Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Jul 2006
Comment Letter Case ReportsOsteosarcoma without radiographic evidence of tumor.
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Clin. Orthop. Relat. Res. · Jul 2006
Comparative StudyPrevalence and risk factors for symptomatic thromboembolic events after shoulder arthroplasty.
Deep venous thrombosis and pulmonary embolism after shoulder arthroplasty are not well described. We sought to identify the frequency of deep venous thrombosis and pulmonary embolisms in patients after shoulder arthroplasties to compare these rates with the frequency of deep venous thrombosis and pulmonary embolisms among patients who had total hip and total knee arthroplasties, and to identify associated risk factors. The New York State Department of Health Statewide Planning and Research Cooperative System database was used to identify hospital admissions of patients having shoulder, hip, or knee arthroplasties between 1985 and 2003 with or without an associated diagnostic code for deep venous thrombosis or pulmonary embolism. This resulted in a retrospective cohort of 328,301 procedures. The frequency of deep venous thrombosis was 5.0 per 1000 procedures for shoulder arthroplasties compared with 15.7 for hip arthroplasties and 26.9 for knee arthroplasties. The frequency of pulmonary embolisms was 2.3 for shoulder arthroplasties, 4.2 for hip arthroplasties, and 4.4 for knee arthroplasties. Increasing age, trauma, and cancer were risk factors for thromboembolic events after shoulder arthroplasties. Although the absolute rates of thromboembolic complications were less in patients who had shoulder arthroplasties compared with those of patients who had lower extremity procedures, a larger percentage of these complications were pulmonary embolisms. Perioperative antithrombotic prophylaxis may be beneficial to reduce the frequency of deep venous thrombosis and pulmonary embolisms among patients having shoulder arthroplasties, particularly in higher-risk groups. ⋯ Prognostic study, Level II (retrospective study). See the Guidelines for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Jun 2006
Comparative StudyFixation of posterior malleolar fractures provides greater syndesmotic stability.
Syndesmotic injuries are common in ankle fractures. Traditional syndesmosis fixation may be associated with a secondary procedure. When the posterior malleolus is fractured, the posterior syndesmotic ligaments may remain intact and attached to the fragment. ⋯ Compared with the intact specimens, stiffness was restored to 70% after fixation of the posterior malleolus, and to 40% after syndesmosis stabilization. Syndesmotic stability may be obtained more effectively by fixation of the posterior malleolus rather than by using a syndesmotic screw. Although additional clinical investigation is warranted, these concepts may be useful in eliminating syndesmotic screw fixation in select patients.
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Clin. Orthop. Relat. Res. · Jun 2006
Comparative StudySurgical treatment of distal clavicle fractures using the clavicular hook plate.
From 1999 to 2003, 34 patients with unstable distal clavicular fractures (Neer Type 2) had surgery using the acromioclavicular titanium hook plate. To investigate the reliability of clavicular hook plate fixation and the effects of hook plates in the subacromial space, we retrospectively reviewed clinical results for pain, shoulder function, range of motion, and radiographic results. The Japanese Orthopaedic Association scores for shoulder disorders indicated good clinical results (mean, 98.3 points). ⋯ This plate fixation method is useful for treating unstable distal clavicular fracture. However, careful operative planning and familiarity with the technique are necessary to prevent complications including subacromial impingement, rotator cuff damage, acromion fracture, and hook cut-out. Care must be used when establishing the position of the hook hole, and it is best to remove the plate after bony union.
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Clin. Orthop. Relat. Res. · Jun 2006
Comparative StudyMisuse of baseline comparison tests and subgroup analyses in surgical trials.
It is unclear whether the misuse of statistical tests that compare patients' baseline characteristics and subgroup analyses in randomized controlled trials can be extrapolated to the surgical literature. We did an observational study evaluating the current use of baseline comparability tests and subgroup analyses in surgical randomized controlled trials. Published surgical randomized controlled trials in four medical journals were identified. ⋯ Forty-nine (91%) analyses were performed post hoc without prior hypotheses. Investigators reported differences between subgroups in 31 (57%) of the analyses, all of which were featured in the summary or conclusion. These inferences may be misleading, making their application to clinical practice unwarranted.