The American journal of orthopedics
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Anterior pelvic external fixation using supra-acetabular bone pins is frequently used for manipulation and reduction of unstable pelvic ring injuries prior to definitive fixation. The supra-acetabular bone pin must be strategically placed in order to provide optimal frame stability, patient comfort, and hip mobility, without obstructing subsequent osseous fixation pathways. ⋯ The intraoperative imaging is detailed. The bone pin starting point is located more cranially at the anterior inferior iliac spine than previously described and the pin is directed to accommodate better hip motion.
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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.
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Pain following orthopedic surgery is common and often suboptimally managed, with many patients reporting acute moderate to severe pain following surgery. Opioids are often used to manage this pain, yet this can result in significant side effects and complications, including constipation, nausea, vomiting, respiratory distress, and other central nervous system issues. ⋯ Liposomal bupivacaine uses DepoFoam® technology that allows for the extended release of injected drugs. When used as the foundation of a multimodal regimen, it is effective in reducing postsurgical pain for up to 72 hours while reducing the need for opioids for pain relief.
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Diabetes mellitus is a well-established risk factor for postoperative complications of total joint arthroplasty (TJA). We conducted a study to identify a specific hemoglobin A1c (HbA1c) level at which immediate postoperative complication rates increased after TJA. HbA1c levels were measured within 90 days preoperatively. ⋯ We found that mean postoperative complication rates increased along with HbA1c levels; HbA1c levels higher than 7.5% correlate strongly with a higher rate of postoperative complications. These findings provide a good foundation for prospective studies and further evidence of the effects of HbA1c levels. If an adequate treatment plan for these patients emerges, these findings may help lower readmission rates as well.