The Iowa orthopaedic journal
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Spinal fusion surgery is an effective but costly treatment for select spinal pathology. Historically iliac crest bone graft (ICBG) has remained the gold standard for achieving successful arthrodesis. Given well-established morbidity autograft harvest, multiple bone graft replacements, void fillers, and extenders have been developed. The objective of this study was to evaluate the in vivo efficacy and safety of two mineralized collagen bone void filler materials similar in composition. Both bone void fillers were composed of hydroxyapatite (HA), tricalcium phosphate (TCP) and bovine collagen. The first test article (Bi-Ostetic bioactive glass foam or "45S5") also contained 45S5 bioactive glass particles while the second test article (Formagraft or "FG") did not. 45S5 and FG were combined with bone marrow aspirate and iliac crest autograft and compared to ICBG in an established posterolateral spine fusion rabbit model. ⋯ This study has confirmed the biocompatibility, safety, efficacy and bone healing characteristics of the HA-TCP collagen (with or without 45S5 bioactive glass) composites. The results show that the 3 test groups had equivalent long-term fusion performance and outcome at 12 weeks. However, the presence of 45S5 bioactive glass seemed to accelerate the fusion process as evidenced by the higher fusion rates at 4 and 8 weeks for the HA-TCP-collagen composite containing bioactive glass particles. The results also demonstrate that the HA-TCP-45S5 bioactive glass-collagen composite used as an extender closely mirrors the healing characteristics (i.e. amount and quality of bone) of the 100% autograft group.
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The end screw in a fracture plate creates the greatest resistance to bending. For osteoporotic fractures treated with plates, there is some question as to the optimal screw insertion technique for the screw farthest from the fracture. A locked, oblique end screw was previously shown to increase resistance to periprosthetic fracture. It is unknown, however, how this end screw configuration would resist pullout when subjected to bending. ⋯ Osteoporotic fractures are challenging to treat. The current study and the existing literature show that resistance to both bending loads and refracture at the end of a plate are minimized with a locked screw angled away from the fracture.
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Displaced lateral condyle humeral fractures in children are treated operatively to maximize function and growth of the elbow. Traditionally an open approach is used for reduction of the fracture, but recent series have shown promising results with closed reduction. Percutaneous pins are typically used for fixation, no matter the reduction method. This retrospective review compares our experience with early complications after open and closed reduction of these fractures. ⋯ IV.
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Unplanned hospital readmission following orthopedic procedures results in significant expenditures for the Medicare population. In order to reduce expenditures, hospital readmission has become an important quality metric for Medicare patients. The purpose of the present study is to determine the incidence and risk factors for 30-day readmissions after hip fracture surgery. ⋯ The overall rate of readmission following hip fracture surgery was moderate. Surgeons should consider discharge optimization in the at risk cohorts identified here, particularly patients with multiple medical comorbidities or an elevated ASA class, and should focus on wound complications and fall risks in order to minimize readmissions. Further, quality-reporting metrics should account for the risk factors identified here, in order to prevent penalties against surgeons who take on complex patients.
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Randomized Controlled Trial
A Randomized Prospective Study Of The Use Of Ipads In Reducing Anxiety During Cast Room Procedures.
Cast room procedures can be a source of anxiety for children. Various techniques, including music therapy, have been evaluated as a way to ease this anxiety. The use of iPads as a form of distraction during cast room procedures has not previously been evaluated and was the purpose of the current study. ⋯ The results of this study show a significant decrease in heart rate when transitioning from the waiting room to the cast room while watching videos on the iPad. iPad-based video delivery appears to decrease anxiety prior to cast room procedures. iPad-based game play is difficult to assess as elevations in heart rate prior to the procedure are presumed to be related to game play and confound the observed effect it may have on anxiety related to the procedure.