Clinical orthopaedics and related research
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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
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
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.
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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
Closed medical negligence claims can drive patient safety and reduce litigation.
Medical liability reform is viewed by many physician groups as a means of reducing medical malpractice litigation and lowering healthcare costs. However, alternative approaches such as closed medical negligence claims data may also achieve these goals. ⋯ Tort reform, in the form of legislatively prescribed limits on damages arising from lawsuits, is not the only means of addressing the incidence and costs related to medical malpractice litigation. As the experience of anesthesia and obstetric physicians has demonstrated, safety guidelines derived from analyzing past medical malpractice litigation can achieve the same goals while also promoting patient safety.