The Iowa orthopaedic journal
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Numerous studies have examined the elution characteristics and the effects of antibiotics from bone cement. this study seeks to determine the effect that surface area and volume have on the elution characteristics and bioavailability of tobramycin and vancomycin when mixed in polymethylmethacralate (PMMA) bone cement in various combinations. It also investigates the mechanical properties of antibiotic-impregnated bone cement and its relationship to surface area and volume. ⋯ This study advanced our overall understanding of the elution characteristics and biomechanics of PMMA bone cement impregnated with tobramycin and vancomycin.
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Randomized, controlled study in a laboratory setting. Blinded observations/assessment of study outcomes. ⋯ In this commonly used rabbit posterolateral fusion model, Mastergraft(®) Strip with BMA in an autograft extender mode produces biomechanical and radiographic results similar to autograft fusion alone.
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The deltoid ligament is the primary ligamentous stabilizer of the ankle joint. Both superficial and deep components of the ligament can be disrupted with a rotational ankle fracture, chronic ankle instability, or in late stage adult acquired flatfoot deformity. The role of deltoid ligament repair in these conditions has been limited and its contribution to arthritis is largely unknown. ⋯ Newer tenodesis techniques have been described for late reconstruction of both deep and superficial components in patients with stage 4 adult acquired flatfoot deformity. We describe a technique that provides anatomic ligament-to-bone repair of the superficial and deep bundles of the deltoid ligament while reducing the talus toward the medial malleolar facet of the tibiotalar joint with anchor-to-post reinforcement of the ligamentous repair. This technique may protect and allow the horizontally oriented fibers of the deep deltoid ligament to heal with the appropriate resting length while providing immediate stability of the construct.
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Peripheral nerve blocks (PNB) are a common adjuvant for anesthesia. There is little orthopedic literature regarding the incidence of neurogenic complaints and quality of pain control. ⋯ Cohort study type III.
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Clopidogrel, an inhibitor of ADP-induced platelet aggregation, is indicated for the reduction of atherosclerotic events in patients with atherosclerosis documented by recent stoke, myocardial infarction, acute coronary syndrome, and established peripheral arterial disease. In cardiovascular studies, clopidogrel has been associated with increased chest tube output, transfusion rates, and re-exploration rates. Few studies have addressed the possible complications of clopidogrel in hip fractures. Our study aims to assess the perioperative blood loss and transfusion rates in geriatric patients with hip fractures on clopidogrel. We hypothesize that patients on clopidogrel will have higher perioperative blood loss and transfusion rates. ⋯ A growing body of evidence supports early (within 48 hrs) surgery for elderly patients with hip fractures. the pharmacokinetics of clopidogrel do not allow for bleeding time to return to normal until the drug has been discontinued for five days. Our study shows that patients taking clopidogrel upon admission for hip fracture are at increased risk of blood transfusions when surgery is performed within two calendar days of admis-sion. this risk must be balanced by the potential benefits of early surgery.