Bulletin of the NYU hospital for joint diseases
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Clavicle fractures remain one of the more common fractures encountered in the orthopaedic office. Nonoperative management remains the standard of care in most cases. ⋯ When operative reduction and fixation is indicated, there are numerous techniques to aid the surgeon patient care. This article reviews the midshaft clavicle fracture and discusses recent outcome studies on patients with fracture shortening and approaches to operative management.
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Bull NYU Hosp Jt Dis · Jan 2009
Computer-assisted navigation in hip resurfacing arthroplasty - a single-surgeon experience.
Hip resurfacing arthroplasty is a technically challenging procedure, and orientation of the femoral component is critical to avoid implant failure. The use of computer-assisted navigation has been shown to decrease the learning curve for beginners in hip resurfacing and to improve the surgeon's ability to produce consistent results. Computer navigation offers real-time feedback, with the opportunity to produce improved repeatability to optimize patient outcomes. ⋯ Twenty-five non-navigated hip resurfacing arthroplasties, performed by the same surgeon, were evaluated as a matching group. Mean operative times for the computer-assisted hip resurfacing were 101 minutes, as compared to 104 minutes in the non-navigated group. We found that in the hands of an experienced hip resurfacing surgeon, the addition of computer-assisted navigation had no effect on the learning curve, but did provide feedback and repeatability to the surgeon.
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Bull NYU Hosp Jt Dis · Jan 2009
Multicenter Study Comparative StudyResurfacing arthroplasty for patients with osteonecrosis.
The suitability of third-generation metal-on-metal hip resurfacing products for patients with a primary diagnosis of osteonecrosis has been debated. The preservation of femoral head bone stock for femoral prosthetic support is essential for the long-term stability of implants. A modern hip resurfacing system was implanted in 1148 hips as part of a United States multicenter investigational device exemption study. ⋯ Survival rates were not significantly different (95.9% and 95.8% at 24 months for osteoarthritis and osteonecrosis respectively, p = 0.46). Resurfacing arthroplasty for patients with osteonecrosis appears to be a reasonable alternative, taking into consideration implant size, patient gender, and size of femoral deficiency. Further characterization is needed to identify those specific patients with osteonecrosis for whom resurfacing arthroplasty would be appropriate.
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The distal radioulnar joint (DRUJ) acts in concert with the proximal radioulnar joint to control forearm rotation. The DRUJ is stabilized by the triangular fibrocartilage complex (TFCC). ⋯ TFCC and DRUJ injuries are part of the common pattern of injuries we see with distal radius fractures. While much attention has been paid to the treatment of the distal radius fractures, many of the poor outcomes are due to untreated or unrecognized injuries to the DRUJ and its components.
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Bull NYU Hosp Jt Dis · Jan 2009
Review Case ReportsPeroneal nerve injury with foot drop complicating ankle sprain--a series of four cases with review of the literature.
Foot drop has many etiologies. One rarely mentioned and often neglected reason for foot drop is an acute inversion sprain of the ankle. Over the past 14 years, a collection of 32 cases of foot drop have been compiled in our orthopaedic and physiatric practices. ⋯ Proposed mechanisms for this type of foot drop are discussed, including traction and compression of the common peroneal nerve as it winds around the neck of the fibula, and possible compression by hematoma. Surgical versus conservative treatment is described. The functional impairment associated with foot drop is detailed.