The Iowa orthopaedic journal
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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.
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Randomized Controlled Trial Multicenter Study Comparative Study
A randomized, prospective study comparing intertrochanteric hip fracture fixation with the dynamic hip screw and the dynamic helical hip system in a community practice.
To evaluate the clinical performance of the Dynamic Helical Hip System (DHHS) spiral blade relative to the Dynamic Hip Screw (DHS) lag screw. ⋯ Both implants performed well in a majority of cases. The higher incidence of failure in the DHHS group is concerning, despite the low numbers. The mechanism of failure of the DHHS implant left adequate bone stock for attempts at revision fixation.
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Many intra-articular fracture patients eventually experience significant functional deficits, pain, and stiffness from post-traumatic osteoarthritis (PTOA). Over the last several decades, continued refinement of surgical reconstruction techniques has failed to markedly improve patient outcomes. New treatment paradigms are needed - ideally, bio/pharmaceutical. ⋯ The severity of the initial joint injury is indexed primarily on the basis of the energy released in fracture, obtained from validated digital image analysis of CT scans. Chronic contact stress elevations are indexed by patient-specific finite element stress analysis, using models derived from post-reduction CT scans. These new measures, conceived in the laboratory, have been taken through the stage of validation, and then have been applied in studies of intra-articular fracture patients, to relate these biomechanical indices of cartilage insult to the incidence and severity of PTOA This body of work has provided a novel framework for developing and testing new approaches to forestall PTOA following intra-articular fractures.
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PROXIMAL JUNCTIONAL KYPHOSIS (PJK) IS DEFINED AS: 1) Proximal junction sagittal Cobb angle >≥10°, and 2) Proximal junction sagittal Cobb angle of at least 10° greater than the pre-operative measurement PJK is a common complication which develops in 39% of adults following surgery for spinal deformity. The pathogenesis, risk factors and prevention of this complication are unclear. ⋯ Prognostic case-control study - Level III.
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Residency programs are continually attempting to predict the performance of both current and potential residents. Previous studies have supported the use of USMLE Steps 1 and 2 as predictors of Orthopaedic In-Training Examination (OITE) and eventual American Board of Orthopaedic Surgery success, while others show no significant correlation. A strong performance on OITE examinations does correlate with strong residency performance, and some believe OITE scores are good predictors of future written board success. The current study was designed to examine potential differences in resident assessment measures and their predictive value for written boards. ⋯ USMLE Step 1 and 2 scores along with OITE scores are helpful in gauging an orthopaedic resident's performance on written boards. Lower USMLE scores along with consistently low OITE scores likely identify residents at risk of failing their written boards. Close monitoring of the annual OITE scores is recommended and may be useful to identify struggling residents. Future work involving multiple institutions is warranted and would ensure applicability of our findings to other orthopedic residency programs.