The American journal of orthopedics
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Management of clavicle fractures continues to evolve. Indications for operative management seem to be expanding, particularly in athletic youth. ⋯ To my knowledge, this case report is the first to describe use of a biodegradable implant. The subcutaneous position of the clavicle makes it ideal for fixation with a biodegradable implant in which no second surgery is required for implant removal.
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Although trigger finger is a condition commonly treated by orthopedic surgeons, we have not found sufficient studies in the literature addressing the treatment of trigger finger that persists following A1 pulley release. We identified 12 fingers in 11 patients with symptoms of trigger finger following A1 pulley release who subsequently underwent resection of 1 or both slips of the flexor digitorum superficialis tendon. Ten patients (11 fingers) presented for follow-up at a mean of 21 months after surgery. ⋯ Grip and pinch strength were comparable to the contralateral side. Mean total active range of motion of the affected digit was 252°. Resection of 1 or both slips of the flexor digitorum superficialis is an effective method for treatment of recalcitrant trigger finger.
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Comparative Study
Mini-open versus open decompression and fusion for lumbar degenerative spondylolisthesis with stenosis.
The outcome of less invasive surgical techniques in comparison to traditional surgical techniques has been the source of debate. In this retrospective study, 51 patients who had undergone posterior lumbar fusion along with bilateral decompression were enrolled. Twenty-one patients underwent fusion using a standard, midline open technique (open group) and 30 patients underwent fusion using a mini-open technique, with a small, central incision for the decompression and bilateral paramedian incisions for the posterolateral fusion and placement of cannulated pedicle screws (mini-open group). ⋯ Operative times, blood loss, and length of hospitalization failed to show statistically significant differences between the groups, although there was a trend toward less blood loss and shorter hospitalization in the mini-open group. Fusion results and complications were similar between the 2 groups. Both techniques resulted in similarly statistically significant improvements in pain and clinical function.
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Identification of preexisting cardiovascular risk factors is important in projecting postoperative outcomes. Using claims data for 16,317 patients who underwent total hip arthroplasty and/or total knee arthroplasty, we performed logistic regression and survival analysis to determine the effects of hypertension, diabetes, dyslipidemia,and obesity (both independently and in clusters) on incidence of myocardial infarction (MI), venous thromboembolism (VTE), and revision arthroplasty. Our results indicated that diabetes (odds ratio [OR],1.55; P<.05) and hypertension (OR, 1.56; P<.05) were independent risk factors for postoperative MI. ⋯ Risk for VTE did not change significantly with 1, 2, or 3 risk factors but reached statistical significance when all 4 risk factors were present (hazard ratio, 3.20; P = .05). There was no association between cardiovascular risk factors and incidence of revision arthroplasty. Our analysis confirmed that diabetes and hypertension are risk factors for postoperative MI, but the respective significant and near significant increased risks for MI and VTE seen with cardiovascular risk factor clustering merit further evaluation of the role of metabolic syndrome in patients who undergo arthroplasty.