The Journal of bone and joint surgery. American volume
-
J Bone Joint Surg Am · Sep 2010
Relationship between the pivot shift and Lachman tests: a cadaver study.
While the Lachman and pivot shift tests have been used clinically for decades to assess the anterior cruciate ligament, the relationship between the two has undergone limited experimental study. The goal of this study was to evaluate biomechanical relationships between the Lachman and pivot shift tests in anterior cruciate ligament-deficient and reconstructed knees. ⋯ Our findings suggest that the magnitude of laxity of an injured knee, when considered alone, may not accurately predict the magnitude of the pivot shift, but the difference in laxity between the injured knee and the normal knee (the injured-normal difference) could be a good clinical predictor of the injured-normal difference in the pivot shift. We demonstrated that an insufficiently tensioned anterior cruciate ligament graft could substantially reduce anterior laxity, while leaving the pivot shift evaluation virtually unchanged.
-
J Bone Joint Surg Am · Sep 2010
Commercial liquid bags as a potential source of venous air embolism in shoulder arthroscopy.
Venous air embolism is a rare but potentially fatal complication of arthroscopy. Fatal venous air embolism has been reported with as little as 100 mL of air entering the venous system. During liquid-only arthroscopy, avenues for air introduction into the joint are limited. Therefore, we hypothesized that commercially prepared 3-L saline-solution bags are a source of potentially fatal amounts of gas that can be introduced into the joint by arthroscopic pumps. ⋯ Because a saline-solution arthroscopic pump is theoretically a closed system, venous air embolism has not been a concern. However, this study shows that it is possible to pump a fatal amount of air from 3-L saline-solution bags into an environment susceptible to the creation of emboli. Evacuation of air from the 3-L bags prior to use may eliminate this risk.
-
J Bone Joint Surg Am · Aug 2010
Influence of obesity on femoral osteolysis five and ten years following total hip arthroplasty.
The most important long-term complication following total hip arthroplasty is periprosthetic femoral osteolysis. A sizeable proportion of patients who undergo arthroplasty are obese. While patient activity, implant type, and quality of fixation are known risk factors for osteolysis, the literature concerning obesity is sparse and controversial. Our primary objective was to evaluate the influence of obesity on the risk of osteolysis five and ten years after primary total hip arthroplasty with a cemented stem. Secondary objectives were to evaluate clinical outcome and patient satisfaction. ⋯ Prognostic Level I. See Instructions to Authors for a complete description of levels of evidence.
-
J Bone Joint Surg Am · Aug 2010
Timing of wound closure in open fractures based on cultures obtained after debridement.
The timing of wound closure in open fractures has remained an inexact science. Numerous recommendations have been made for the management of these injuries regarding the optimal time to perform competent wound closure, with all advice based on subjective parameters. The purpose of this study was to determine the utility of a prospective protocol with use of wound cultures obtained after irrigation and debridement as a guide to the timing of wound closure following an open fracture of an extremity. ⋯ Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.