The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Jan 2007
Perceptions and competence in evidence-based medicine: Are surgeons getting better? A questionnaire survey of members of the Dutch Orthopaedic Association.
The Journal of Bone and Joint Surgery, American Volume (The Journal) recently initiated a section called "Evidence-Based Orthopaedics." Furthermore, a level-of-evidence rating is now used in The Journal to help readers in clinical decision-making. Little is known about whether this recent emphasis has influenced surgeons' perceptions about and competence in evidence-based medicine. Therefore, we examined perceptions and competence in evidence-based medicine among Dutch orthopaedic surgeons. ⋯ Evidence-based medicine is welcomed by Dutch orthopaedic surgeons. The recent emphasis on evidence-based medicine is reflected in an increased awareness about The Journal's evidence-based medicine section, levels of evidence, and the largest evidence-based medicine resource: the Cochrane reviews. Younger orthopaedic surgeons had better knowledge about evidence-based medicine. The development and use of evidence-based resources as well as preappraised summaries such as The Journal's evidence-based medicine abstracts and Cochrane reviews were perceived as the best way to move from opinion-based to evidence-based orthopaedic practice.
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J Bone Joint Surg Am · Jan 2007
Internal oblique radiographs for diagnosis of nondisplaced or minimally displaced lateral condylar fractures of the humerus in children.
Several radiographic criteria based on only standard anteroposterior and lateral radiographs have been suggested for predicting the stability of lateral condylar fractures of the humerus in children. Despite adherence to these guidelines, further displacement often occurs after the initial diagnosis and stability assessment. The purpose of this study was to define the usefulness of an internal oblique radiograph in the assessment of these fractures. ⋯ It is not optimal to evaluate the amount of displacement and the stability of a lateral condylar fracture of the humerus in children on the basis of just anteroposterior and lateral elbow radiographs. Classifications should be based on the greatest displacement seen on at least three radiographic views, especially the internal oblique view.
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J Bone Joint Surg Am · Dec 2006
Randomized Controlled Trial Comparative StudyTotal hip arthroplasty and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck. A randomized, controlled trial.
Hemiarthroplasty and total hip arthroplasty are commonly used to treat displaced intracapsular fractures of the femoral neck, but each has disadvantages and the optimal treatment of these fractures remains controversial. ⋯ Total hip arthroplasty conferred superior short-term clinical results and fewer complications when compared with hemiarthroplasty in this prospectively randomized study of mobile, independent patients who had sustained a displaced fracture of the femoral neck.
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National data documenting the impact of pediatric trauma in general and of pediatric orthopaedic trauma in particular on the rates of hospital admissions and emergency-room visits have been reported. This study documents the frequency of and work involved in the care of pediatric orthopaedic trauma by a single urban pediatric orthopaedic group practice. ⋯ This study documents the frequency and work relative value of the care of musculoskeletal injuries in an urban pediatric orthopaedic practice in the outpatient and inpatient settings. It is a snapshot in time of current trends in pediatric orthopaedic practice, but these data may have implications for future resource allocation of the pediatric orthopaedic manpower in North America.
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J Bone Joint Surg Am · Dec 2006
Randomized Controlled Trial Multicenter Study Comparative StudyPhysical therapy alone compared with core decompression and physical therapy for femoral head osteonecrosis in sickle cell disease. Results of a multicenter study at a mean of three years after treatment.
Osteonecrosis of the femoral head is a common complication in patients with sickle cell disease, and collapse of the femoral head occurs in 90% of patients within five years after the diagnosis of the osteonecrosis. However, the efficacy of hip core decompression to prevent the progression of osteonecrosis in these patients is still controversial. ⋯ In this randomized prospective study, physical therapy alone appeared to be as effective as hip core decompression followed by physical therapy in improving hip function and postponing the need for additional surgical intervention at a mean of three years after treatment.