The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Sep 2008
"Surgery is certainly one good option": quality and time-efficiency of informed decision-making in surgery.
Informed decision-making has been widely promoted in several medical settings, but little is known about the actual practice in orthopaedic surgery and there are no clear guidelines on how to improve the process in this setting. This study was designed to explore the quality of informed decision-making in orthopaedic practice and to identify excellent time-efficient examples with older patients. ⋯ In this study, which we believe is the first to focus on informed decision-making in orthopaedic surgical practice, we found opportunities for improvement but we also found that excellent informed decision-making is feasible and can be accomplished in a time-efficient manner.
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J Bone Joint Surg Am · Sep 2008
Patient compliance with clinical follow-up after total joint arthroplasty.
Periodic clinical and radiographic evaluation is commonly recommended by orthopaedic surgeons to monitor patients following total joint arthroplasty, yet the compliance with and efficacy of patient follow-up protocols have not been well defined. The purpose of this study was to evaluate patient compliance with early clinical follow-up after total hip arthroplasty or total knee arthroplasty. ⋯ Patient compliance with clinical follow-up after total joint arthroplasty in response to a verbal request made by the surgeon once at three months and once at one year postoperatively was poor in this series. These data indicate that this method (one-time verbal instruction) is insufficient to ensure compliance for follow-up after total joint arthroplasty.
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J Bone Joint Surg Am · Aug 2008
Trigger finger: prognostic indicators of recurrence following corticosteroid injection.
Corticosteroid injections are commonly used in the treatment of flexor tenosynovitis in adults. The present study was performed in an attempt to identify prognostic indicators of symptom recurrence one year after corticosteroid injection for the treatment of trigger digits. ⋯ At one year following injection, 56% of the digits had a recurrence of symptoms. Younger age, insulin-dependent diabetes mellitus, involvement of multiple digits, and a history of other tendinopathies of the upper extremity were associated with a higher rate of treatment failure. Symptoms often recurred several months after the injection.
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J Bone Joint Surg Am · Aug 2008
Comparative StudyComparison of thoracolumbar motion produced by manual and Jackson-table-turning methods. Study of a cadaveric instability model.
Patients who have sustained a spinal cord injury remain at risk for further neurologic deterioration until the spine is adequately stabilized. To our knowledge, no study has previously addressed the effects of different bed-to-operating room table transfer techniques on thoracolumbar spinal motion in an instability model. We hypothesized that the conventional logroll technique used to transfer patients from a supine position to a prone position on the operating room table has the potential to confer significantly more motion to the unstable thoracolumbar spine than the Jackson technique. ⋯ This study addresses in-hospital patient safety. Performing the Jackson turn requires approximately half as many people as required for a manual logroll. This study suggests that the Jackson technique should be considered for supine-to-prone transfer of patients with known or suspected instability of the thoracolumbar spine.
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J Bone Joint Surg Am · Aug 2008
Comparative StudyGeographic variation in epidural steroid injection use in medicare patients.
The rates of epidural steroid injections have increased dramatically over time, with conflicting evidence regarding the efficacy of epidural steroid injections for the treatment of various low-back pain disorders. Given the uncertainty about their role, we sought to evaluate the geographic variation in the use of epidural steroid injections for low back pain within the United States. We also sought to determine whether greater rates of epidural steroid injections are associated with lower rates of lumbar surgery. ⋯ There is substantial geographic variation in the rates of epidural steroid injections within the United States. Southern states tend to have the highest procedure rates, whereas northeastern states have the lowest. Injection rates are positively correlated with lumbar surgery rates; therefore, epidural steroid injections do not appear to be substituting for lumbar surgeries or reducing overall rates of lumbar surgery.