Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Sep 2014
Comparative StudyHow does a novel monoplanar pedicle screw perform biomechanically relative to monoaxial and polyaxial designs?
Minimally invasive spinal fusions frequently require placement of pedicle screws through small incisions with limited visualization. Polyaxial pedicle screws are favored due to the difficulty of rod insertion with fixed monoaxial screws. Recently, a novel monoplanar screw became available that is mobile in the coronal plane to ease rod insertion but fixed in the sagittal plane to eliminate head slippage during flexion loads; however, the strength of this screw has not been established relative to other available screw designs. ⋯ Polyaxial screw heads slip on the screw shank at lower values than monoaxial or monoplanar screws, and this results in angular change between the rod and pedicle screw, which could cause loss of segmental lordosis. The novel monoplanar screw used in this study may combine ease of rod placement with sagittal plane strength.
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Clin. Orthop. Relat. Res. · Sep 2014
Is the all-arthroscopic tibial inlay double-bundle PCL reconstruction a viable option in multiligament knee injuries?
All-arthroscopic tibial inlay double-bundle (DB) posterior cruciate ligament (PCL) reconstruction avoids an open dissection and the "killer turn" while maintaining the advantage of an anatomic graft. However, clinical data on the viability of this surgical technique in multiligamentous knee injuries are lacking. ⋯ Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
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The multiple-ligament-injured knee represents a special challenge, being an uncommon injury that is both severe and complicated to treat. Many studies have evaluated patients treated for this injury, but most are limited in their scope. The evaluation of this injury and its treatment using an administrative database might provide a different perspective. ⋯ Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Sep 2014
ReviewVascular and nerve injury after knee dislocation: a systematic review.
Vascular injury is a devastating complication of acute knee dislocation. However, there are wide discrepancies in the reported frequency of vascular injury after knee dislocations, as well as important differences among approaches for diagnosis of this potentially limb-threatening problem. ⋯ This review enhances our understanding of the frequency of vascular injury and repair, amputation, and nerve injuries after knee dislocation. It also illustrates the lack of consensus among practitioners regarding the diagnostic and treatment algorithm for vascular injury. After pooling existing data on this topic, no outcomes-driven conclusions could be drawn regarding the ideal diagnostic modality or indications for surgical repair. In light of these findings and the morbidity associated with a missed diagnosis, clinicians should err on the side of caution in ruling out arterial injury.
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Clin. Orthop. Relat. Res. · Sep 2014
Multicenter StudyWhat is the frequency of vascular injury after knee dislocation?
Vascular injury secondary to an acute knee dislocation is a known complication. However, there exist wide discrepancies in the reported rate of vascular injury in this setting. ⋯ Level IV, prognostic study. See Instructions for Authors for a complete description of levels of evidence.