Orthopedics
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Randomized Controlled Trial Comparative Study
Navigation Makes Transforaminal Lumbar Interbody Fusion Less Invasive.
The current study presents a navigated transforaminal lumbar interbody fusion (TLIF) technique that requires only a 4-cm incision to accomplish a single-level TLIF. The authors compared its efficacy and efficiency with those of conventional TLIF. Forty patients who were indicated for single-level lumbar fusion were included and randomized to either the navigated-TLIF group or the conventional-TLIF group. ⋯ Average ODI score improved significantly in both groups immediately postoperatively and was maintained in the following 2 years. Navigation can make single-level TLIF less invasive. Compared with conventional TLIF, navigated TLIF proved to be superior with regard to incision length, intraoperative blood loss, bed rest period, and length of hospital stay. [Orthopedics.2016; 39(5):e857-e862.].
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The use of bundled payments is growing because of their potential to align providers and hospitals on the goal of cost reduction. However, such gain sharing could incentivize providers to "cherry-pick" more profitable patients. Risk adjustment can prevent this unintended consequence, yet most bundling programs include minimal adjustment techniques. ⋯ If the results are generalizable, Medicare bundled payments for TKA encompassing acute inpatient care should be adjusted upward by the stated amounts for older patients, those with elevated ASA class, and patients meeting MCC criteria. This is likely an underestimate for many bundling models, including the Comprehensive Care for Joint Replacement program, incorporating varying degrees of postacute care. Failure to adjust for factors that affect costs may create adverse incentives, creating barriers to care for certain patient populations. [Orthopedics. 2016; 39(5):e911-e916.].
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The current study investigated the incidence of complications after surgery for distal radial fractures. This multicenter retrospective study was conducted at 11 institutions. A total of 824 patients who had distal radius fractures that were treated surgically between January 2010 and August 2012 were identified. ⋯ There was no rupture of the flexor pollicis longus tendon because careful attention was paid to the relationship between the implant and the tendon. Peripheral nerve palsy may have been caused by intraoperative traction in 7 cases, temporary fixation by percutaneous Kirschner wires in 3 cases, and axillary nerve block in 1 case; 1 case appeared to be idiopathic. Tendon ruptures were mainly caused by mechanical stress. [Orthopedics.2016; 39(5):e893-e896.].