Bulletin of the NYU hospital for joint diseases
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When the aim of the randomized controlled trial (RCT) is to show that one treatment is superior to another, a statistical test is employed and the trial (test) is called a superiority trial (test). Often a nonsignificant superiority test is wrongly interpreted as proof of no difference between the two treatments. Proving that two treatments are equal in performance is impossible with statistical tools; at most, one can show that they are equivalent. ⋯ In this report, the three types of trials are compared, but the main focus is on the non-inferiority trial. Special attention is paid to the practical implications when setting up a non-inferiority trial. Illustrations are taken from a clinical trial in osteoarthritis and from thrombolytic research.
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Bull NYU Hosp Jt Dis · Jan 2008
Does a traction-internal rotation radiograph help to better evaluate fractures of the proximal femur?
The standard radiographic series for evaluation of a suspected hip fracture in most centers includes an anteroposterior (AP) radiograph of the pelvis, as well AP and cross-table lateral views of the hip. The natural femoral neck anteversion, as well as the fracture deformity, however, may make accurate fracture classification difficult. We have noted that inexperienced physicians sometimes misclassify hip fractures based on the initial radiographic series, which may lead to errors both in surgical planning and implant choice. At our institution, we routinely obtain a physician-assisted traction-internal rotation radiograph of the affected hip in all fractures of the proximal femur. The purpose of the current study was to examine the usefulness of the traction-internal rotation radiograph for the classification of hip fractures by junior residents in our department. ⋯ The routine addition of a traction-internal rotation radiograph increased the ability to accurately classify proximal femur fractures by junior residents in our department. This has a direct impact in accurate surgical planning and implant choice.
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The posterolateral region of the knee is an anatomically complex area that plays an important role in the stabilization of the knee relative to specific force vectors at low angles of knee flexion. A renewed interest in this region and advanced biomechanical studies have brought additional understanding of both the anatomy and the function of posterolateral structures in knee stabilization and kinematics. ⋯ The failure of the reconstruction of cruciate ligaments may be due to unrecognized or untreated posterolateral corner injuries. Various methods of repair and reconstruction have been described and new research is yielding superior results from reconstruction of this region.
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Articular cartilage defects are common and play a significant role in degenerative joint disease. Cartilage is unable to regenerate, secondary to an inherent lack of vascular supply, thus, various techniques have been described in an attempt to treat and potentially restore these defects. ⋯ Only then can the surgeon choose to perform a repair or a restoration of the articular surface. Current literature and techniques for the treatment of articular cartilage defects are reviewed, with an algorithm developed for the management of articular cartilage defects by orthopaedic surgeons.
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Bull NYU Hosp Jt Dis · Jan 2007
Comparative StudyComparison of fixation methods for scaphoid nonunions: a biomechanical model.
The purpose of this study was to analyze the relative bio- mechanical stability of three types of internal ixation with cancellous bone graft in a cadaveric, scaphoid nonunion model. A scaphoid nonunion model was created by remov- ing a volar wedge of bone from the waist of the scaphoid in 18 fresh frozen human cadavers. Cancellous sawbone graft was inserted into the osteotomy site and three groups of six cadavers each were then internally ixed with a pair of parallel 0.045-inch K-wires, Mini-Acutrak screws, or Standard Acutrak screws, respectively for each group. ⋯ The screws have increased strength of ixation and stiffness when compared to K-wires. Also, unlike the K wires, the Acutrak screws enhance fracture healing by achieving interfragmentary compression. Even in a cancel- lous bone graft model, interfragmentary compression was achieved and our concern that the bone graft would "spit out" was allayed.