The Journal of bone and joint surgery. American volume
-
J Bone Joint Surg Am · Aug 2007
Comparative StudyA comparison of total hip and knee replacement in specialty and general hospitals.
The emergence of specialty orthopaedic hospitals has generated widespread controversy, but little is known about the quality of care they deliver. Our objective was to compare the characteristics and outcomes of patients undergoing major joint replacement in specialty orthopaedic and general hospitals. ⋯ After adjustment for patient characteristics and hospital volume, the specialty orthopaedic hospitals had better patient outcomes, as measured by Medicare administrative data, than did the general hospitals.
-
J Bone Joint Surg Am · Aug 2007
Magnetic resonance imaging of arthroscopic supraspinatus tendon repair.
While a number of studies have documented the very good clinical results of arthroscopic rotator cuff repair, very few authors have specifically assessed cuff integrity, supraspinatus atrophy, and fatty infiltration and their influence on the clinical outcome. ⋯ The clinical and structural results of arthroscopic repairs of isolated supraspinatus tears are equal to those reported following open repair. Fatty infiltration and muscle atrophy cannot be reversed by successful arthroscopic repair. Higher degrees of muscular atrophy and fatty infiltration preoperatively are associated with recurrence of the tear as well as progression of fatty infiltration and muscular atrophy and an inferior clinical result.
-
J Bone Joint Surg Am · Jul 2007
Timely fracture-healing requires optimization of axial fixation stability.
Bone-healing is known to be sensitive to the mechanical stability of fixation. However, the influence on healing of the individual components of fixation stiffness remains unclear. The aim of this study was to investigate the relationship between the initial in vitro fixation stiffness and the strength and stiffness of the callus after nine weeks. We hypothesized that axial stiffness would determine the healing outcome. ⋯ In this study, a clear relationship between the stability of fixation and the mechanical strength of the healing tibia was seen. Moderate levels of axial stability were associated with the highest callus strength and stiffness.
-
J Bone Joint Surg Am · Jul 2007
Are outcomes of bimalleolar fractures poorer than those of lateral malleolar fractures with medial ligamentous injury?
Recommendations for surgical treatment and expected outcomes differ for two unstable patterns of supination-external rotation ankle injuries. We compared the demographic characteristics and functional outcome following surgical stabilization between the two types of supination-external rotation type-4 fractures: distal fibular fracture with a deltoid ligament rupture and bimalleolar fracture. ⋯ At one year after surgical stabilization of an unstable ankle fracture, most patients experience little or mild pain and have few restrictions in functional activities. However, the functional outcome for those with a bimalleolar fracture is worse than that for those with a lateral malleolar fracture and disruption of the deltoid ligament, possibly because of the injury pattern and the energy expended.