The American journal of orthopedics
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The purpose of this study was to analyze the efficacy of femoral nerve blocks (FNBs) in decreasing postoperative narcotic use in adolescents undergoing patellar realignment surgery (PRS). All patients who underwent PRS at 2 children's hospitals between 1998 and 2002 were included in the study. ⋯ Total postoperative i.v. morphine use was statistically significantly different among the 3 groups: 9.0 mg for FNB, 26.43 mg for PRN-IV, and 64.7 mg for PCA. FNB use was effective in significantly decreasing postoperative i.v. narcotic use.
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Leg-length inequality after total hip arthroplasty remains a controversial issue. In the study reported here, we sought to determine whether significant leg-length discrepancies (> 6 mm) can be minimized with use of an intraoperative x-ray. In each case, preoperative templating was carefully performed, an intraoperative pelvis x-ray was obtained to assess accuracy, and appropriate adjustments were made. ⋯ Mean postoperative leg-length discrepancy was 0.3 mm (SD, 2.6 mm; range, -6 to +6 mm). No legs were lengthened or shortened by more than 6 mm. Significant leg-length discrepancies can be minimized with use of an intraoperative pelvis x-ray.
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The goals of the present study were to assess if there is an association between preoperative cardiac evaluation and surgery timing in patients with a hip fracture, to evaluate the relationship between surgery timing and postoperative morbidity and mortality, and to determine if the proper patients are being selected for noninvasive cardiac testing based on the practice guidelines published by the American College of Cardiology/American Heart Association Task Force. Surgery delay secondary to cardiac clearance may be a risk factor for increased postoperative complications that is independent of a patient's general medical condition. Surgical treatment of acute hip fractures may be delayed by many factors besides preoperative cardiac clearance, but it is the job of the orthopedic surgeon, who best understands the importance of timely surgery for a hip fracture, to minimize delays. Careful screening of patients who have sustained a hip fracture can improve overall outcomes by minimizing the number of patients whose surgical treatment is unnecessarily delayed for cardiac clearance.