The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · May 2005
Randomized Controlled Trial Multicenter Study Clinical TrialDevice for zone-II flexor tendon repair. A multicenter, randomized, blinded, clinical trial.
The stainless-steel Teno Fix tendon-repair device has improved biomechanical characteristics compared with those of suture repair, and it was well tolerated in a canine model. The purpose of this study was to compare the Teno Fix with suture repair in a clinical setting. ⋯ The Teno Fix is safe and effective for flexor tendon repair if the tendon size and exposure are sufficient. Tendon repairs with the Teno Fix have lower rupture rates and similar functional outcomes when compared with conventional repair, particularly in patients who are noncompliant with the rehabilitation protocol.
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J Bone Joint Surg Am · May 2005
ReviewEvidence-based review of the role of aprotinin in blood conservation during orthopaedic surgery.
Aprotinin is a serine protease inhibitor with antifibrinolytic properties that has been approved as a blood-conserving drug in cardiac surgery by the United States Food and Drug Administration. On the basis of the current evidence from Level-I trials, we make a grade-A recommendation for use of the high-dose aprotinin regimen in hip and spine surgery. Because of conflicting data, the low-dose aprotinin therapy as well as the use of aprotinin in patients with cancer cannot be recommended (grade-I recommendation). High-quality randomized trials are necessary to determine the optimal (and minimal) therapeutic dose of aprotinin and the optimal time of aprotinin administration during surgery.
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J Bone Joint Surg Am · May 2005
Complications of fluoroscopically guided extraforaminal cervical nerve blocks. An analysis of 1036 injections.
A number of serious complications associated with fluoroscopically guided extraforaminal cervical nerve blocks have been reported in the literature. The purpose of the present study was to determine the rate of complications associated with these blocks and to determine whether needle positioning during the procedure affected the prevalence of complications at one institution. ⋯ No catastrophic complications occurred in this series of 1036 nerve blocks. We found that the medial-lateral needle depth as seen on frontal-view radiographs was not associated with complications, although the anterior positioning of the needle as seen on lateral-view radiographs was associated with minor complications. Our results suggest that, with our technique, cervical nerve blocks are relatively safe procedures.
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J Bone Joint Surg Am · Apr 2005
Randomized Controlled Trial Comparative Study Clinical TrialA minimal-incision technique in total hip arthroplasty does not improve early postoperative outcomes. A prospective, randomized, controlled trial.
Minimally invasive total hip arthroplasty has stirred substantial controversy with regard to whether it provides superior outcomes compared with total hip arthroplasty performed through longer incisions. The orthopaedic literature is deficient in well-designed scientific studies to support the clinical superiority of this approach. The objective of this study was to compare the results of a single mini-incision approach with those of a standard-incision total hip arthroplasty in the early postoperative period. ⋯ Minimally invasive total hip arthroplasty performed through a single-incision posterior approach by a high-volume hip surgeon with extensive experience in less invasive approaches to the hip is safe and reproducible. However, it offers no significant benefit in the early postoperative period compared with a standard incision of 16 cm. As it is not known whether lower-volume and less-experienced surgeons can achieve similar results, the mini-incision technique merits further study before wide dissemination and implementation of this family of surgical approaches can be recommended.
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J Bone Joint Surg Am · Apr 2005
Clinical Trial Controlled Clinical TrialTranexamic acid reduces postoperative blood loss in cementless total hip arthroplasty.
Tranexamic acid, an inhibitor of fibrinolysis that blocks the lysine-binding site of plasminogen to fibrin, has been reported to reduce intraoperative and postoperative blood loss in patients undergoing total hip arthroplasty with cement. However, there have been few reports describing the effects of tranexamic acid on blood loss during and following total hip arthroplasty without cement. ⋯ In patients undergoing total hip arthroplasty without cement, preoperative administration of tranexamic acid is associated with decreased postoperative blood loss during the first twenty-four hours, especially during the first four hours after surgery.