Acta orthopaedica
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Modern descriptions of the percutaneous triple hemisection technique for Achilles tendon lengthening do not take into account the axial twist in the ligament. We were concerned that technical failures of the lengthening technique might occur more often than has been reported, and analyzed the results of the triple hemisection technique in cadaveric tendons in quantitative and qualitative terms, focusing on insufficient or complete tenotomies. ⋯ Our findings support our hypothesis that technical failures in the triple hemisection procedure occur more often than acknowledged. Despite the scarce but good clinical results described in children, we suggest performing this technique as an open procedure, especially in cases where the boundaries of the tendon are less easily palpable (adults, obese children), and to use the largest possible distance between the hemisections.
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Randomized Controlled Trial
Effects of celecoxib on blood loss, pain, and recovery of function after total knee replacement: a randomized placebo-controlled trial.
Pain management after surgery has been used as a sales argument for the use of COX-2 inhibitors, but their potential positive and negative effects have not been fully investigated. We thus conducted a controlled evaluation of the effect of celecoxib on perioperative blood loss, pain relief and consumption of analgesics, range of motion, and subjective outcome in conjunction with total knee replacement (TKR). ⋯ Celecoxib does not increase perioperative blood loss but reduces pain during the postoperative period after TKR. It is not necessary to discontinue celecoxib before surgery. The postoperative use of celecoxib did not increase range of motion or subjective outcome 1 year after TKR.
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Anterior knee pain and young age of the patient have been considered justification for removal of a tibial intramedullary nail. There have been few reports on the outcome after nail removal, however. ⋯ The results of nail removal to alleviate pain are poor. Removal of a nail should not be undertaken unless there is a convincing indication.
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The mechanical properties of current external fixator systems for unstable (type C) pelvic ring fractures are inferior to internal fixation, and are not optimal for definitive treatment. We explored methods to increase stability of external fixator constructs. ⋯ The new concept of parasymphyseal pin fixation connected to an external fixator of the pelvic ring produces a considerable increase in stability for the treatment of type C pelvic ring injuries, as does an increase in pin diameter and alternative pin positioning.