Clinical orthopaedics and related research
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The requirement of obtaining informed consent before medical procedures is well established. With patients having greater access to information through information technology and owing to other factors, disclosure that goes beyond the traditional elements of the risks, benefits, and alternatives to an intervention is demanded from physicians. ⋯ Judicial decisions have subtly expanded the doctrine of informed consent beyond its traditional limits, at least in some cases. As informed consent law continues to develop, physicians should ask if information would be material to a reasonable patient while making medical decisions; if so, such information should be disclosed.
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Clin. Orthop. Relat. Res. · May 2012
Comparative StudyLocal recurrence has only a small effect on survival in high-risk extremity osteosarcoma.
Tumor enlargement after chemotherapy is considered one of the high-risk factors for local recurrence and survival in osteosarcoma. We hypothesized patients with this risk factor will have similar survival regardless of the development of local recurrence. ⋯ Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · May 2012
Minimal epicondylectomy improves neurologic deficits in moderate to severe cubital tunnel syndrome.
Previous studies of minimal medial epicondylectomy for cubital tunnel syndrome included patients with mild disease, making it difficult to determine how much this procedure improved sensory and motor impairments in patients with moderate to severe disease. ⋯ Level IV, therapeutic study. See the guidelines for authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · May 2012
Limited intraobserver and interobserver reliability for the common measures of hip joint congruency used in dysplasia.
A congruent hip frequently is cited in the literature as a prerequisite for performing a reconstructive pelvic osteotomy for hip dysplasia. The designation as congruent is important as incongruent joints generally are regarded as requiring a salvage-type procedure. Several measures of congruency are described in the literature, but it is unclear whether these measures are reliable. ⋯ Hip congruency has long been cited as a requirement for a reconstructive pelvic osteotomy, but based on the above findings, there is no clear agreement regarding what comprises a congruent joint. Thus, better criteria are needed to assess preoperative hip congruency to determine the role of congruency in patient outcomes after surgery for hip dysplasia.
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Clin. Orthop. Relat. Res. · May 2012
Perioperative clopidogrel and postoperative events after hip and knee arthroplasties.
Hip and knee arthroplasties are widely performed and vascular disease among patients having these procedures is common. Clopidogrel is a platelet inhibitor that decreases the likelihood of thrombosis. It may cause intraoperative and postoperative bleeding, but its discontinuation increases the risk of vascular events. There is currently no consensus regarding the best perioperative clopidogrel regimen that balances these concerns. ⋯ Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.