Clinical orthopaedics and related research
-
Clin. Orthop. Relat. Res. · Jun 2012
Case ReportsSpinal cord injury resulting from injury missed on CT scan: the danger of relying on CT alone for collar removal.
Strict criteria have been used before removing cervical collars in patients with injuries who have midline pain or are unable to be reliably examined. This sometimes leads to prolonged immobilization in cervical collars or use of MRI to rule out injury. Several studies suggest a collar may be removed in the absence of fractures, dislocation, or pathologic subluxation on a cervical CT scan. This may avoid the morbidity of prolonged cervical immobilization or cost of advanced imaging study but risks devastating consequences from missing injuries. ⋯ CT scans are excellent at detecting bony injuries but not ligamentous injuries. Removing cervical collars based on CT scans alone may be expeditious, but some injuries may be missed without further imaging. Our case demonstrates the catastrophic consequences of missing a cervical spine injury and emphasizes the need for maintaining the cervical collar in high-risk patients until proper imaging can be obtained.
-
Clin. Orthop. Relat. Res. · Jun 2012
Meta Analysis Comparative StudyWhich is the best alternative for displaced femoral neck fractures in the elderly?: A meta-analysis.
Treatment of displaced femoral neck fractures includes internal fixation and arthroplasty. However, whether arthroplasty or internal fixation is the primary treatment for displaced femoral neck fractures in elderly patients remains a subject for debate. The literature contains conflicting evidence regarding rates of mortality, revision surgery, major postoperative complications, and function in elderly patients with displaced femoral neck fractures treated either by internal fixation or arthroplasty (either hemiarthroplasty or THA). ⋯ Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
-
Clin. Orthop. Relat. Res. · Jun 2012
Comparative StudySimilar survival but better function for patients after limb salvage versus amputation for distal tibia osteosarcoma.
Amputation has been the standard surgical treatment for distal tibia osteosarcoma. Advances in surgery and chemotherapy have made limb salvage possible. However, it is unclear whether limb salvage offers any improvement in function without compromising survival. ⋯ Level III, retrospective comparative study. See the Guidelines for Authors for a complete description of levels of evidence.
-
Clin. Orthop. Relat. Res. · Jun 2012
Influence of screw design, sex, and approach in scaphoid fracture fixation.
Screw fixation of scaphoid fractures has gained popularity. A long central screw has been shown to be biomechanically advantageous. ⋯ Scaphoids in women are smaller than in men. Theoretically, fixation of scaphoid fractures through a volar approach will allow the surgeon to use longer screws. The screw design has a significant influence on the screw length that can be used in scaphoid fracture fixation. We recommend using a differential pitch screw with a thread diameter of 3.9 mm or less.
-
Clin. Orthop. Relat. Res. · Jun 2012
Combined anterior-posterior surgery is the most important risk factor for developing proximal junctional kyphosis in idiopathic scoliosis.
Several studies have identified risk factors for proximal junctional kyphosis (PJK) after instrumentation for scoliosis, but the relative risks are unclear. ⋯ Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.