The Orthopedic clinics of North America
-
Evidence-based medicine integrates clinical expertise, patients' values and preferences, and the best available evidence from the medical literature. Evidence-based orthopedics is a model to assist surgeons to improve the process of asking questions, obtaining relevant information efficiently, and making informed decisions with patients. With an increasing appreciation for higher levels of evidence, orthopedic surgeons should move away from lower forms of evidence. The adoption of randomized trials and high-quality prospective studies to guide patient care requires 2 prerequisites: (1) greater appreciation for the conduct of randomized trials in orthopedics and (2) improved education and training in evidence-based methodologies in surgery.
-
Orthop. Clin. North Am. · Jan 2010
ReviewSoft tissue and biomechanical challenges encountered with the management of distal tibia nonunions.
A thoughtful treatment algorithm is required to optimally treat distal tibia nonunion. A healthy respect for the tenuous soft tissue envelope, compromised vascularity, and challenging mechanical environment is advisable. Achieving osseous union and improved functionality requires an individualized plan of care based on the personality of the nonunion and host. Attention must be focused on providing mechanical stability at the site of nonunion and providing biologic supplementation.
-
Orthop. Clin. North Am. · Jan 2010
ReviewAutograft and nonunions: morbidity with intramedullary bone graft versus iliac crest bone graft.
This article focuses on comparing patient morbidity with harvesting bone graft for the treatment of nonunions from three different sites. Anterior iliac crest graft is the most commonly used site; however, the posterior iliac crest and intramedullary canal provide greater quantities of bone. ⋯ The intramedullary canal, when compared with anterior and posterior iliac crest, offers the largest quantity of bone graft with the least amount of patient donor site morbidity. The intramedullary canal also appears to be a bone graft source that can be reharvested, unlike the anterior and posterior iliac crest donor sites.
-
Orthop. Clin. North Am. · Jan 2010
Case ReportsTreatment of large segmental bone defects with reamer-irrigator-aspirator bone graft: technique and case series.
Treatment of large segmental defects using conventional autogenous iliac crest bone graft can be limited by volume of cancellous bone and donor site morbidity. The reamer-irrigator-aspirator (RIA) technique allows access to a large volume of cancellous bone graft containing growth factors with potency equal to or greater than autograft material from the iliac crest. The purpose of this study was to evaluate the effectiveness of RIA-harvested autogenous bone graft for treating large segmental defects of long bones.
-
Orthop. Clin. North Am. · Oct 2009
Randomized Controlled Trial Comparative StudyMinimally invasive carpal tunnel release.
We prospectively compared the safety and effectiveness of mini-incision (group A) and a limited open technique (group B) for carpal tunnel release (CTR) in 185 consecutive patients operated between November 1999 and May 2001, with a 5-year minimum follow-up. Patients in Group A had a minimally invasive approach (<2 cm incision), performed using the KnifeLight (Stryker, Kalamazoo, Michigan) instrument. ⋯ Mini-incision CTR showed advantages over standard technique in early recovery, pillar pain, and recurrence rate. The recovery period after mini-incision is shorter than after standard procedure.