Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · May 2004
Review Comparative StudyTreatment of the mangled lower extremity after a terrorist blast injury.
Terrorist bombings, with resultant blast injuries, have been increasing in frequency during the past 30 years. Injury to the musculoskeletal system is common in victims who survive such attacks. Substantial injury to the limbs may occur through several different mechanisms, each of which may affect prognosis and alter the treatment algorithm. ⋯ This management protocol may improve the medical facility's ability to manage system resources while treating patients with severe blast injuries. The decision of whether to salvage or proceed with limb amputation is one of the most difficult in orthopaedic trauma. A basic education in the mechanisms of blast damage, a methodical approach to resuscitation, and mangled extremity treatment, likely can improve surgical success.
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Clin. Orthop. Relat. Res. · May 2004
Review Comparative StudyPulmonary aspects of treatment of long bone fractures in the polytrauma patient.
During the past decade, there have been significant advances in the treatment of long bone fractures in the polytraumatized patient. The major controversy in this area is whether definitive long bone stabilization needs to be done emergently. ⋯ The major benefits of fixation are: (1). improve mobilization to enhance pulmonary function; (2). decreased narcotic requirements with improved pain control after fixation; and (3). early aggressive fluid resuscitation associated with operative intervention. Patients with multisystem injury who are underresuscitated or are unstable should have early external fixation because temporizing skeletal stabilization until definitive fixation can be done.
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Clin. Orthop. Relat. Res. · May 2004
Comparative StudyEffect of postoperative delirium on outcome after hip fracture.
Nine-hundred twenty-one community-dwelling patients 65 years of age or older, who sustained an operatively treated hip fracture from July 1, 1987 to June 30, 1998 were followed up for the development of postoperative delirium. The outcomes examined in the current study were postoperative complication rates, in-hospital mortality, hospital length of stay, hospital discharge status, 1-year mortality rate, place of residence, recovery of ambulatory ability, and activities of daily living 1 year after surgery. Forty-seven (5.1%) patients were diagnosed with postoperative delirium. ⋯ Patients who had postoperative delirium develop had a significantly longer length of hospitalization. They also had significantly higher rates of mortality at 1 year, were less likely to recover their prefracture level of ambulation, and were more likely to show a decline in level of independence in basic activities of daily living at the 1-year followup. There was no difference in the rate of postoperative complications, in-hospital mortality, discharge residence, and recovery of instrumental activities of daily living at 1 year.
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Clin. Orthop. Relat. Res. · Apr 2004
Comparative StudyHigher cumulative revision rate of knee arthroplasties in younger patients with osteoarthritis.
This study was designed to test the hypothesis that younger patients treated for osteoarthritis and similar conditions using total knee arthroplasty and unicompartmental knee arthroplasty have a lower implant survival rate when compared with older patients. Previous studies have been done on a small number of patients and only included the younger patients. In many cases patients treated for rheumatoid arthritis have been included in the studies and exceptional survival rates have been reported. ⋯ The results showed a higher cumulative revision rate for the group of younger patients in all statistical analyses and the risk ratio for revision was significantly lower for the group of older patients. The risk for revision decreased for both groups when considering the year of surgery. This is probably attributable to better implant components and surgical techniques.