Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Mar 2003
Posteromedial dislocation of the elbow with lateral condyle fracture in children.
Posteromedial dislocation of the elbow in children is an extremely rare injury. The current study describes four boys with posteromedial dislocation of the elbow associated with a displaced fracture of the lateral humeral condyle. The patients ranged in age from 6 to 12 years (average age, 9 years 6 months). ⋯ Healing and return of normal function occurred in all but one patient who had minor loss of full extension. Average duration of followup was 7 years 6 months (range, 3-13 years). Dislocation of the elbow associated with a displaced fracture of the lateral humeral condyle can be treated by closed reduction of the elbow dislocation and open anatomic reduction and fixation of the lateral condyle fracture with good results.
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Clin. Orthop. Relat. Res. · Mar 2003
Elastic stable intramedullary nailing of midclavicular fractures with a titanium nail.
This study presents the results of a minimally invasive operative treatment for markedly displaced midclavicular fractures. In all patients a flexible titanium nail was inserted in an unreamed technique from the sternal end of the clavicle. The result of surgery was determined with clinical and radiographic controls. ⋯ Intramedullary nailing of midclavicular fractures with a flexible titanium nail is a safe minimally invasive surgical technique with excellent functional and cosmetic results compared with plate fixation or conservative treatment. Marked pain reduction along with early restoration of shoulder function and early mobilization are advantageous for patients. This technique can be used as an alternative treatment to conservative procedures or plate fixation in patients with markedly displaced midclavicular fractures, multiple trauma, fractures of the lower extremities, or associated shoulder girdle injuries.
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Clin. Orthop. Relat. Res. · Mar 2003
Long-term administration of clodronate does not prevent fracture healing in rats.
Clinicians have been concerned that fractures do not heal properly in individuals exposed to bisphosphonate treatment, a treatment that strongly affects bone metabolism. The current study attempted to clarify the long-term effects of clodronate (dichloromethylene bisphosphonate) treatment on fracture healing in growing rats. Clodronate was administered subcutaneously twice a week in a dose of 2 mg/kg or 10 mg/kg. ⋯ Clodronate treatment does not seem to prolong the fracture healing process, even when administered on a long-term basis before the fracture. Clodronate increases the size of the callus, but has only a minor effect on its biomechanical properties. The current results suggest that long-term clodronate treatment does not inhibit fracture healing.
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Clin. Orthop. Relat. Res. · Mar 2003
Gun control in the United States: ethical perspectives for the twenty-first century.
The current author will explore the way we should think about the ethical implications of gun control in the United States today. The generating pedagogy will be: (1) an explication of worldview perspectives, personal and community as per the author's recently published writings; (2) a discussion of the worldviews of both sides of the gun control debate; (3) a critical appraisal of the positions of each side; and (4) some suggestions about a future that is without ordinary citizen ownership of guns. The author argues that based on an ethical rights model of analysis, an ordinary citizen's right to bear arms is outweighed by other competing rights claims.
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Clin. Orthop. Relat. Res. · Feb 2003
ReviewAn analysis of orthopaedic liability in the acute care setting.
The risk of litigation in the emergency room is not directly proportional to the severity of injury. In fact, the risk of initiation of legal action is greater in cases of relatively modest permanent and partial disability. In these cases, failure to obtain and document informed consent, failure to effectively communicate with the patient and family, and failure to assure followup and prompt assessment of complications are the factors that have most frequently led to litigation. ⋯ Access to useful data of a legal nature is extremely difficult. Only a small number of cases go on to a jury-based decision of public record. It is difficult to get accurate and complete information on the total number of cases filed, cases withdrawn, terms of settlements, and arbitrations because of the confidential nature of the settlement process.