The American journal of orthopedics
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There is growing concern about the emergence of an "opioid epidemic" in the United States, where the abuse of opioids has had a devastating impact on public health and safety. Around 250 million prescriptions for pain medication are now written each year in this country, and 46 people die from an overdose of a prescription pain medication every day. ⋯ A variety of government organizations and expert groups, such as the American Society of Anesthesiologists Task Force on Acute Pain Management, now recommend multimodal analgesia and weighing the benefits and risks of systemic opioids. The Joint Commission also has recommended that strategies for pain management include a patient-centered approach that takes into consideration the accompanying risks and benefits--including the potential risk of dependency, addiction, and abuse.
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Fracture of the distal radius is the most common wrist injury. Treatment of complex intra-articular fractures of the distal radius requires an accurate diagnosis of the fracture pattern and a thoughtful approach to fixation. We propose a new term, sustentaculum lunatum, for the palmar lunate facet. ⋯ It is also key to restoring the anatomy of the palmar distal radial metaphysis during internal fixation. We provide a review of the structure and function of the sustentaculum lunatum and describe fixation techniques. This article is intended to promote awareness of this fragment in the treatment of fractures of the distal radius.
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Carpometacarpal (CMC) joint dislocations are uncommon injuries that account for less than 1% of hand injuries. Dorsal dislocations of the CMC joints are more frequent than volar dislocations. Palmar dislocations can be either ulnopalmar or radiopalmar. ⋯ In our case of radiopalmar dislocation, diagnosis was delayed, and attempts at closed reduction were unsuccessful. Therefore, it was treated by open reduction and Kirschner-wire fixation. This article reports a rare type of injury and discusses its management.
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Orthopedic sports medicine continues to evolve, owing much of its clinical management and practice to rigorous academic research. In this review, we identify and describe the top 100 cited articles in clinical sports medicine and recognize the authors and institutions driving the research. We collected articles (excluding basic science, animal, and cadaveric studies) from the 25 highest-impact sports medicine journals and analyzed them by number of citations, journal, publication date, institution, country, topic, and author. ⋯ The Hospital for Special Surgery and the University of Bern contributed the most articles (5 each). This study provides a comprehensive list of the past century's major academic contributions to sports medicine. Residents and fellows may use this list to guide their scholarly investigations.
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Case Reports
Iatrogenic Femoral Neck Fracture After Closed Reduction of Anterior Hip Dislocation in the Emergency Department.
This is a case report detailing an iatrogenic femoral neck fracture (FNF) after closed reduction of an anterior hip dislocation. While iatrogenic FNF is a known complication of closed reduction, there are few published reports of the circumstances surrounding these fractures, and there has been no discussion of possible risk factors predisposing to this injury. This case report and review of the literature identifies the current incidence of FNF with closed reduction of anterior dislocations of the hip, as well as possible antecedent risk factors for this complication. As a result of this case report, we have changed our protocol for treatment of these injuries.