The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Mar 2008
Outcomes of posterior wall fractures of the acetabulum. Surgical technique.
The Musculoskeletal Function Assessment (MFA) is a validated, reliable, self-administered questionnaire that is useful for determining functional status. The Merle d'Aubigné score is a clinical measure of hip function. The purpose of the present study was to evaluate the outcome information provided by these two instruments after operative treatment of elementary posterior wall fractures of the acetabulum. ⋯ The total MFA scores for patients with a posterior wall fracture of the acetabulum were significantly worse than normative reference values. Thus, complete recovery after a posterior wall fracture of the acetabulum is uncommon, with residual functional deficits involving wide-ranging aspects of everyday living that do not necessarily have an obvious direct connection to hip function. Although the modified Merle d'Aubigné score may be useful for evaluating isolated hip function in patients who have been treated for an acetabular fracture, its shortcomings limit its usefulness as a method for evaluating functional outcome in these patients. Research efforts should be directed toward the identification of the psychosocial and other underlying determinants of functional outcome and potential related treatment interventions.
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J Bone Joint Surg Am · Mar 2008
Randomized Controlled TrialAcute patellar dislocation in children and adolescents: a randomized clinical trial.
The treatment of acute patellar dislocation in children is controversial. Some investigators have advocated early repair of the medial structures, whereas others have treated this injury nonoperatively. The present report describes the long-term subjective and functional results of a randomized controlled trial of nonoperative and operative treatment of primary acute patellar dislocation in children less than sixteen years of age. ⋯ The long-term subjective and functional results after acute patellar dislocation are satisfactory in most patients. Initial operative repair of the medial structures combined with lateral release did not improve the long-term outcome, despite the very high rate of recurrent instability. A positive family history is a risk factor for recurrence and for contralateral patellofemoral instability. Routine repair of the torn medial stabilizing soft tissues is not advocated for the treatment of acute patellar dislocation in children and adolescents.
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J Bone Joint Surg Am · Mar 2008
Comparative StudyLateral entry compared with medial and lateral entry pin fixation for completely displaced supracondylar humeral fractures in children. Surgical technique.
Closed reduction and percutaneous pin fixation is the treatment of choice for completely displaced (type-III) extension supracondylar fractures of the humerus in children, although controversy persists regarding the optimal pin-fixation technique. The purpose of this study was to compare the efficacy of lateral entry pin fixation with that of medial and lateral entry pin fixation for the operative treatment of completely displaced extension supracondylar fractures of the humerus in children. ⋯ With use of the specific techniques employed in this study, both lateral entry pin fixation and medial and lateral entry pin fixation are effective in the treatment of completely displaced (type-III) extension supracondylar fractures of the humerus in children.
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J Bone Joint Surg Am · Mar 2008
Comparative StudyUninstrumented in situ fusion for high-grade childhood and adolescent isthmic spondylolisthesis: long-term outcome. Surgical technique.
Intermediate-term radiographic studies have shown that anterior and circumferential techniques result in high fusion rates in patients with high-grade spondylolisthesis, whereas posterolateral fusion is less successful. We are not aware of any long-term comparative studies in which these three methods have been evaluated with regard to functional outcome, including systematic spinal mobility and trunk strength measurements. ⋯ As assessed on the basis of patient-based outcomes, circumferential in situ fusion provided slightly better long-term results than did posterolateral or anterior in situ fusion. When the radiographic and functional results were combined with the patient-based outcomes, the overall differences between the three groups were small.
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J Bone Joint Surg Am · Mar 2008
Randomized Controlled Trial Multicenter Study Comparative StudyNonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. Surgical technique.
Recent studies have shown a high prevalence of symptomatic malunion and nonunion after nonoperative treatment of displaced midshaft clavicular fractures. We sought to compare patient-oriented outcome and complication rates following nonoperative treatment and those after plate fixation of displaced midshaft clavicular fractures. ⋯ Operative fixation of a displaced fracture of the clavicular shaft results in improved functional outcome and a lower rate of malunion and nonunion compared with nonoperative treatment at one year of follow-up. Hardware removal remains the most common reason for repeat intervention in the operative group. This study supports primary plate fixation of completely displaced midshaft clavicular fractures in active adult patients.