The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Jun 2002
Long-term outcome after tibial shaft fracture: is malunion important?
Fractures of the shaft of the tibia often heal with some angulation. Although there is biomechanical evidence that such angulation alters load transmission through the joints of the lower limb, it is not clear whether it can eventually lead to osteoarthritis. ⋯ The thirty-year outcome after a tibial shaft fracture is usually good, although mild osteoarthritis is common. Fracture malunion is not the cause of the higher prevalence of symptomatic ankle and subtalar osteoarthritis on the side of the fracture. Although varus malalignment of the lower limb occurs occasionally and may cause osteoarthritis in the medial compartment of the knee, other factors are more important in causing osteoarthritis after a tibial shaft fracture.
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J Bone Joint Surg Am · May 2002
In situ fixation of pelvic nonunions following pathologic and insufficiency fractures.
A nonunion of the pelvic ring after a pathologic or insufficiency fracture of osteopenic bone is rare. The purpose of the present study was to evaluate the radiographic and clinical results of in situ fixation of these nonunions. ⋯ In situ fixation of a nonunion of the pelvic ring following a pathologic or insufficiency fracture can result in a decrease in pelvic pain and instability along with an improvement in walking ability. A high percentage of patients complain of persistent pain, even if there is radiographic evidence of union of the pelvic ring.
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J Bone Joint Surg Am · May 2002
Comparative StudyComparison of anterior and posterior iliac crest bone grafts in terms of harvest-site morbidity and functional outcomes.
Previous studies have demonstrated high complication rates after harvest of iliac crest bone grafts. This study was undertaken to compare the morbidity related to the harvest of anterior iliac crest bone graft with that related to the harvest of posterior iliac crest bone graft and to determine differences in functional outcome. ⋯ In this series, the complication rate was lower than those previously reported by other investigators. Harvest of a posterior iliac crest bone graft was associated with a significantly lower risk of postoperative complications. On the basis of the results of this study, we recommend that iliac crest bone graft be harvested posteriorly whenever possible.
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J Bone Joint Surg Am · May 2002
Scalene regional anesthesia for shoulder surgery in a community setting: an assessment of risk.
A retrospective review of shoulder procedures using scalene block anesthesia was performed. ⋯ Informed consent discussions regarding scalene block anesthesia should include information on the prevalence of complications and the efficacy of the technique.
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J Bone Joint Surg Am · Apr 2002
Randomized Controlled Trial Comparative Study Clinical TrialAnterior knee pain after intramedullary nailing of fractures of the tibial shaft. A prospective, randomized study comparing two different nail-insertion techniques.
Anterior knee pain is the most common complication after intramedullary nailing of the tibia. Dissection of the patellar tendon and its sheath during nailing is thought to be a contributing cause of chronic anterior knee pain. The purpose of this prospective, randomized study was to assess whether the prevalence or the intensity of anterior knee pain following intramedullary nailing of a tibial shaft fracture is reduced by the use of a paratendinous incision for the nail entry portal. ⋯ Compared with a transpatellar tendon approach, a paratendinous approach for nail insertion does not reduce the prevalence of chronic anterior knee pain or functional impairment by a clinically relevant amount after intramedullary nailing of a tibial shaft fracture.