Bulletin of the NYU hospital for joint diseases
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Bull NYU Hosp Jt Dis · Jan 2008
Risk of injury associated with the use of seat belts and air bags in motor vehicle crashes.
Although air bags have been reported to reduce passenger mortality in frontal collisions, they have also been reported as a cause of injury in motor vehicle collisions(MVCs). The purpose of this study was to evaluate a large cohort of patients involved in MVCs to determine mortality and the pattern of injuries associated with seat belt use and air bag deployment. Information on patients involved in MVCs from 1988 to 2004 was obtained from the National Trauma Data Bank (NTDB). ⋯ Air bags and seat belts used in combination decreased the risk of potentially fatal injuries, but increased the risk of lower extremity injuries (odds ratio, 1.35). The use of any type of restraint led to a decrease in the risk of injury or mortality in MVCs. Only half of all individuals in this study used any type of restraint device, which indicates the need for significant improvements in public health and safety seat belt utilization programs.
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Bull NYU Hosp Jt Dis · Jan 2008
Treatment of trochanteric fractures with the PFNA (proximal femoral nail antirotation) nail system - report of early results.
Currently, intramedullary devices are widely used for the treatment of trochanteric femoral fractures. A new device designed by AO/ASIF, the PFNA (proximal femoral nail antirotation), represents a unique intramedullary nail system for improved management, particularly in the elderly. The aim of the present study was to analyze the results of treatment with PFNA in 50 patients with trochanteric fractures. ⋯ The length of the surgical procedure averaged 20.3 min, and intraoperative blood loss averaged 22.8 mL. Reoperation was necessary in two patients (4%). We conclude that the PFNA nail is as effective as other implants in the treatment of trochanteric fractures.
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Bull NYU Hosp Jt Dis · Jan 2008
ReviewOrthopaedic anesthesia - part 2. Common techniques of regional anesthesia in orthopaedics.
Anesthesia may be considered in terms of two categories: general and regional. The aim of general anesthesia is to induce analgesia, sedation, amnesia, suppression of autonomic reflexes, and relaxation of muscles. ⋯ Although neuraxial blocks comprise an important part of regional anesthesia, they are typically performed by anesthesiologists in an operative setting for major procedures of the lower extremities. The intent of this article is to familiarize the orthopaedist with techniques that have implications for emergency rooms and other ambulatory settings in which regional techniques are sometimes favored over general alternatives because they entail less risk of systemic side effects and may involve more cost-effective use of resources.
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Bull NYU Hosp Jt Dis · Jan 2008
Predictors of mortality after hip fracture: a 10-year prospective study.
The role of medical, social, and functional covariates on mortality after hip fracture was examined over a 16-year period. A total of 1109 patients with hip fractures were included in a prospective database. The inclusion criteria were patients who were age 65 years or older, ambulatory prior to fracture, cognitively intact, living in their own home at the time of the fracture, and had sustained a nonpathological femoral neck or intertrochanteric chip fracture. ⋯ The predictors of mortality were advanced age, male gender, high American Society of Anesthesiologists (ASA)classification, the presence of a major postoperative complication, a history of cancer, chronic obstructive pulmonary disorder, a history of congestive heart failure,ambulating with an assistive device, or being a household ambulator prior to hip fracture. The increased mortality risk was highest during the first year after hip fracture and returned to the risk of the standard population 3 years postoperatively. Males who are 65 to 84 years had the highest mortality risk.
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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.