Bulletin of the NYU hospital for joint diseases
-
Bull NYU Hosp Jt Dis · Jan 2010
Randomized Controlled Trial Comparative StudySkin traction and placebo effect in the preoperative pain control of patients with collum and intertrochanteric femur fractures.
Proximal femur fractures are one of the most common injuries necessitating operative treatment. The aim of this prospective study was to evaluate and compare the possible effects of the preoperative application of a skin traction device, with or without weights, on pain relief in patients with acute proximal femur fracture. ⋯ This study indicates that pillow placement under an injured limb can be safely used instead of traction, which has no significant benefit. However, an external device, such as a skin traction kit without weight, may be used in patients with persistent pain; this external device may have an additive placebo effect, as was proven in this study.
-
Informed consent is a legal document that summarizes what will take place in a study in a language the study subjects can understand and is the process by which a person decides whether or not to participate in a study. The document is not limited to explaining the intervention or potential risks and benefits but is also the source of understanding why the study is being done and what the particular study will add to what is already known. ⋯ The central role of an informed consent document in any study could be vitally expanded and enhanced with inclusion and full disclosure of its content through clinical trial registries and published reports in the literature, bringing improved transparency to the entire clinical trial process. Transparency is important for the maintenance of high standards in clinical research and for public trust of the process, a sometimes underrecognized factor in healthcare initiatives.
-
Bull NYU Hosp Jt Dis · Jan 2010
The effectiveness of tricyclic antidepressants on lumbar spinal stenosis.
Tricyclic antidepressants have not been explicitly studied in the conservative treatment of lumbar spinal stenosis. A retrospective chart review was conducted in a subset of patients with chronic low back pain and lumbar spinal stenosis managed with low dose tricyclic antidepressants. Of 26 patients, 20 reported improvement in back pain. ⋯ Patients with both leg and back pain reported improvement in greater proportion than patients with back pain alone. According to this study tricyclic antidepressants appear to be effective in controlling lumbar spinal stenosis symptoms in this patient population. Tricyclic antidepressants need to be further analyzed in randomized controlled studies as a means to conservatively manage lumbar spinal stenosis with stratification based on location of pain.
-
The issue of athletic participation after hip and knee arthroplasty has become more relevant in recent years, with an increase in the number of young and active patients receiving joint replacements. This article reviews patient-, surgery-, implant-, and sports-related factors, and discusses currently available guidelines that should be considered by the physician when counseling patients regarding a return to athletic activity after total joint arthroplasty. Current evidence regarding appropriate athletic participation after total hip arthroplasty, resurfacing hip arthroplasty, total knee arthroplasty, and unicondylar knee arthroplasty is reviewed.
-
Three percent of all biceps tendon ruptures occur at the distal aspect, where the tendon inserts into the radial tuberosity. Distal bicep tendon ruptures typically occur in middle-aged males after an eccentric extension load is applied to the elbow. Patients usually complain of a sudden, sharp, and painful tearing sensation in the antecubital region, with a palpable defect. ⋯ Partial ruptures are significantly less common and initially can be treated conservatively. Chronic tears are more difficult to treat because of possible tendon retraction and poor tissue quality. Tendon grafts using semitendinosus, fascia lata, hamstring, Achilles (calcaneal), or flexor carpi radialis have been successfully used for length restoration in these cases.