Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Nov 2010
Multicenter StudyRecurrence after and complications associated with adjuvant treatments for sacral giant cell tumor.
The best treatment of giant cell tumor of the sacrum is controversial. It is unclear whether adjuvant treatment with intralesional surgery reduces recurrences or increases morbidity. ⋯ Adjuvants did not change the likelihood of local recurrence when combined with intralesional surgery but the complication rate was high.
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Clin. Orthop. Relat. Res. · Nov 2010
Surgical margins and local control in resection of sacral chordomas.
The treatment of choice in sacral chordoma is surgical resection, although the risk of local recurrence and metastasis remains high. The quality of surgical margins obtained at initial surgery is the primary factor to improve survival reducing the risk of local recurrence, but proximal sacral resections are associated with substantial perioperative morbidity. ⋯ Surgical margins affect the risk of local recurrence. Previous intralesional surgery was associated with a higher rate of local recurrence. Intraoperative contamination did not affect the risk of local recurrence when wide margins were subsequently attained.
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Clin. Orthop. Relat. Res. · Nov 2010
Increased chondrocyte death after steroid and local anesthetic combination.
Hyaline articular cartilage has limited repair and regeneration capacity. Intraarticular administration of glucocorticoid and local anesthetic injections play an important role in the therapy of osteoarthritis. Glucocorticoids and anesthetics reportedly enhance apoptosis in chondrocytes, but effects of the combined use of glucocorticoids and local anesthetics are unknown. ⋯ The combination of glucocorticoids and local anesthetics has an adverse effect on articular chondrocytes, and it raises a question regarding whether concomitant administration should be used in treating osteoarthritis.
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Clin. Orthop. Relat. Res. · Oct 2010
Multiplanar osteotomy with limited wide margins: a tissue preserving surgical technique for high-grade bone sarcomas.
Limb-salvage surgery has been used during the last several decades to treat patients with high-grade bone sarcomas. In the short- and intermediate-term these surgeries have been associated with relatively good function and low revision rates. However, long-term studies show a high rate of soft tissue, implant, and bone-related complications. Multiplanar osteotomy with limited wide margins uses angled bone cuts to resect bone tumors with the goal of complete tumor removal while sparing host tissue although its impact on local recurrence is not known. ⋯ Level IV, therapeutic study. See the guidelines online for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Oct 2010
Comparative StudyLow-income countries' orthopaedic information needs: challenges and opportunities.
The Internet should, in theory, facilitate access to peer-reviewed scientific articles for orthopaedic surgeons in low-income countries (LIC). However, there are major barriers to access, and most full-text journal articles are available only on a subscription basis, which many in LIC cannot afford. Various models exist to remove such barriers. We set out to examine the potential, and reality, of journal article access for surgeons in LIC by studying readership patterns and journal access through a number of Internet-based initiatives, including an open access journal ("PLoS Medicine"), and programs from the University of Toronto (The Ptolemy Project) and World Health Organization (WHO) (Health InterNetwork Access to Research Initiative [HINARI]). ⋯ Free or low-cost Internet-based initiatives can improve access to the medical literature in LIC. Open access journals are a key component to providing clinically relevant literature to the regions and healthcare workers who need it most.