The Journal of bone and joint surgery. American volume
-
J Bone Joint Surg Am · Dec 2006
Randomized Controlled TrialContinuous infusion of local anesthetic at iliac crest bone-graft sites for postoperative pain relief. A randomized, double-blind study.
Autologous bone graft is the so-called gold standard for reconstruction of bone defects and nonunions. The most frequent complication is donor site pain. The iliac crest is a common source for autologous bone graft. The purpose of this study was to determine whether a continuous infusion of 0.5% bupivacaine into the iliac crest harvest site provides pain relief that is superior to the relief provided by systemic narcotic pain medication alone in patients undergoing reconstructive orthopaedic trauma procedures. ⋯ No difference in perceived pain was found between the groups. The results of this small, unstratified study indicate that continuous infusion of bupivacaine at iliac crest bone-graft sites during the postoperative period is not an effective pain-control measure in hospitalized patients receiving systemic narcotic medication.
-
J Bone Joint Surg Am · Dec 2006
Surgical outcomes of posterior lumbar interbody fusion in elderly patients.
We are aware of no reports on the surgical results of posterior lumbar interbody fusion in elderly patients. The purpose of this study was to investigate the clinical and radiographic results of posterior lumbar interbody fusion with pedicle screws in patients older than seventy years of age and compare them with results in younger patients. We also investigated the association between the clinical and radiographic results. ⋯ No obvious differences in the clinical results were observed between the age groups with the numbers available. Postoperative adjacent segment degeneration was less frequent and collapsed union and delayed union were more common in the elderly group. The fusion results did not appear to affect the postoperative clinical results in this study.
-
J Bone Joint Surg Am · Dec 2006
Randomized Controlled Trial Multicenter Study Comparative StudyOpen reduction and internal fixation compared with circular fixator application for bicondylar tibial plateau fractures. Results of a multicenter, prospective, randomized clinical trial.
Standard open reduction and internal fixation techniques have been successful in restoring osseous alignment for bicondylar tibial plateau fractures; however, surgical morbidity, especially soft-tissue infection and wound necrosis, has been reported frequently. For this reason, several investigators have proposed minimally invasive methods of fracture reduction followed by circular external fixation as an alternative approach. To our knowledge, there has been no direct comparison of the two operative approaches. ⋯ Both techniques provide a satisfactory quality of fracture reduction. Because percutaneous reduction and application of a circular fixator results in a shorter hospital stay, a marginally faster return of function, and similar clinical outcomes and because the number and severity of complications is much higher with open reduction and internal fixation, we believe that circular external fixation is an attractive option for these difficult-to-treat fractures. Regardless of treatment method, patients with this injury have substantial residual limb-specific and general health deficits at two years of follow-up.
-
J Bone Joint Surg Am · Dec 2006
Comparative StudyDiagnosis of scaphoid fracture displacement with radiography and computed tomography.
Displacement is an important risk factor for nonunion of scaphoid wrist fractures. We compared computed tomography with radiographs with regard to their ability to detect displacement. ⋯ Computed tomography improves the reliability of detecting scaphoid fracture displacement but has a more limited effect on accuracy, which remains <80%. The utility of computed tomography scans for diagnosing scaphoid fracture displacement is affected by the low prevalence of fracture displacement. This study suggests that computed tomography scans are useful for ruling out displacement but not for diagnosing it. We recommend that all scaphoid fractures be evaluated with computed tomography in order to rule out displacement.
-
J Bone Joint Surg Am · Nov 2006
Comparative StudyUncemented total hip arthroplasty in young adults with osteonecrosis of the femoral head: a comparative study.
The outcome of uncemented total hip arthroplasty in patients with osteonecrosis of the femoral head in general, and in young adults in particular, remains largely unknown. This study evaluated the clinical and radiographic results of uncemented total hip arthroplasty in young adults with osteonecrosis of the femoral head and compared these results to those seen in young adults with osteoarthritis. ⋯ Therapeutic Level III. See Instructions to Authors on jbjs.org for a complete description of levels of evidence.