The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Feb 2009
Soft-tissue resurfacing of the glenoid in the treatment of glenohumeral arthritis in active patients less than fifty years old.
Soft-tissue resurfacing of the glenoid, with arthroplasty of the humeral head, has been proposed as a viable treatment option for younger patients with symptomatic osteoarthritis of the shoulder. The purpose of this study was to evaluate our results with soft-tissue resurfacing of the glenoid in patients with glenohumeral arthritis who were less than fifty years of age, as we were concerned that this type of procedure was leading to poor outcomes. ⋯ Soft-tissue resurfacing of the glenoid with an Achilles tendon allograft combined with humeral head arthroplasty is not a reliable method of treatment of glenohumeral arthritis in an active patient younger than fifty years of age, as the clinical outcome is poor. Moreover, we found no evidence that the graft acts as a durable bearing surface.
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J Bone Joint Surg Am · Jan 2009
Surgical treatment of early wound complications following primary total knee arthroplasty.
Wound-healing problems are a known complication after primary total knee arthroplasty. However, little is known about the clinical outcomes for patients who require surgical treatment of these early wound-healing problems. The purpose of the present study was to determine the incidence, risk factors, and long-term sequelae of early wound complications requiring surgical treatment. ⋯ Patients requiring early surgical treatment for wound-healing problems after primary total knee arthroplasty are at significantly increased risk for further complications, including deep infection and/or major subsequent surgery, specifically, resection arthroplasty, amputation, or muscle flap coverage. These results emphasize the importance of obtaining primary wound-healing after total knee arthroplasty.
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J Bone Joint Surg Am · Jan 2009
Anterior-posterior and rotatory stability of single and double-bundle anterior cruciate ligament reconstructions.
Some surgeons presently reconstruct both the anteromedial and posterolateral bundles of the anterior cruciate ligament. The purposes of this study were to measure the abilities of single-bundle and anatomic double-bundle reconstructions to restore anteroposterior laxities and rotational kinematics to intact knee levels and to compare graft forces in reconstructed knees with forces in the native anterior cruciate ligament for the same loading conditions. ⋯ The single-bundle reconstruction produced graft forces, knee laxities, and coupled tibial rotations that were closest to normal. Adding a posterolateral graft to an anteromedial graft tended to reduce laxities and tibial rotations, but the reductions were accompanied by markedly higher forces in the posterolateral graft near 0 degrees that occasionally caused it to fail during tests with internal torque or anterior tibial force.
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J Bone Joint Surg Am · Jan 2009
Multicenter StudyDelayed internal fixation of femoral shaft fracture reduces mortality among patients with multisystem trauma.
Fractures of the femoral shaft are common and have potentially serious consequences in patients with multiple injuries. The appropriate timing of fracture repair is controversial. The purpose of the present study was to assess the effect of timing of internal fixation on mortality in patients with multisystem trauma. ⋯ Delayed repair of femoral shaft fracture beyond twelve hours in patients with multisystem trauma, which may allow time for appropriate resuscitation, reduces mortality by approximately 50%. Patients with serious abdominal injury benefit most from delayed treatment. These results support delaying definitive treatment of long-bone injuries in patients with multisystem trauma as a means of so-called damage-control in order to reduce adverse outcomes.
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J Bone Joint Surg Am · Jan 2009
Multicenter StudyOperative management of distal radial fractures with 2.4-millimeter locking plates. A multicenter prospective case series.
In the past decade, there has been a trend toward open reduction and internal fixation of unstable distal radial fractures. There are now more than thirty different implant designs specific for the fixation of distal radial fractures. A multicenter prospective study of a case series was conducted to determine the efficacy of the operative management of distal radial fractures stabilized with 2.4-mm locking plates. ⋯ Internal fixation of displaced distal radial fractures with implants featuring locking screw fixation can result in good-to-excellent outcomes with a limited number of complications.