The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Jul 2005
Percutaneous autologous bone-marrow grafting for nonunions. Influence of the number and concentration of progenitor cells.
Bone marrow aspirated from the iliac crest contains progenitor cells that can be used to obtain bone-healing of nonunions. However, there is little available information regarding the number and concentration of these cells that are necessary to obtain bone repair. The purpose of this study was to evaluate the number and concentration of progenitor cells that were transplanted for the treatment of nonunion, the callus volume obtained after the transplantation, and the clinical healing rate. ⋯ Percutaneous autologous bone-marrow grafting is an effective and safe method for the treatment of an atrophic tibial diaphyseal nonunion. However, its efficacy appears to be related to the number of progenitors in the graft, and the number of progenitors available in bone marrow aspirated from the iliac crest appears to be less than optimal in the absence of concentration.
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Late-onset tibia vara (Blount disease) can be difficult to treat because of frequent morbid obesity and associated deformities, including distal femoral varus, proximal tibial procurvatum, and distal tibial valgus, that contribute to lower extremity malalignment. We present a comprehensive approach that addresses all components of the deformity and allows restoration of the anatomic and mechanical axes. ⋯ This comprehensive approach allowed restoration of the mechanical and anatomic axes of the lower extremity in patients with late-onset tibia vara, resulting in a resolution of symptoms as a result of normalization of the weight-bearing forces across the knee and ankle. We believe that this approach will decrease the risk of early degenerative arthritis of the knee.
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J Bone Joint Surg Am · Jul 2005
Comparative StudyAssessment of two thoracolumbar fracture classification systems as used by multiple surgeons.
The reproducibility and repeatability of modern systems for classification of thoracolumbar injuries have not been sufficiently studied. We assessed the interobserver and intraobserver reproducibility of the AO (Arbeitsgemeinschaft für Osteosynthesefragen) classification and compared it with that of the Denis classification. Our purpose was to determine whether the newer, AO system had better reproducibility than the older, Denis classification. ⋯ Both the Denis and the AO system for the classification of spine fractures had only moderate reliability and repeatability. The tendency for well-trained spine surgeons to classify the same fracture differently on repeat testing is a matter of some concern.
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J Bone Joint Surg Am · Jul 2005
Body mass index as a predictor of complications after operative treatment of acetabular fractures.
Obesity, a growing public health concern, is often thought to be an important risk factor for postoperative complications. We hypothesized that body mass index is predictive of complications after operative treatment of acetabular fractures. ⋯ Body mass index is predictive of complications after operative treatment of acetabular fractures.
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J Bone Joint Surg Am · Jul 2005
Meta Analysis Comparative StudyPatellar resurfacing in total knee arthroplasty. A meta-analysis.
Patellar resurfacing during total knee arthroplasty remains controversial. We aimed to evaluate the effectiveness of this technique through an evaluation of the current literature. ⋯ The available evidence indicates that patellar resurfacing reduces the risks of reoperation and anterior knee pain after total knee arthroplasty. The observed effects are clinically important despite their modest magnitude. Additional, carefully designed randomized trials are required to strengthen this claim.