The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Dec 2009
Randomized Controlled Trial Comparative StudyReduction of acute anterior dislocations: a prospective randomized study comparing a new technique with the Hippocratic and Kocher methods.
There are several methods to reduce anterior shoulder dislocations, but few studies have compared the efficacy, safety, and reliability of the different techniques. As a result, deciding which technique to use is seldom based on objective criteria. The aim of the present study was to introduce a new method to reduce an anterior shoulder dislocation, which we have termed "FARES" (Fast, Reliable, and Safe), and to compare it with the Hippocratic and Kocher methods in terms of efficacy, safety, and the intensity of pain felt by the patient during reduction. ⋯ The FARES method is a significantly more effective, faster, and less painful method of reduction of an anterior shoulder dislocation in comparison with the Hippocratic and Kocher methods. It is easily performed by only one physician, it is applicable to anterior shoulder dislocations as well as simple fracture-dislocations, and its use is associated with no more morbidity than that associated with the other two methods.
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J Bone Joint Surg Am · Dec 2009
Clinical TrialSurgical stress-induced immune cell redistribution profiles predict short-term and long-term postsurgical recovery. A prospective study.
The experience of undergoing surgery is known to induce a short-term, fight-or-flight physiological stress response. As an optimum immune response at the site of surgery would enhance tissue repair, we examined surgical stress-induced immune cell redistribution profiles as predictors, and potential mediators, of short and long-term postoperative recovery. We tested the a priori hypothesis that predefined adaptive immune cell redistribution profiles observed during surgery will predict enhanced postoperative recovery. ⋯ Immune cell redistribution that is induced by the stress of undergoing surgery can predict (and may partially mediate) postoperative healing and recovery. These findings may provide the basis for identifying patients (either prospectively or during surgery) who are likely to show good as opposed to poor recovery following surgery and for designing interventions that would maximize protective immune responses and enhance the rate and extent of recovery.
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J Bone Joint Surg Am · Dec 2009
Assessment of technical skills of orthopaedic surgery residents performing open carpal tunnel release surgery.
Motor skills assessment is an important part of validating surgical competency. The need to test surgical skills competency has gained acceptance; however, assessment methods have not yet been defined or validated. The purpose of the present study was to evaluate the reliability and validity of four testing measures for the integrated assessment of orthopaedic surgery residents with regard to their competence in performing carpal tunnel release. ⋯ The results of the present study suggest that both knowledge and cadaver testing discriminate between novice and accomplished residents. However, although failure of the knowledge test can predict failure on technical skills testing, the presence of knowledge does not necessarily ensure successful performance of technical skills, as cognitive testing and technical skills testing are separate domains.
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Although plantar fasciitis is the most common cause of heel pain, little has been reported on the incidence rates of this disorder. We sought to determine the incidence rate and demographic risk factors of plantar fasciitis in an ethnically diverse and physically active population of United States military service members. ⋯ Female sex; black race; junior enlisted, senior enlisted, and senior officer rank groups; service in the Army or Marines; and increasing age are all risk factors for plantar fasciitis.