The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Dec 2010
Comparative StudyComparison of surgical outcomes of intra-articular calcaneal fractures by age.
Internal fixation is an accepted treatment for displaced fractures of the calcaneus. Operative intervention in older patients, however, is traditionally discouraged in the literature. The purpose of this study was to compare the outcomes of internal fixation of intra-articular fractures of the calcaneus on the basis of patient age. ⋯ In this series, outcomes of older patients are at least equivalent to those of younger patients undergoing internal fixation for an intra-articular calcaneal fracture. Operative intervention appears to be a reasonable option for displaced calcaneal fractures in older patients. Physiologic age should be considered when evaluating older patients, and individualized treatment plans remain critical because patients with low physical demands or who have medical complications may be better candidates for nonoperative treatment. Prospective studies are needed in this area.
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J Bone Joint Surg Am · Dec 2010
ReviewReview of successful litigation against english health trusts in the treatment of adults with orthopaedic pathology: clinical governance lessons learned.
Reviewing litigation brought against health institutions is a clinical governance issue and can help to prevent further cases. While large-scale databases are rare, the British National Health Service Litigation Authority deals with claims brought against all public health trusts in England. ⋯ These findings highlight the fact that education and vigilance remain important components of orthopaedic training as many of the cases of successful litigation had a preventable cause.
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J Bone Joint Surg Am · Dec 2010
How displaced are "nondisplaced" fractures of the medial humeral epicondyle in children? Results of a three-dimensional computed tomography analysis.
The management of fractures of the medial humeral epicondyle is controversial, but the primary issue is the relationship of outcomes to the extent of fracture displacement. This study compares the use of radiographs and three-dimensional computed tomography for determining the amount of displacement in medial humeral epicondylar injuries deemed to be minimally displaced (<5 mm) or nondisplaced. ⋯ Standard radiographs (anteroposterior and lateral views) are not sufficient to measure anterior displacement nor accurate enough to measure medial displacement of medial humeral epicondylar fractures. Internal oblique radiographs of the elbow appear to approximate the true anterior displacement, but three-dimensional computed tomography is the most accurate method to assess true displacement. The results of this study demonstrate that fractures that are found to be minimally displaced or nondisplaced by radiographs may have >1 cm of anterior displacement, for which surgery is usually recommended.
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J Bone Joint Surg Am · Dec 2010
Randomized Controlled Trial Multicenter StudyOperative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation.
To date, studies directly comparing the rerupture rate in patients with an Achilles tendon rupture who are treated with surgical repair with the rate in patients treated nonoperatively have been inconclusive but the pooled relative risk of rerupture favored surgical repair. In all but one study, the limb was immobilized for six to eight weeks. Published studies of animals and humans have shown a benefit of early functional stimulus to healing tendons. The purpose of the present study was to compare the outcomes of patients with an acute Achilles tendon rupture treated with operative repair and accelerated functional rehabilitation with the outcomes of similar patients treated with accelerated functional rehabilitation alone. ⋯ This study supports accelerated functional rehabilitation and nonoperative treatment for acute Achilles tendon ruptures. All measured outcomes of nonoperative treatment were acceptable and were clinically similar to those for operative treatment. In addition, this study suggests that the application of an accelerated-rehabilitation nonoperative protocol avoids serious complications related to surgical management.
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J Bone Joint Surg Am · Dec 2010
Clinical assessment of the ulnar nerve at the elbow: reliability of instability testing and the association of hypermobility with clinical symptoms.
Ulnar nerve hypermobility has been reported to be present in 2% to 47% of asymptomatic individuals. To our knowledge, the physical examination technique for diagnosing ulnar nerve hypermobility has not been standardized. This study was designed to quantify the interobserver reliability of the physical examination for ulnar nerve hypermobility and to determine whether ulnar nerve hypermobility is associated with clinical symptoms. ⋯ Ulnar nerve hypermobility occurs in over one-third of the adult population. Utilizing a standardized physical examination, a diagnosis of ulnar nerve hypermobility can be established with substantial interobserver reliability. In the general population, ulnar nerve hypermobility does not appear to be associated with an increased symptomatology attributable to the ulnar nerve.