The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Feb 2010
Physicians' ability to manually detect isolated elevations in leg intracompartmental pressure.
Serial physical examination is recommended for patients for whom there is a high index of suspicion for compartment syndrome. This examination is more difficult when performed on an obtunded patient and relies on the sensitivity of manual palpation to detect compartment firmness-a direct manifestation of increased intracompartmental pressure. This study was performed to establish the sensitivity of manual palpation for detecting critical pressure elevations in the leg compartments most frequently involved in clinical compartment syndrome. ⋯ Manual detection of compartment firmness associated with critical elevations in intracompartmental pressure is poor.
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J Bone Joint Surg Am · Feb 2010
Outcome following open reduction and internal fixation of open pilon fractures.
A variety of treatment options exist for open pilon fractures of the distal end of the tibia. In this study, we evaluated the use of a staged protocol designed to minimize the risk of soft-tissue complications and to allow for optimal reduction of the fracture. ⋯ Open reduction and internal fixation of open pilon fractures was accomplished with an acceptable outcome and a low prevalence of soft-tissue complications. We believe these results can be reproduced through routine use of an individualized treatment algorithm including the use of staged procedures, meticulous soft-tissue management, liberal use of temporizing external fixation, and a patient-specific approach to fixation and soft-tissue coverage.
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J Bone Joint Surg Am · Feb 2010
Comparative StudySpinal anesthesia mediates improved early function and pain relief following surgical repair of ankle fractures.
To our knowledge, no study to date has compared the use of spinal and general anesthesia in patients undergoing operative fixation of an unstable ankle fracture. The purpose of this study was to assess the effects of anesthesia type on postoperative pain and function in a large cohort of patients. ⋯ Patients who undergo fixation of an ankle fracture under spinal anesthesia seem to experience less pain and have better function in the early postoperative period. We recommend that, unless there is a specific contraindication, patients should be offered spinal anesthesia when undergoing operative fixation of an ankle fracture.
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J Bone Joint Surg Am · Feb 2010
Minimal clinically important differences in ASES and simple shoulder test scores after nonoperative treatment of rotator cuff disease.
The minimal clinically important difference is the smallest difference in an outcome score that a patient perceives as beneficial. The purpose of this study was to determine the minimal clinically important difference in the American Shoulder and Elbow Surgeons (ASES) score and in the Simple Shoulder Test (SST) score for patients treated nonoperatively for rotator cuff disease. ⋯ Patients with rotator cuff disease who are treated without surgery and have a 2-point change in the SST score or a 12 to 17-point change in the ASES score experience a clinically important change in self-assessed outcome. These minimal clinically important differences can provide the basis for determining if significant differences in outcomes after treatment are clinically relevant.