The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Jan 2008
Patient risk factors, operative care, and outcomes among older community-dwelling male veterans with hip fracture.
Although more than 1200 hip fracture repairs are performed in United States Department of Veterans Affairs hospitals annually, little is known about the relationship between perioperative care and short-term outcomes for veterans with hip fracture. The purpose of the present study was to test whether perioperative care impacts thirty-day outcomes, with patient characteristics being taken into account. ⋯ In addition to recognizing the importance of patient-related factors, we identified operative factors that were related to thirty-day surgical outcomes. It will be important to investigate whether modifying operative factors, such as reducing surgical delays to less than four days, can directly improve the outcomes of hip fracture repair.
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J Bone Joint Surg Am · Jan 2008
Risk factors for surgical site infection following orthopaedic spinal operations.
Surgical site infections are not uncommon following spinal operations, and they can be associated with serious morbidity, mortality, and increased resource utilization. The accurate identification of risk factors is essential to develop strategies to prevent these potentially devastating infections. We conducted a case-control study to determine independent risk factors for surgical site infection following orthopaedic spinal operations. ⋯ Diabetes was associated with the highest independent risk of spinal surgical site infection, and an elevated preoperative or postoperative serum glucose level was also independently associated with an increased risk of surgical site infection. The role of hyperglycemia as a risk factor for surgical site infection in patients not previously diagnosed with diabetes should be investigated further. Administration of prophylactic antibiotics within one hour before the operation and increasing the antibiotic dosage to adjust for obesity are also important strategies to decrease the risk of surgical site infection after spinal operations.
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J Bone Joint Surg Am · Jan 2008
The impact of trauma-center care on functional outcomes following major lower-limb trauma.
Although studies have shown that treatment at a trauma center reduces a patient's risk of dying following major trauma, important questions remain as to the effect of trauma centers on functional outcomes, especially among patients who have sustained major lower-limb trauma. ⋯ This study provides evidence that patients who sustain high-energy lower-limb trauma benefit from treatment at a level-I trauma center.
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J Bone Joint Surg Am · Jan 2008
Cementless humeral resurfacing arthroplasty in active patients less than fifty-five years of age.
Cementless humeral resurfacing arthroplasty is a bone-conserving arthroplasty option for patients with glenohumeral arthritis. It has been successful in the older patient population. However, data regarding the results of arthroplasty in younger, more active patients are lacking. We report the two-year results of this procedure in active patients who were less than fifty-five years of age. ⋯ Cementless humeral resurfacing arthroplasty is a viable treatment option for younger, active patients. Early results indicate that the desired function and pain relief can be expected. Implant loosening and glenoid wear do not appear to be concerns in the short term despite the high activity levels of many patients. Long-term follow-up is needed to determine if these results persist.
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J Bone Joint Surg Am · Jan 2008
Comparative StudyAssessment of lower limb alignment: supine fluoroscopy compared with a standing full-length radiograph.
While a full-length standing anteroposterior radiograph of the lower extremity provides the best radiographic method for assessing limb alignment, other methods must be used intraoperatively. We have employed intraoperative fluoroscopy with use of an electrocautery cord to assess limb alignment in the supine patient. ⋯ Intraoperative fluoroscopy with use of the electrocautery cord method is a useful tool for assessing lower limb alignment in patients with a normal body mass index and