The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Mar 2016
Effect of a Cast on Short-Term Reproducibility and Bone Parameters Obtained from HR-pQCT Measurements at the Distal End of the Radius.
High-resolution peripheral quantitative computed tomography (HR-pQCT) is a promising tool to assess the fracture-healing process at the microscale in vivo. Since casts are often used during fracture treatment, they might affect the assessment of bone density, microarchitectural, and biomechanical parameters and the short-term reproducibility of those parameters, e.g., as a result of beam-hardening. The aim of this study was to assess the effect of a plaster-of-Paris and/or fiberglass cast on bone parameters and on the short-term reproducibility of the HR-pQCT measurements of those parameters. ⋯ A plaster-of-Paris cast has a considerable effect on HR-pQCT measurements. A fiberglass cast only marginally affects the bone parameters, and the short-term reproducibility of HR-pQCT measurements in patients with a fiberglass cast is comparable with that in patients without a cast. In studies on fracture-healing using HR-pQCT, a fiberglass cast is desirable if immobilization is indicated. The use of a plaster-of-Paris cast should be avoided if possible; however, if not avoidable, corrections after the scan are desirable to adjust for the error introduced in the bone parameters.
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J Bone Joint Surg Am · Feb 2016
Comparative StudyDoes Surgical Correction of Right Thoracic Scoliosis in Syringomyelia Produce Outcomes Similar to Those in Adolescent Idiopathic Scoliosis?
Practice guidelines for deformity correction in patients with syringomyelia-associated scoliosis (SMS) remain ill defined. Although surgeons experienced in treating adolescent idiopathic scoliosis (AIS) are commonly called on to treat SMS, no study has directly compared the results of surgical treatment between patients with SMS and those with AIS. The present study was performed to compare the radiographic and clinical outcomes of posterior spinal fusion between patients with right-thoracic SMS and those with right-thoracic AIS. ⋯ Despite the differences in preoperative status, adolescents with idiopathic right thoracic scoliosis and those with syringomyelia-associated right thoracic scoliosis had comparable clinical and radiographic outcomes of pedicle-screw-based posterior spinal fusion, without neurologic complications.
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J Bone Joint Surg Am · Feb 2016
Comparative StudyIntramedullary Nailing Compared with Spica Casts for Isolated Femoral Fractures in Four and Five-Year-Old Children.
Flexible intramedullary nailing (IMN) is a valuable tool in the treatment of femoral fractures in school-age children, whereas spica cast immobilization has been the standard of care for younger children. We compared these treatment modalities in a group of preschool-age children (four to five years of age). ⋯ Preschool-age children (four to five years old) with an isolated femoral fracture have similar clinical and radiographic outcomes regardless of whether they are treated with immediate spica cast immobilization or IMN.
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J Bone Joint Surg Am · Jan 2016
Comparative StudyCost-Effectiveness of Bariatric Surgery Prior to Total Knee Arthroplasty in the Morbidly Obese: A Computer Model-Based Evaluation.
Obesity is associated with adverse outcomes and increased costs after total knee arthroplasty. Bariatric surgery is an effective treatment for morbid obesity, but its cost-effectiveness for weight loss prior to total knee arthroplasty is unknown. The purpose of this study was to evaluate the cost-effectiveness of bariatric surgery prior to total knee arthroplasty for patients in whom medical treatment of obesity and knee osteoarthritis had failed. ⋯ Economic and Decision Analysis Level II. See Instructions for Authors for a complete description of levels of evidence.
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J Bone Joint Surg Am · Jan 2016
Randomized Controlled Trial Comparative StudyAugmented Compared with Nonaugmented Surgical Repair After Total Achilles Rupture: Results of a Prospective Randomized Trial with Thirteen or More Years of Follow-up.
This prospective randomized trial with a mean fourteen-year follow-up compared simple end-to-end repair with fascial flap-augmented repair for acute Achilles tendon ruptures. ⋯ Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.