Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Dec 2014
Apical and intermediate anchors without fusion improve Cobb angle and thoracic kyphosis in early-onset scoliosis.
The main goal of treatment in early-onset scoliosis is to obtain and maintain curve correction while simultaneously preserving spinal, trunk, and lung growth. This study introduces a new surgical strategy, called the modified growing rod technique, which allows spinal growth and lung development while controlling the main deformity with apical and intermediate anchors without fusion. The use of intraoperative traction at the initial procedure enables spontaneous correction of the deformity and decreases the need for forceful correction maneuvers on the immature spine and prevents possible implant failures. This study seeks to evaluate (1) curve correction; (2) spinal length; (3) number of procedures performed; and (4) complications with the new approach. ⋯ In this preliminary study, the modified growing rod technique with apical and intermediate anchors provided satisfactory curve control, prevented progression, maintained rotational stability, and allowed continuation of trunk growth with a low implant-related complication rate.
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Clin. Orthop. Relat. Res. · Dec 2014
Revision surgery occurs frequently after percutaneous fixation of stable femoral neck fractures in elderly patients.
Femoral neck fractures are a major public health problem. Multiple-screw fixation is the most commonly used surgical technique for the treatment of stable femoral neck fractures. ⋯ Level IV, therapeutic study.
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Clin. Orthop. Relat. Res. · Dec 2014
Comorbidities in patients undergoing total knee arthroplasty: do they influence hospital costs and length of stay?
Increasing national expenditures and use associated with TKA have resulted in pressure to reduce costs through various reimbursement cuts. However, within the arthroplasty literature, few studies have examined the association of medical comorbidities on resource use and length of stay after joint arthroplasty. ⋯ Level IV, economic and decision analysis. See the Instructions for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Dec 2014
Subject-specific patterns of femur-labrum contact are complex and vary in asymptomatic hips and hips with femoroacetabular impingement.
Femoroacetabular impingement (FAI) may constrain hip articulation and cause chondrolabral damage, but to our knowledge, in vivo articulation and femur-labrum contact patterns have not been quantified. ⋯ Dual-fluoroscopy and model-based tracking provided the ability to assess hip kinematics in vivo during the entire impingement examination. The high variability in observed labrum-femur contact patterns at the terminal position of the examination provides evidence that subtle anatomic features could dictate underlying hip biomechanics. Although femur-labrum contact occurs in asymptomatic and symptomatic hips at the terminal position of the impingement examination, contact may occur at reduced adduction and internal rotation in patients with FAI. Use of minimum bone-to-bone distance may not appropriately identify the region of femur-labrum contact. Additional research, using a larger cohort and appropriate statistical tests, is required to confirm the findings of this exploratory study.
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Clin. Orthop. Relat. Res. · Dec 2014
Fracture reduction and primary ankle arthrodesis: a reliable approach for severely comminuted tibial pilon fracture.
Posttraumatic arthritis and prolonged recovery are typical after a severely comminuted tibial pilon fracture, and ankle arthrodesis is a common salvage procedure. However, few reports discuss the option of immediate arthrodesis, which may be a potentially viable approach to accelerate overall recovery in patients with severe fracture patterns. ⋯ Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.