Orthopedics
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In conclusion, intraspinal lumbar synovial cysts are uncommon causes of sciatic pain. Intraspinal synovial cysts are associated with degenerative arthritis of the lumbar spine. The radiographic findings on myelography are non-specific, but CT and MRI are helpful in establishing the diagnosis and in differentiating synovial cysts from other extradural lesions.
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Seven patients with comminuted subtrochanteric fractures of the femur were treated with Russell-Taylor reconstruction intramedullary nails. Six of the seven fractures were AO/ASIF Type C and had resulted from high-energy trauma. ⋯ There were no delayed unions, nonunions, infections, or implant failures, either postoperatively or during follow up, which averaged 20.8 months (range: 16 to 28). The Russell-Taylor device offers mechanical and biologic advantages, and extends the indications for locked intramedullary nailing to include fractures at the level of or including the lesser trochanter.
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American hospitals face increasing constraints due to a variety of factors. Federal and state diagnostic-related group (DRG) prospective hospital pricing has caused tremendous fiscal pressure on hospitals; many face substantial financial deficits. We analyzed the volume of orthopedic surgical procedures performed by an individual orthopedic surgeon for all patients (N = 2,134) treated for a 3-year period at a large academic medical center; these surgeons were arbitrarily divided into low volume or high volume. ⋯ Pearson correlation showed an inverse relationship between cost per patient and physician volume for nonemergency patients -0.201 (P less than .0001), and emergency patients, -0.321 (P less than .0001). Although the reasons for these findings appeared multifactoral, they raise important issues related to orthopedic surgical hospital costs, access, and quality of care. In addition, they suggest that hospital cost for these patients (and perhaps outcome) may be related to orthopedic surgical volume, and that DRG hospital payment (on the margin) may affect future orthopedic surgical practice opportunities.