Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Jun 2005
Recalcitrant nonunion of the distal humerus: treatment with free vascularized bone grafting.
We sought to determine whether open reduction and internal fixation in combination with free vascularized bone grafting and elbow contracture release is an effective treatment for patients with recalcitrant distal humeral nonunions with segmental bone loss. In addition, we wondered whether this treatment strategy has an acceptable complication rate. Five patients, with an average age of 48 years, form the basis of our study. An average of 3.4 surgical procedures were done before the vascularized bone grafting for treatment of nonunion. The average time from injury until the index vascularized graft was 37.2 months. All patients had elbow pain at rest and had severe functional limitations related to the nonunion. There was segmental bone loss averaging 3.2 cm at the time of vascularized grafting. Four of the five patients with nonunions had clinical and radiographic union at the latest followup, and one patient required a total elbow arthroplasty because of articular collapse after the vascularized grafting procedure. The average time from vascularized grafting until bony union was 4.5 months (range, 3-6 months). There were no other complications in this patient group. Free vascularized bone grafting is a treatment alternative for distal humeral fracture nonunion, especially in younger patients who have nonunions with segmental bone loss that are refractory to conventional fixation and bone grafting techniques. ⋯ 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. · Jun 2005
Discrepancies between proceedings abstracts and posters at a scientific meeting.
The proceedings handbook of abstracts from scientific meetings aims to provide meeting attendees with an accurate summary of scientific presentations. Given that posters are prepared closer to the meeting than the abstracts for the proceedings book, we hypothesized that there is a high rate of inconsistency between abstracts in the proceedings handbook and the corresponding posters. We compared the poster abstracts printed in the proceedings handbook with the actual posters at the 71st annual meeting of the American Academy of Orthopaedic Surgeons in 2004. ⋯ Our findings suggest that discrepancies between the poster abstracts in the proceedings handbook and actual poster presentations are common, but changes in conclusions are rare. Meeting attendees should not assume that the proceedings handbook provides an accurate reflection of poster presentations. Visiting the poster section is recommended.
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Clin. Orthop. Relat. Res. · Jun 2005
Comorbidities increase complication rates in patients having arthroplasty.
The objective of our study was to assess the effect of comorbidities (hypertension, diabetes, obesity, and their combinations) on postoperative complications and discharge status in patients having shoulder, hip, and knee arthroplasty (n = 959,839). The association between outcomes and each of the comorbidities was assessed using multivariable logistic regression after adjusting for age, race, household income, gender, and hospital volume. In the multivariable models, postoperative complications were more likely in patients with hypertension, diabetes, or obesity as compared with patients without these comorbidities (for hypertension, odds ratio = 1.07; 95% confidence interval range, 1.04-1.11; for obesity, odds ratio = 1.3; 95% confidence interval range, 1.22-1.41). The likelihood of a nonhomebound disposition of patients on discharge was 1.30 times (95% confidence interval range, 1.27-1.32) in patients with diabetes and 1.45 times (95% confidence interval range, 1.40-1.49) in patients who were obese as compared with patients without these respective comorbidities. Patients with a combination of comorbidities also had a higher likelihood of postoperative complications and nonhomebound discharge. Results of our study showed that hypertension, diabetes, and obesity are independent predictors of increased postoperative complications and non-homebound discharge in patients undergoing shoulder, hip, or knee arthroplasty. ⋯ Prognostic study, Level II-1 (retrospective study). See the Guidelines for Authors for a complete description of levels of evidence.