The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Jul 2014
Factors Affecting Readmission Rates Following Primary Total Hip Arthroplasty.
Readmissions following total hip arthroplasty are a focus given the forthcoming financial penalties that hospitals in the United States may incur starting in 2015. The purpose of this study was to identify both preoperative comorbidities and postoperative conditions that increase the risk of readmission following total hip arthroplasty. ⋯ Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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J Bone Joint Surg Am · Jul 2014
Preoperative Radiographic and CT Findings Predicting Syndesmotic Injuries in Supination-External Rotation-Type Ankle Fractures.
The Lauge-Hansen classification system does not provide sufficient data related to syndesmotic injuries in supination-external rotation (SER)-type ankle fractures. The aim of the present study was to investigate factors helpful for the preoperative detection of syndesmotic injuries in SER-type ankle fractures using radiographs and computed tomography (CT). ⋯ Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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J Bone Joint Surg Am · Jul 2014
Anatomic Determinants of Sacral Dysmorphism and Implications for Safe Iliosacral Screw Placement.
Upper sacral segment dysplasia increases the risk of cortical perforation during iliosacral screw insertion. Dysmorphic sacra have narrow and angled upper osseous corridors. However, there is no validated definition of this anatomic variation. We hypothesized that pelves could be quantitatively grouped by anatomic measurements. ⋯ Sacral dysmorphism was found in 41% of the pelves. The major determinants of sacral dysmorphism are upper sacral segment coronal and axial angulation. The sacral dysmorphism score quantifies dysmorphism and can be used in preoperative planning of iliosacral screw placement.
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J Bone Joint Surg Am · Jul 2014
ReviewProper Patient Positioning and Complication Prevention in Orthopaedic Surgery.
➤ The consequences of improper intraoperative positioning can be profound: it not only may cause substantial morbidity but also may be a major area of litigation, particularly when peripheral nerve injury occurs.➤ The ulnar nerve is most likely to be injured secondary to improper positioning. The elbow should be flexed ≤90° and the forearm placed in a neutral or slightly supinated position intraoperatively to minimize pressure in the cubital tunnel.➤ Pressure-related complications, such as pressure ulcers and alopecia, are best avoided by the use of adequate padding. Cushions on the operating-room table and armrest should be emphasized under osseous prominences.➤ Positioning the head in a non-neutral alignment or arm abduction of ≥90° may result in injury to the brachial plexus.➤ The hemilithotomy position increases intracompartmental pressure in the leg on the uninjured side. The risk of well-leg compartment syndrome can be minimized by avoiding this position if possible.
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J Bone Joint Surg Am · Jul 2014
Rate of and Risk Factors for Reoperations After Open Reduction and Internal Fixation of Midshaft Clavicle Fractures: A Population-Based Study in Ontario, Canada.
Reoperation rates following open reduction and internal fixation (ORIF) of midshaft clavicle fractures have been described, but reported rates of nonunion, malunion, infection, and implant removal have varied. We sought to establish baseline rates of, and risk factors for, reoperations following clavicle ORIF in a large population cohort. ⋯ Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.