The American journal of orthopedics
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Burst fractures are less common in children than in adults because of the greater mobility and elasticity of the pediatric spine. Because of these spine characteristics, these fractures may behave differently in childhood than in adulthood. To try to address these differences, we reviewed our experience with 11 children (5 boys, 6 girls) treated for burst fractures. ⋯ Anterior vertebral compression improved an average of 15% (range, 24%-39%). In the children treated nonoperatively, kyphosis progressed an average of 9 degrees (range, 15 degrees - 24 degrees), and anterior vertebral compression increased a further 8% (range, 36%-44%). Our results showed that (a) the children who sustained burst fractures tended to develop mild progressive angular deformity at the site of the fracture, (b) operative stabilization prevented further kyphotic deformity as well as decreased the length of hospitalization without contributing to further cord compromise, and (c) nonoperative treatment of burst fracture was a viable option in neurologically intact children, but progressive angular deformity occurred during the first year after the fracture.
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A study was undertaken to determine the confidence of graduating family practice residents in the management of musculoskeletal conditions and to determine the level of exposure of graduating family practice residents to fracture care. A 2-page questionnaire consisting of 50 items was sent to 680 graduating family practice residents at 100 randomly selected residency training programs throughout the United States. Family practice residents were questioned about their fracture care experience, including the number of fractures diagnosed, the number of fractures reduced, the number of fractures treated to healing, and the number of casts and splints applied. ⋯ Family practice residents who had rotated on an orthopedic service for 8 weeks or more during their training reported significantly higher confidence for all 4 skills-physical examination (P = .003), radiographic evaluation (P = .003), diagnosis (P = .007), and treatment (P = .009). In conclusion, family practice residents show relatively low confidence in the management of musculoskeletal conditions and receive minimal exposure to all aspects of fracture care. Confidence can be improved with greater exposure to the musculoskeletal sciences--such as a rotation of 8 weeks or more on an orthopedic surgery service.
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Anterior cruciate ligament (ACL) procedures are associated with significant postoperative pain and have traditionally been done on a short-stay hospitalization basis because of concerns for adequate postoperative analgesia. A retrospective chart review was performed to determine postoperative intravenous patient-controlled analgesia (PCA) morphine requirements for 80 patients who had undergone arthroscopically assisted ACL reconstruction under general anesthesia by means of a patellar tendon autograft by 1 of 2 surgeons. ⋯ A comparison between the surgeons revealed that 1 surgeon had significantly longer intraoperative surgical, tourniquet, and anesthesia times; however, there was no difference in the length of recovery room stay, amount of postoperative PCA morphine used, or time to hospital discharge. Predicting which patients may benefit from short-stay hospitalization after arthroscopic ACL reconstruction may be difficult because of considerable interpatient differences in postoperative analgesic requirements.
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Dyspareunia after heterotopic ossification of the adductor longus is a rare complication. We describe a patient with symptomatic heterotopic ossification of the adductor muscle that developed years after sustaining a fracture of the inferior pubic ramus in association with an injury to the adductor longus muscle. The patient's pain was reduced and his dyspareunia resolved after excision of the adductor longus heterotopic ossification and subsequent physical therapy.