The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Jun 2009
Comparative StudyNear-infrared spectroscopy in lower extremity trauma.
Near-infrared spectroscopy measures the percentage of hemoglobin oxygen saturation in the microcirculation of tissue up to 3 cm below the skin. The purpose of this study was to describe the measurable response of normal tissue oxygenation in the leg after acute trauma with use of this technique. ⋯ Tibial fracture produces a predictable increase in tissue oxygenation as measured by near-infrared spectroscopy. The corresponding compartment of the contralateral leg can provide strong utility as an internal control value when evaluating the hyperemic response to injury.
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J Bone Joint Surg Am · Jun 2009
Uncemented grit-blasted straight tapered titanium stems in patients younger than fifty-five years of age. Fifteen to twenty-year results.
Total hip arthroplasty without cement is frequently performed in young active patients, but only limited outcomes data are available after durations of follow-up of more than fifteen years. ⋯ After a minimum duration of follow-up of fifteen years, the survival of this type of femoral component is excellent in individuals younger than fifty-five years. The main mode of stem failure was a periprosthetic fracture due to trauma, or late aseptic loosening in a small percentage of the hips in which the femoral implant was undersized. The high rate of failure of the acetabular components was attributable to a poor design that is no longer in use.
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Many surgical questions are not amenable to investigation with a randomized controlled trial; thus, investigators must select an appropriate observational study design. Case-control studies are relatively inexpensive and can be conducted in comparatively little time. ⋯ They are particularly useful when the outcome of interest is rare or when the time to development of the outcome is long. We present an overview of the case-control study, with a focus on trial design and interpretation of results.
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J Bone Joint Surg Am · May 2009
Randomized Controlled Trial Comparative StudyAugmented compared with nonaugmented surgical repair of a fresh total Achilles tendon rupture. A prospective randomized study.
Augmented and nonaugmented techniques have been used for the operative repair of a fresh complete Achilles tendon rupture. Augmented techniques have been favored for their stronger pullout strengths but have been avoided because of the risk of wound complications. If proven to be equally good, the nonaugmented technique would be the method of choice. In the present study, we hypothesized that augmentation with a down-turned gastrocnemius fascia flap would not provide better results than would end-to-end suture repair with use of the Krackow locking loop surgical technique. ⋯ Augmented repair of a fresh total Achilles tendon rupture does not have any advantage over simple end-to-end repair.