Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Apr 2015
Multicenter StudyGood functional recovery of complex elbow dislocations treated with hinged external fixation: a multicenter prospective study.
After a complex dislocation, some elbows remain unstable after closed reduction or fracture treatment. Function after treatment with a hinged external fixator theoretically allows collateral ligaments to heal without surgical reconstruction. However, there is a lack of prospective studies that assess functional outcome, pain, and ROM. ⋯ A hinged external elbow fixator provides enough stability to start early mobilization after an acute complex elbow dislocation and residual instability. This was reflected in good functional outcome scores and only slight disability despite a relatively high complication rate.
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Clin. Orthop. Relat. Res. · Apr 2015
Is neuraxial anesthesia safe in patients undergoing surgery for treatment of periprosthetic joint infection?
There is concern that neuraxial anesthesia in patients undergoing surgery for treatment of a periprosthetic joint infection (PJI) may increase the risk of having a central nervous system infection develop. However, the available data on this topic are limited and contradictory. ⋯ Central nervous system infections after neuraxial anesthesia in patients with a PJI appear to be exceedingly rare. Based on the findings of this study, it may be time for the anesthesiology community to reevaluate the risk of sepsis as a relative contraindication to the use of neuraxial anesthesia.
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Clin. Orthop. Relat. Res. · Apr 2015
Correlations between a dedicated orthopaedic complications grading system and early adverse outcomes in joint arthroplasty.
Reliable classification of postoperative complications is important for quality improvement efforts. In 2014, The Knee Society proposed a grading system for complications after TKA, but to our knowledge, a relationship between complication grades and surgical outcomes has not yet been established. ⋯ We found that the proposed grading system is applicable to TKA and THA in terms of documentation of complication severity and as an indicator of increased LOS and increased unplanned readmissions or reoperation rates. That total complication grade was a better predictor of LOS than maximum grade suggests that multiple complications of a lesser grade can be just as important as a single higher grade complication in terms of effect on outcomes.
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Clin. Orthop. Relat. Res. · Mar 2015
Morbidity and readmission after open reduction and internal fixation of ankle fractures are associated with preoperative patient characteristics.
Ankle fractures are common and can be associated with severe morbidity. Risk factors for short-term adverse events and readmission after open reduction and internal fixation (ORIF) of ankle fractures have not been fully characterized. ⋯ Level III, prognostic study.
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Clin. Orthop. Relat. Res. · Mar 2015
Multicenter StudyWhat is the use of imaging before referral to an orthopaedic oncologist? A prospective, multicenter investigation.
Patients often receive advanced imaging before referral to an orthopaedic oncologist. The few studies that have evaluated the value of these tests have been single-center studies, and there were large discrepancies in the estimated frequencies of unnecessary use of diagnostic tests. ⋯ Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.