The Iowa orthopaedic journal
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Review Comparative Study
High tibial osteotomy versus unicompartmental knee arthroplasty for medial compartment arthrosis of the knee: a review of the literature.
This review examined the literature regarding high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA), focusing on indications, survivorship and functional outcomes of the two procedures, as well as revision to total knee arthroplasty (TKA) after failed HTO or UKA. HTO and UKA share the same indications in selected cases of medial unicompartmental knee arthrosis. These indications include patients who are: 1) 55 to 65 years old; 2) moderately active; 3) non-obese; 4) have mild varus malalignment; 5) no joint instability; 6) good range of motion; and 7) moderate unicompartmental arthrosis. ⋯ Whether revision HTO and UKA-to-TKA perform any worse than primary TKA is still controversial. With the correct indications, both treatments produce durable and predictable outcomes in the treatment of medial unicompartmental arthrosis of the knee. There is no evidence of superior results of one treatment over the other.
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Comparative Study
Pediatric sports-related lower extremity fractures: hospital length of stay and charges: what is the role of the primary payer?
The purposes of this study were (a) to evaluate the distribution by primary payer (public vs. private) of U.S. pediatric patients aged 5-18 years who were hospitalized with a sports-related lower extremity fracture and (b) to discern the adjusted mean hospital length of stay and mean charge per day by payer type. ⋯ Further research is required to identify factors that are associated with different length of stay and mean charge per day by payer type, and explore whether observed differences in hospital length of stay are the result of private payers enhancing patient care, thereby discharging patients in a more efficient manner.
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Comparative Study
Intraoperative femoral nerve stimulation in evaluation of patellar tracking: tourniquet effects and catheter placement.
Dynamic intraoperative assessment of patella tracking utilizes femoral nerve stimulation to contract the quadriceps muscles in assessing the proper distance to transfer the tibial tubercle during distal realignment procedures for patellofemoral instability. ⋯ Increased tourniquet inflation times require greater stimulus amplitude to generate quadriceps muscle contraction. Ultrasound guidance for catheter placement can provide femoral nerve stimulation at low amplitudes.
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Review Case Reports
Giant cell tumor of the sacrum and spine: series of 23 cases and a review of the literature.
Although there have been a few large case series of giant cell tumor (GCT) in the spine and sacrum, the treatment of these lesions remains controversial. We are reporting 23 additional cases of giant cell tumor in the spine and sacrum gathered from our institution and the personal consultation files of the senior author. Ten lesions occurred in the sacrum with an average age of 31 years (range of 13-49) and 13 occurred in the mobile spine with an average age of 39.1 years (range of 13-64). ⋯ Eleven spinal GCT patients were treated with en bloc surgical resection and two developed a recurrence, the other two spinal GCT patients were treated with intralesional surgical resection and both developed a recurrence. Giant cell tumors of the spine and sacrum should be managed with en bloc resections whenever possible as this provides the greatest chance for cure. When the risk of post-operative neurologic deficit after en bloc excision is high, as in most of our sacral lesions, conservative therapy involving arterial embolization and intralesional resection offers the best results.
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The treatment of displaced calcaneal fractures remains controversial. Early surgical management to restore articular congruence and the structural function of the calcaneus is widely accepted as the best way to avoid the negative consequences of malunion. Concerns remain however regarding the best approach for reducing and maintaining reduction of these complex fractures, while minimizing the risk of surgical complications. ⋯ The vascular anatomy of the lateral calcaneal artery related to this approach was also studied with 16 cadaver legs. The lateral calcaneal artery (LCA) passed within 2 mm of the superior border of floor of the Superior Peroneal Retinaculum (SPR) at the midline of the peroneal sheath. By avoiding dissection through the deep portion of the SPR, the lateral calcaneal artery can be protected, thus preserving the blood supply to the lateral calcaneal skin flap.