The American journal of orthopedics
-
The incidence of proximal humerus fractures in the elderly has been rising. Concomitantly, operative fixation with use of locking plates has been increasing. ⋯ More recent clinical and biomechanical studies suggest that use of these strategies may reduce complications after locked plating of osteoporotic proximal humerus fractures. Furthermore, a multidisciplinary approach to the evaluation and treatment of osteoporosis may be beneficial in these patients.
-
Pedicle subtraction osteotomies are being used with increasing frequency to treat the problem of sagittal imbalance caused by a variety of diseases. Here we describe a simple technique that assists in osteotomy closure and has proved effective and reliable in maintaining correction.
-
Hip fractures are the most costly fall-related fractures. Differences in hospital length of stay (LOS) based on type of surgery could have major financial implications in a potential bundled payment system in which all hip fractures are reimbursed a standard amount. We conducted a study to analyze differences in hospital LOS and costs for total hip arthroplasty (THA), hemiarthroplasty (HA), cephalomedullary nailing, open reduction and internal fixation (ORIF), and closed reduction and percutaneous pinning (CRPP). ⋯ After several patient factors were adjusted for, ORIF was associated with 0.84 fewer in-patient days and $3805.20 less in hospitalization costs compared with HA/THA (P=.042). CRPP was associated with 1.63 fewer days and $7383.90 less in costs than HA/THA (P=.0076). Our results provide insight into the financial implications of hip fracture fixation and identify targets for quality improvement initiatives to improve efficiency of resource utilization.
-
Management of postsurgical analgesia is an important consideration in orthopedic procedures, including joint arthroplasty. Inadequate postsurgical analgesia is associated with increased hospital length of stay, delayed ambulation, and reduced exercise capacity. ⋯ Liposome bupivacaine has been well tolerated in clinical studies and has had a low rate of treatment-related adverse events. To date, there has been no signal of cardiac toxicity, chondrolysis, or delayed wound healing associated with liposome bupivacaine.
-
Unstable proximal interphalangeal (PIP) joint fracture-dislocations, which can cause significant disability, can be treated with multiple techniques. Extension-block pinning (EBP) allows for early motion and is less technically demanding than alternative surgical treatments. In the study reported here, 12 patients with unstable dorsal PIP fracture-dislocations were treated with closed reduction of the PIP joint followed by percutaneous insertion of a Kirschner wire (K-wire) into the distal aspect of the proximal phalanx. ⋯ One patient developed a malunion, which was treated with corrective osteotomy. EBP is a simple, safe, and reproducible technique for unstable PIP fracture-dislocations. This technique yields outcomes similar to those reported for more complex surgical procedures.