The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Sep 2008
Randomized Controlled Trial Comparative StudyThe influence of early weight-bearing compared with non-weight-bearing after surgical repair of the Achilles tendon.
The optimal rehabilitation protocol after surgical repair of an Achilles tendon rupture has not been well defined. The objective of this randomized study was to compare the effect of early weight-bearing with that of non-weight-bearing on early postoperative recovery following repair of an acutely ruptured Achilles tendon. ⋯ Early weight-bearing after surgical repair of an acute Achilles tendon rupture improves health-related quality of life in the early postoperative period and has no detrimental effect on recovery.
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J Bone Joint Surg Am · Sep 2008
ReviewVariability in the assessment of fracture-healing in orthopaedic trauma studies.
There is a lack of consensus among orthopaedic surgeons in the assessment of fracture-healing. We conducted a systematic review of recent clinical studies of long-bone fracture care that were published in three major orthopaedic journals to identify current definitions of fracture-healing. ⋯ We found a lack of consensus with regard to the definition of fracture-healing in the current orthopaedic literature. Without valid and reliable clinical or radiographic measures of union, the interpretation of fracture care studies remains difficult.
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J Bone Joint Surg Am · Sep 2008
Comparative StudyTibial lengthening over an intramedullary nail with use of the Ilizarov external fixator for idiopathic short stature.
The details regarding bone formation and complication rates associated with tibial lengthening over an intramedullary nail with use of the Ilizarov external fixator have not been reported, to our knowledge. The purpose of this study was to review our experiences with this procedure, performed in individuals with idiopathic short stature. In addition, we compared the results of lengthening over a nail, in terms of the observed bone formation and the complications, with those of the conventional Ilizarov method. ⋯ Tibial lengthening with use of the Ilizarov external fixator over an intramedullary nail results in new bone formation of a quality equal to that obtained with the conventional Ilizarov method; however, it reduces the duration of external fixation and the rate of complications.
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J Bone Joint Surg Am · Sep 2008
Randomized Controlled Trial Multicenter StudyLumbar discectomy outcomes vary by herniation level in the Spine Patient Outcomes Research Trial.
The Spine Patient Outcomes Research Trial showed an overall advantage for operative compared with nonoperative treatment of lumbar disc herniations. Because a recent randomized trial showed no benefit for operative treatment of a disc at the lumbosacral junction (L5-S1), we reviewed subgroups within the Spine Patient Outcomes Research Trial to assess the effect of herniation level on outcomes of operative and nonoperative care. ⋯ The advantage of operative compared with nonoperative treatment varied by herniation level, with the smallest treatment effects at L5-S1, intermediate effects at L4-L5, and the largest effects at L2-L3 and L3-L4. This difference in effect was mainly a result of less improvement in patients with upper lumbar herniations after nonoperative treatment.
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J Bone Joint Surg Am · Sep 2008
Defining substantial clinical benefit following lumbar spine arthrodesis.
Validated health-related quality-of-life measures have become important standards in the evaluation of the outcomes of lumbar spine surgery. However, there are few well-defined criteria for clinical success based on these measures. The minimum clinically important difference is an important demarcation, but it could be considered a floor value rather than a goal in defining clinical success. Therefore, we sought to define thresholds of substantial clinical benefit for commonly used health-related quality-of-life measures following lumbar spine arthrodesis. ⋯ We believe that thresholds of substantial clinical benefit for commonly used health-related quality-of-life measures following lumbar spine arthrodesis are important as they describe a magnitude of change that the patient recognizes as a major improvement.