reference to sterility and cell viability.
Occasionally, a bone graft or comminuted fracture fragment is dropped on the operating-room floor and becomes contaminated. The purpose of this study was to determine an optimal method for sterilizing this bone with the minimum sacrifice of cell viability. ⋯ Of the easily accessible protocols studied, mechanical agitation and serial washes of bone graft in povidone-iodine that is allowed to dry offers the best balance between complete sterilization of contaminated bone and maintenance of tissue viability.
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J Bone Joint Surg Am · Mar 2011
Impaired growth of denervated muscle contributes to contracture formation following neonatal brachial plexus injury.
The etiology of shoulder and elbow contractures following neonatal brachial plexus injury is incompletely understood. With use of a mouse model, the current study tests the novel hypothesis that reduced growth of denervated muscle contributes to contractures following neonatal brachial plexus injury. ⋯ Injury of the upper trunk of the brachial plexus leads to impaired growth of the biceps and brachialis muscles, which are responsible for elbow flexion contractures, and impaired growth of the subscapularis muscle, which correlates with internal rotation contracture of the shoulder. Shoulder muscle imbalance alone causes neither subscapularis shortening nor internal rotation contracture. Impaired muscle growth cannot be explained solely by absence of functioning satellite cells.
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J Bone Joint Surg Am · Mar 2011
Internal fixation of type-C distal femoral fractures in osteoporotic bone: surgical technique.
Fixation of distal femoral fractures remains a challenge, especially in osteoporotic bone. This study was performed to investigate the biomechanical stability of four different fixation devices for the treatment of comminuted distal femoral fractures in osteoporotic bone. ⋯ The findings of this study support the concept that, for intramedullary nails, the kind of distal interlocking pattern affects the stabilization of distal femoral fractures. Four-screw distal locking provides the highest axial stability and nearly comparable torsional stability to that of the angular stable plate; the four-screw distal interlocking construct was found to have the best combined (torsional and axial) biomechanical stability.
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J Bone Joint Surg Am · Mar 2011
Revision arthroscopic rotator cuff repair: repair integrity and clinical outcome: surgical technique.
Literature regarding the outcomes of revision rotator cuff repair is limited. The purposes of the present study were to report the tendon repair integrity and clinical outcomes for a cohort of patients following revision arthroscopic rotator cuff repair and to examine factors related to tendon healing and the influence of healing on clinical outcomes. ⋯ Revision arthroscopic rotator cuff repair results in reliable pain relief and improvement in shoulder function in selected cases. Approximately half of the revision repairs can be expected to be intact at a minimum of one year following surgery. Patient age and the number of torn tendons are related to postoperative tendon integrity. The postoperative integrity of the rotator cuff can have a significant influence on shoulder abduction strength and the Constant score.