Orthopedics
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This study was designed to evaluate trends in incidence and treatment patterns for intracapsular hip fractures and to evaluate risk factors for complications and mortality. Patients with an intracapsular hip fracture who underwent internal fixation, hemiarthroplasty, or total hip arthroplasty (THA) were identified from a 5% nationwide sample of Medicare data (1998-2007). The authors identified 41,053 patients with intracapsular hip fractures between 1998 and 2007. ⋯ Primary THA is performed more often in younger patients with fewer comorbidities. The incidence of intracapsular hip fracture decreased by 21.8% over the past decade. This decrease is likely the result of multiple factors, most significantly increased awareness and medical management of osteoporosis.
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Randomized Controlled Trial Comparative Study
Intra-articular injection of hyaluronate versus corticosteroid in adhesive capsulitis.
The goal of this study was to prospectively compare the early clinical results of intra-articular injection of hyaluronate or corticosteroid in patients with idiopathic adhesive capsulitis. The authors' hypothesis was that there would be no difference between groups. Sixty-eight patients with idiopathic adhesive capsulitis were equally randomized to receive either corticosteroid or hyaluronate injection. ⋯ Internal rotation was significantly lower at week 2 in the hyaluronate group compared with the corticosteroid group (P=.015). Internal rotation improved at week 12, with no significant difference between groups. Patients treated with intra-articular injection of hyaluronate and corticosteroid for idiopathic adhesive capsulitis showed significant improvement in early clinical scores and range of motion without significant differences between groups.
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The authors retrospectively reviewed 269 patients treated from September 2006 to August 2011 with the minimally invasive plate osteosynthesis (MIPO) technique using a universal reconstruction ribbon plate for fresh displaced midshaft fracture of the clavicle. Mean follow-up was 40.6 months. All had bony union (average healing time, 14.6 weeks). ⋯ A total of 258 patients were satisfied with the results of this surgery. This technique appears to be safe, simple, effective, and practical and to lead to rapid recovery, a high rate of union, a favorable cosmetic effect, and excellent function restoration. Thus, it can be considered an alternative to conventional plate osteosynthesis, intramedullary fixation, or non-operative treatment for fresh displaced midshaft clavicle fractures.
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This article describes a patient in whom a broken cerclage wire migrated from the left hip into the left ventricle. A 71-year-old woman was admitted to the authors' hospital for preoperative examination before femoral hernia repair. Chest radiograph showed a metallic wire in the left ventricle. ⋯ Because of the high risk of surgical left ventriculotomy associated with searching for wire that had migrated into the myocardial wall, patient monitoring was planned. Definitive management of this complication constitutes a dilemma. Although this complication is highly unusual, the possibility of intracardiac migration of broken wire should be considered when deciding on prophylactic surgical removal of hardware after fracture or osteotomy healing.