The American journal of orthopedics
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Tumoral calcinosis, a rare disease manifesting with periarticular, calcified masses in soft tissues, can be either primary or secondary to a disease, such as systemic sclerosis. In the case reported here, a patient diagnosed with systemic sclerosis presented with hard calcified masses that involved the shoulders and hips.
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Metal-on-metal (MOM) hip resurfacing has become an increasingly popular treatment for young, active patients with degenerative disease of the hip, as bearing surfaces with better wear properties are now available. One proposed advantage of resurfacing is its ability to be successfully revised to total hip arthroplasty (THA). In addition, radiographic parameters that may predict failure in hip resurfacing have yet to be clearly defined. ⋯ Conversion of aseptic failure of hip resurfacing to conventional THA leads to clinical outcomes similar to those of patients who undergo uncomplicated hip resurfacing. The orientation of the femur and the components placed play a large role in implant survival in hip resurfacing. More work needs to be done to further elucidate these radiographic parameters.
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Comparative Study
Does surgeon volume for total hip arthroplasty affect outcomes after hemiarthroplasty for femoral neck fracture?
We conducted a study to compare complication rates in patients treated with hemiarthroplasty for femoral neck fracture by surgeons with variable experience in primary total hip arthroplasty (THA) and revision THA. A cohort of Medicare beneficiaries (N = 115,352) was identified from Medicare part A claims from 1994 and 1995. All patients had undergone hemiarthroplasty for femoral neck fracture. ⋯ Revision surgery rates, however, were statistically higher for the high-volume group than for the no-volume group at 90 days (0.9% vs 0.7%), 1 year (3.3% vs 2.9%), and 5 years (8.4% vs 7.7%). There were no differences in rates of venous thromboembolism or deep infection between the groups. Surgical experience in primary and revision THA has a significant effect on patient outcomes after hemiarthroplasty for femoral neck fracture.
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Segmental neurofibromatosis (NF-5) is an extremely rare variant of neurofibromatosis involving a single extremity without pathologic features beyond the midline. A case of segmental neurofibromatosis involving the sciatic nerve and its branches is presented with a detailed description of the patient's preoperative findings plus postoperative course through 1-year follow-up. Clinical, histologic, and genetic findings are given along with a brief review of the literature on segmental neurofibromatosis. Last, treatment options and postoperative care recommendations are provided.
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There is a wide variety of treatments for disruption of the syndesmosis. There is also controversy as to which device should be used for fixation of the syndesmosis, how many devices should be used, how many cortices the screws should engage, and whether, when, and where the screws should be removed. We conducted a study to determine how orthopedic surgeons manage these injuries. ⋯ Routine removal of syndesmotic screws was done in the operating room in 95% of cases; it was done at 3 months in 49% of cases, at 4 months in 37%, and at 6 months in 12%. The most common method for treating syndesmotic injuries was through use of 3.5-mm screws engaging 4 cortices routinely removed in the operating room at 3 months. Number of screws used to fix the syndesmosis, either 1 or 2, was evenly split.