The Iowa orthopaedic journal
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The ideal treatment strategy for the dorsally comminuted distal radius fracture continues to evolve. Newer plate designs allow for variable axis screw placement while maintaining the advantages of locked technology. The purpose of this study is to compare the biomechanical properties of one variable axis plate with two traditional locked constructs. ⋯ In this analog bone fracture gap model, the variable axis locking technology was stiffer in axial compression than other plates, though less stiff in bending.
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A laterally tracking patella is commonly seen in patients with chronic recurrent lateral patellar dislocations. Clinical appearance of the J-sign occurs when the patella is congruent with the trochlear groove in flexion and moves over the lateral border of the femoral condyle as the lower leg reaches complete extension. A Fulkerson osteotomy procedure corrects this maltracking of the patella by medially transferring the tibial tubercle. There are many radiographic patellofemoral indices that can be used describe this incongruence about the patelloformal joint. The current literature supports the use of the tibial tubercle-trochlear groove (TT-TG) index in determining the appropriate amount medialization of the extensor mechanism. However there is little agreement in how far to transfer the tibial tubercle to best achieve maximum patello-femoral congruency. It is the senior author's belief that lateral patellar edge (LPE) measure on voluntary quadriceps active hyperextension MRI scan has the strongest correlation with final operative tibial tubercle transfer distance needed to achieve maximum patellofemoral congruency. ⋯ The hypothesis that voluntary quadriceps active hyperextension MRI LPE measurement best correlated with tibial tubercle transfer distance was incorrect. The data collected showed correlation and statistical significance for voluntary quadriceps active flexion LPE with required tibal tubercle transfer distance (Pearson 0.34, alpha 0.026). The MRI measurement that best correlated with tibial tubercle transfer distance was voluntary quadriceps active flexion measure of TT-TG (Pearson .556, alpha< 0.001).
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Fat embolism syndrome (FES) is a multi-organ disorder with potentially serious sequelae that is commonly seen in the orthopaedic patient population after femur fractures. The major clinical features of FES include hypoxia, pulmonary dysfunction, mental status changes, petechiae, tachycardia, fever, thrombocytopenia, and anemia. Due to technological advances in supportive care and intramedullary reaming techniques, the incidence of FES has been reported as low as 0.5 percent. ⋯ His symptoms included unresponsiveness, disconjugate gaze, seizures, respiratory distress, fever, anemia, thrombocytopenia, and visual changes. Head computed tomography and brain magnetic resonance imaging showed pathognomonic white-matter punctate lesions and watershed involvement. With early recognition and supportive therapy and seizure therapy, the patient went on to have complete resolution of symptoms without cognitive sequelae.
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Case Reports
Progressive adult spinal deformity following placement of intrathecal opioid pump: a report of four cases.
Placement of intrathecal opioid pumps (ITOP) for chronic pain is a rare, but described cause of progressive spinal deformity. Over the last two decades there has been several suspected cases at our institution. In this case series, we described the apparent association between placement of an intrathecal opioid pump and progression of spinal deformity. ⋯ Level 4--Case series; case control study (diagnostic studies); poor reference standard; analyses with no sensitivity analyses.
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Chronic back pain treatments have generally been costly and/or ineffective despite advances in medical technology. Patient selection and factors intrinsic to patients, including beliefs and behaviors, have been increasingly looked upon as possible predictive factors for success following multidisciplinary intervention for chronic back pain. The current study investigated the value of using patients' perceived control over health changes (health locus of control) and their perceived ability to engage in pain management behaviors (pain-related self-efficacy) to predict physical and mental health outcomes. ⋯ In addition to supporting the multiple benefits of multidisciplinary rehabilitation, this study suggests that pain-related self-efficacy and health locus of control may be valuable predictors of treatment benefit for chronic back pain patients. These results provide direction in screening for factors that may maximize the potential to benefit from multidisciplinary intervention for chronic back pain.