Acta orthopaedica Scandinavica
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Randomized Controlled Trial Clinical Trial
Intensive geriatric rehabilitation of hip fracture patients: a randomized, controlled trial.
We determined the effect of geriatric rehabilitation of hip fracture patients on mortality, length of hospital stay, and functional recovery. In a randomized, controlled intervention study, 243 community dwelling hip fracture patients over 64 years of age were randomly assigned to 2 rehabilitation groups. ⋯ The intervention group recovered instrumental activities of daily living faster (p = 0.05). Direct costs of medical care during the first year did not differ remarkably.
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Patients in the Norwegian Arthroplasty Register with a total hip replacement (THR) have a lower long-term mortality than the age- and gender-matched Norwegian population. We analyzed the early postoperative mortality after 67,548 THR operations in 68 hospitals reported to the Norwegian Arthroplasty Register between 1987 and 1999. Data on deaths and causes of death were obtained from from Statistics Norway, and on thromboprophylaxis from a separate questionnaire sent to all hospitals. ⋯ Early postoperative mortality increased with age, was higher in men than women, and was usually due to vascular disease. We found only a slight reduction in the 60-day postoperative mortality during the period 1987-1999. All underlying diagnoses for a prosthesis operation had a higher 60-day postoperative mortality than primary osteoarthrosis.
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We retrospectively reviewed 79 patients (80 talar fractures) operated on between 1994 and 1997. The average follow-up was 6 (1-15) years. 15 patients had a Marti/Weber fracture type I, 14 patients a type II, 32 patients a type III, and 19 patients a type IV fracture. 46 patients suffered a fracture of the talar neck, Hawkins type I in 10 patients, type II in 18, type III in 17 and type IV in 1 patient. 18/23 patients directly placed in our department were operated on within 6 hours of admission. Primary arthrodesis of both the ankle and subtalar joint was performed twice. ⋯ Radiographs showed ankle or subtalar arthrosis in two thirds of the patients. A normal range of motion was achieved in 18 ankle and 19 subtalar joints. The overall rate of talar necrosis was 9/80 fractures.
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Randomized Controlled Trial Clinical Trial
Combined intra-articular glucocorticoid, bupivacaine and morphine reduces pain and convalescence after diagnostic knee arthroscopy.
We studied the effect of intra-articullar saline vs. bupivacaine + morphine or bupivacaine morphine + methylprednisolone after diagnostic knee arthroscopy. In a double-blind randomized study, 60 patients undergoing diagnostic knee arthroscopy without a therapeutic procedure were allocated to groups receiving intra-articular saline, intra-articular bupivacaine 150 mg + morphine 4 mg or the same dose of bupivacaine + morphine + intra-articular methylprednisolone 40 mg at the end of arthroscopy during general anesthesia. ⋯ A combination of bupivacaine and morphine reduced pain, duration of immobilization and of convalescence. The addition of methylprednisolone further reduced pain, use of more analgesics, joint swelling and convalescence.
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From January 1993 to December 1997, we treated 78 (75 fresh, 1 delayed union and 2 nonunion) fractures of the mid-third clavicle with open reduction and internal fixation using 3.8 mm Knowles pins. All patients used an arm sling for 2-6 weeks after surgery, and were told to avoid vigorous exercise or work with heavy loads for the next 6 weeks. 73 fractures healed within 6 months. 3 complications occurred relating to the surgical procedures. ⋯ After a mean follow-up of 49 (24-86) months, the average shoulder function, as evaluated by a modified Constant-Murley score, was 97% versus the contralateral shoulder. We suggest that if surgery is indicated, open reduction and internal fixation using a Knowles pin is an effective method for managing mid-third clavicular fractures.