The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Oct 2009
Adductor-related groin pain in recreational athletes: role of the adductor enthesis, magnetic resonance imaging, and entheseal pubic cleft injections.
Adductor dysfunction can cause groin pain in athletes and may emanate from the adductor enthesis. Adductor enthesopathy may be visualized with magnetic resonance imaging and may be treated with entheseal pubic cleft injections. We have previously reported that pubic cleft injections can provide predictable pain relief at one year in competitive athletes who have no evidence of enthesopathy on magnetic resonance imaging and immediate relief only in patients with findings of enthesopathy on magnetic resonance imaging. In this follow-up study, we attempted to determine if the same holds true for recreational athletes. ⋯ Most recreational athletes with adductor enthesopathy have pain relief at one year after entheseal pubic cleft injection, regardless of the findings on magnetic resonance imaging. There were similarities between this group of recreational athletes and the competitive athletes in our previous study, in that the adductor enthesis was the source of pain and entheseal pubic cleft injection was a valuable treatment option. The main difference was that, in this group of recreational athletes, magnetic resonance imaging evidence of adductor enthesopathy did not correlate with the outcome of the injection.
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J Bone Joint Surg Am · Oct 2009
Linked elbow replacement: a salvage procedure for distal humeral nonunion. Surgical technique.
Nonunion is a challenging and not uncommon complication of distal humeral fractures. Our long-term experience with linked semiconstrained total elbow arthroplasty as a salvage procedure for patients with distal humeral nonunion not amenable to internal fixation was investigated. ⋯ Linked semiconstrained total elbow arthroplasty is a salvage procedure that can provide pain relief and restore motion and function in patients with a distal humeral nonunion that is not amenable to internal fixation. Substantial risk factors for failure include an age of less than sixty-five years, multiple previous surgical procedures, and any history of infection.
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J Bone Joint Surg Am · Sep 2009
Comparative StudyTreatment of a segmental nerve defect in the rat with use of bioabsorbable synthetic nerve conduits: a comparison of commercially available conduits.
The use of biodegradable synthetic nerve conduits for the reconstruction of segmental nerve defects has been extensively reported in both animal and human studies, with a majority of studies evaluating sensory nerve recovery. However, few studies have compared these nerve conduits for functional motor recovery. The purpose of this study was to compare three commercially available, synthetic, bioabsorbable nerve conduits and autograft with respect to compound muscle action potentials, maximum isometric tetanic force, wet muscle weight, and nerve histomorphometry. ⋯ The functional outcome in this rat model was similar for the autograft and the poly-DL-lactide-epsilon-caprolactone conduits when they were used to reconstruct a 10-mm sciatic nerve defect. Functional recovery following the use of the polyglycolic acid conduit was the poorest.
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J Bone Joint Surg Am · Sep 2009
Comparative StudyResident duty-hour reform associated with increased morbidity following hip fracture.
The Accreditation Council for Graduate Medical Education implemented resident duty-hour reform for orthopaedic resident surgeons in the United States on July 1, 2003. This study sought to determine whether the change in duty-hour regulations was associated with relative changes in mortality and morbidity for patients with a hip fracture treated in hospitals with and without resident teaching involved in the delivery of medical care. ⋯ Resident duty-hour reform was associated with an accelerated rate of increasing patient morbidity following treatment of hip fractures in teaching institutions. Further research into this concerning finding is needed.
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J Bone Joint Surg Am · Sep 2009
Three-dimensional kinematics of the rheumatoid wrist after partial arthrodesis.
Partial arthrodesis of the wrist, such as radiolunate and radioscapholunate arthrodesis, is intuitively more appealing for the treatment of the rheumatoid wrist than total arthrodesis is because it preserves some motion. However, wrist kinematics after partial arthrodesis are incompletely understood. The purpose of the present study was to evaluate the kinematics of the radiocarpal and midcarpal joints of rheumatoid wrists with use of three-dimensional computed tomography before and after partial arthrodesis. ⋯ The results of this kinematic analysis, which showed that midcarpal motion occurred in the dart-throwing motion plane, may support the use of radiolunate and radioscapholunate arthrodeses as an alternative to total wrist arthrodesis in patients with symptomatic rheumatoid arthritis of the wrist.