Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Apr 2005
Comparative StudyLong-term vertebral changes attributable to postoperative lumbar discitis: a retrospective study of six cases.
A clinical, plain radiographic, and magnetic resonance imaging retrospective followup study was done on six patients with postoperative septic L4-L5 lumbar spondylodiscitis to identify the characteristic long-term radiographic findings predicting the clinical outcome. The mean followup was 12 years (range, 9-13 years). Three patients had moderate low-back pain and two were handicapped. One patient had slight peroneal weakness. Flexibility of the lumbar spine was restricted to some extent in all patients. Laminectomy for spinal stenosis (L4-L5) had been done in one patient and reoperation because of recurring disc herniation was done in two patients. Partial or total bone marrow depletion and corresponding enhancement of fat signals in relation to adjacent vertebral bodies, narrowing of the intervertebral disc space, and irregularity or cavitations affecting one or both end plates were long-term findings of magnetic resonance imaging. Plain radiographs and magnetic resonance imaging scans revealed a complete bony fusion in one patient and partial fusion in one patient. In two patients, residual disc protrusion or herniation in relation to the surgically treated disc was evident; three affecting L3-L4 and two affecting L5-S1 disc levels. Septic postoperative lumbar discitis severely hampers clinical recovery after disc operations and results in long-term changes as seen on magnetic resonance imaging scans. ⋯ Therapeutic study, Level IV (case series--no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Apr 2005
Review Comparative StudyOrthopaedic trauma for the general orthopaedist: avoiding problems and pitfalls in treatment.
The Advanced Trauma Life Support program of the American College of Surgeons has developed a de facto standard of care for the first hour of treatment of patients with trauma who are treated in North America. No equivalent for the treatment of orthopaedic trauma has been established. We provide an overview of the important topics every orthopaedist treating patients with musculoskeletal trauma should be familiar with. The topics include: (1) diagnosis of musculoskeletal injury and documentation of physical exam; (2) pelvic ring injuries; (3) open fractures; (4) compartment syndrome; (5) the timing of definitive fixation in the patient with polytrauma; (6) delayed diagnosis of musculoskeletal injury; and (7) deep venous thrombosis prophylaxis.
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Clin. Orthop. Relat. Res. · Apr 2005
Review Comparative StudyMedicolegal aspects of foot and ankle surgery.
Medicolegal aspects of orthopaedic foot and ankle surgery, including issues of standard of care, complications, and discrepancies between patient and physician expectations, generally are similar to those encountered in other orthopaedic subspecialties. However, there are some unique aspects involving foot and ankle surgery: the standard of care continues to evolve, some complications are specific to the foot and ankle, and patient expectations of particular foot and ankle procedures may exceed those of the foot and ankle surgeon, who often is confronted with challenging pathologic conditions. This review addresses issues of standard of care and complications as they pertain to current practices of orthopaedic foot and ankle surgery.
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Clin. Orthop. Relat. Res. · Apr 2005
Randomized Controlled Trial Comparative Study Clinical TrialTourniquets may increase postoperative swelling and pain after internal fixation of ankle fractures.
Tourniquets frequently are used in orthopaedic surgery to provide a bloodless field. There is still controversy among authors regarding the benefits and potential risks of using a tourniquet. The objective of this prospective randomized study was to quantify the effect of tourniquet use on postoperative swelling, pain, and range of motion after open reduction and internal fixation of ankle fractures. Fifty-four patients with closed ankle fractures were treated surgically; 26 patients were operated on using a thigh tourniquet (Group A), and 28 patients had surgery without the use of a tourniquet (Group B). The groups of patients were similar for age, gender, fracture types, and operative procedures. There was no difference in operation time. Using a tourniquet during open reduction and internal fixation of ankle fractures did increase postoperative swelling and postoperative pain at Day 5 and at Week 6 after surgery. We found a trend for a better range of motion in the ankle until the 6-week followup in the nontourniquet group compared with the group in which the tourniquet was inflated. According to these results we do not recommend using a tourniquet for osteosynthesis of ankle fractures. ⋯ Therapeutic study, Level I-1 (randomized controlled trial). See the Guidelines for Authors for a complete description of levels of evidence.