The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Jun 2004
Primary total hip arthroplasty with a proximally porous-coated femoral stem.
The use of cementless, proximally porous-coated femoral stems for total hip arthroplasty has increased in popularity. The purpose of the present report was to examine the five to ten-year results associated with the use of a so-called second-generation circumferentially proximally porous-coated titanium-alloy stem. ⋯ Given the young age and high activity level of these patients, this stem fared well: the levels of patient function and satisfaction were high, the rates of loosening and revision were very low, and distal osteolysis did not occur. Osseous fixation occurred reliably. Proximal stress-shielding was seen but did not seem to be clinically important.
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J Bone Joint Surg Am · May 2004
Comparative StudyDifferentiation between septic arthritis and transient synovitis of the hip in children with clinical prediction algorithms.
Differentiation between septic arthritis and transient synovitis of the hip in children can be difficult. Kocher et al. recently developed a clinical prediction algorithm for septic arthritis based on four clinical variables: history of fever, non-weight-bearing, an erythrocyte sedimentation rate of >or=40 mm/hr, and a serum white blood-cell count of >12000/mm(3) (>12.0 x 10(9)/L). The purpose of this study was to apply this clinical algorithm retrospectively to determine its predictive value in our patient population. ⋯ Although the use of a clinical prediction algorithm to differentiate between septic arthritis and transient synovitis may have improved the utility of existing technology and medical care to facilitate the diagnosis at the institution at which the algorithm originated, application of the algorithm proposed by Kocher et al. or of our three-variable model does not appear to be valid at other institutions.
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J Bone Joint Surg Am · May 2004
Vascular injuries in knee dislocations: the role of physical examination in determining the need for arteriography.
Popliteal artery injury is frequently associated with knee dislocation following blunt trauma, an injury that is being seen with increasing frequency. The primary purpose of the present study was to evaluate the use of physical examination to determine the need for arteriography in a large series of patients with knee dislocation. The secondary purpose was to evaluate the correlation between physical examination findings and clinically important vascular injury in the subgroup of patients who underwent arteriography. ⋯ Selective arteriography based on serial physical examinations is a safe and prudent policy following knee dislocation. There is a strong correlation between the results of physical examination and the need for arteriography. Increased vigilance may be justified in the case of a patient with a KD-IV dislocation, for whom serial examinations should continue for at least forty-eight hours.
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J Bone Joint Surg Am · May 2004
Distal humeral fractures treated with noncustom total elbow replacement.
The purpose of this study was to review the cases of patients with a distal humeral fracture that was treated with a noncustom total elbow arthroplasty. We hypothesized that, on the basis of the functional and clinical outcome, total elbow replacement is a reliable option for the treatment of elderly patients with a severe, comminuted fracture of the distal part of the humerus. ⋯ Complex distal humeral fractures should be assessed primarily for the reliability with which they can be reconstructed with osteosynthesis. When osteosynthesis is not considered to be feasible, especially in patients who are physiologically older and place lower demands on the joint, total elbow arthroplasty can be considered. This retrospective review supports a recommendation for total elbow arthroplasty for the treatment of an acute distal humeral fracture when strict inclusion criteria are observed.
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J Bone Joint Surg Am · May 2004
Doubling the impact: publication of systematic review articles in orthopaedic journals.
Investigators aim to publish their research papers in top journals to disseminate their findings to the widest possible audience. Systematic reviews of the literature occupy the highest position in currently proposed hierarchies of evidence. We hypothesized that the number of citations (a measure of scholarly interest) for systematic reviews (or meta-analyses) published in leading orthopaedic journals would be greater than the number of citations for narrative reviews published in the same journals. ⋯ Our findings suggest that journal editors and authors can improve the relevance and scholarly interest in their reviews (as shown by the number of citations) by meeting standard guidelines for methodological rigor.