The American journal of orthopedics
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Since falling off a motorcycle 2 years earlier, an 8-year-old, right-hand-dominant boy reported anterior shoulder pain and weakness. After being evaluated by his family physician and completing a course of physical therapy with no symptomatic improvement, he was seen at our institution. Physical examination was remarkable for diminished strength with internal rotation (4/5). ⋯ The patient underwent right shoulder diagnostic arthroscopy with debridement of a partial-thickness articular-sided tear of the supraspinatus tendon followed by open repair of the subscapularis tendon rupture. This case illustrates a traumatic subscapularis tendon injury that is rare in this age group. A few other traumatic subscapularis injuries have been reported in children, but they all demonstrated bony avulsion of the lesser tuberosity.
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Appropriate implant alignment is a major goal of total joint arthroplasty. Obtaining appropriate alignment typically involves making intraoperative decisions in response to visual and tactile feedback. ⋯ Improving implant alignment can be correlated with improved long-term clinical outcomes. However, despite emerging data, many surgeons remain wary of computer-assisted orthopedic surgery.
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Comparative Study
Accuracy of digital templating in total hip arthroplasty.
Digital radiography is becoming the standard of care for many hospitals and clinics worldwide. The introduction of this new standard has led to the development of arthroplasty templating software. We sought to compare our results using the standard acetate method with the new software method. ⋯ The accuracy demonstrated in this study should be achieved easily with any digital templating software. The benefit comes from the ability to scale the templates to the actual x-ray magnification. We expect that this improved accuracy over traditional acetate templating will enhance our ability to restore normal hip biomechanics.
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Thromboembolic events (TEs), including pulmonary embolisms (PEs), are life threatening. Older patients with trauma are at significantly higher risk for these complications. In March 2003, a deep vein thrombosis (DVT) prophylaxis protocol was implemented for use in all trauma patients admitted to our hospital. ⋯ TE rates for the study period trended lower for patients aged 65 or older (6.4% vs 2.2%, P<.1). This protocol did not increase the incidence of bleeding events in this patient population. Protocol-based, risk-adjusted DVT/TE prophylaxis is safe and efficacious in elderly trauma patients who are at increased risk for TEs.