The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Nov 2001
Percutaneous pinning of the proximal part of the humerus. An anatomic study.
Closed reduction and percutaneous pinning of unstable proximal humeral fractures is a well-described technique with some theoretical advantages over open techniques. To our knowledge, the risk of injury to neurovascular structures from percutaneous pinning of the proximal part of the humerus has not been studied. We sought to quantify this risk using a cadaveric model. ⋯ The technique used in this study may be associated with a risk of injury to important anatomic structures about the shoulder. Lateral pins should be distal enough to avoid injury to the anterior branch of the axillary nerve, and multiple fluoroscopic views should be obtained to avoid penetration of the humeral head cartilage. There may be a risk of injury to the cephalic vein, the biceps tendon, and the musculocutaneous nerve with use of anterior pins, and these pins should be employed with caution. Greater tuberosity pins should be placed with the arm in external rotation, should be aimed for a point 20 mm from the inferior aspect of the humeral head, and should not overpenetrate the cortex.
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J Bone Joint Surg Am · Oct 2001
Comparative StudyReliability, validity, and responsiveness of four knee outcome scales for athletic patients.
Many patient-based knee-rating scales are available for the evaluation of athletic patients. However, there is little information on the measurement properties of these instruments and therefore no evidence to support the use of one questionnaire rather than another. The goal of the present study was to determine the reliability, validity, and responsiveness of four knee-rating scales commonly used for the evaluation of athletic patients: the Lysholm scale, the subjective components of the Cincinnati knee-rating system, the American Academy of Orthopaedic Surgeons sports knee-rating scale, and the Activities of Daily Living scale of the Knee Outcome Survey. ⋯ All four scales satisfied our criteria for reliability, validity, and responsiveness, and all are acceptable for use in clinical research.
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Previous reports on perioperative mortality associated with hip arthroplasty have not documented, to our knowledge, patient characteristics and surgical factors that increase the likelihood of death. The purpose of this study was to determine the prevalence of and associated risk factors for perioperative death after elective hip arthroplasty. ⋯ Factors that are associated with an increased risk of mortality within thirty days after elective hip arthroplasty include an older age, male gender, and a history of cardiorespiratory disease. There has been a significant decline in the thirty-day mortality rate after elective hip arthroplasty in the last decade (p < 0.0002); during the 1990s, the overall rate at our institution was 0.15% (twenty-three of 14,989).
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J Bone Joint Surg Am · Sep 2001
The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic subjects : a seven-year follow-up study.
In 1989, a group of sixty-seven asymptomatic individuals with no history of back pain underwent magnetic resonance imaging of the lumbar spine. Twenty-one subjects (31%) had an identifiable abnormality of a disc or of the spinal canal. In the current study, we investigated whether the findings on the scans of the lumbar spine that had been made in 1989 predicted the development of low-back pain in these asymptomatic subjects. ⋯ The findings on magnetic resonance scans were not predictive of the development or duration of low-back pain. Individuals with the longest duration of low-back pain did not have the greatest degree of anatomical abnormality on the original, 1989 scans. Clinical correlation is essential to determine the importance of abnormalities on magnetic resonance images.