The American journal of orthopedics
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Limited information exists to define standard tibial radiographs. The purpose of this study was to define new landmarks on the proximal tibia for standard anteroposterior and lateral radiographs. In 10 cadaveric knees, fibular head bisection was considered the anteroposterior image, and femoral condyle overlap the lateral image. ⋯ Portal position and incidence of damage to intra-articular structures did not significantly differ between groups (P>.05). The "twin peaks" anteroposterior view and "flat plateau" lateral view can safely be used for nail entry portal creation in the anatomic safe zone. Tibia-based radiographic referencing is useful for intramedullary nailing cases in which knee or proximal tibiofibular joint anatomy is altered.
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The United States economy entered a recession in December 2007. This study aims to determine whether the utilization of elective orthopedic surgeries has been impacted by this recession. From January 2007 to December 2009 at a single private practice in New Jersey, 4820 total joint replacement procedures were scheduled, of which 649 of those were cancelled. ⋯ The results show that the rate of financially motivated cancellations increased over time concurring with multiple financial markers reflecting the economic recession. The results suggest that the recession has created a financial barrier for a significant number of Americans, leading to decreased utilization of care. While there was a statistically significant increase in cancellations for financial reasons, the overall rate of cancellations in the total joint population is still low, representing only about 1% of all cases.