Clinical orthopaedics and related research
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The industrial upper limb pain epidemic colloquially known as repetition strain injury rapidly increased in the early 1980s to peak in 1985. Its less precipitous decline coincided with an awareness that repetition strain injury was a nonphysical sociopolitical phenomenon and a corresponding loss of the pecuniary benefits enjoyed by the powerful vested interest groups. Although its protagonists incorrectly claimed that this was a new disease, the rise and fall of repetition strain injury followed its historical predecessors including telegraphists' wrist and writer's cramp. ⋯ These patients were differentiated from those with genuine work related injuries whose symptoms are reproducible, with physical signs easily defined, disease identifiable, and response to physical treatment predictable. Most patients with repetition strain injury genuinely suffered the symptoms of which they complained and made little secondary gain relative to the protagonists of repetition strain injury who had a vested interest. The similarities between Australian repetition strain injury in the 1980s and American cumulative trauma disorder in the 1990s is compelling.
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Clin. Orthop. Relat. Res. · May 1998
ReviewUpdate on the management of open fractures of the tibial shaft.
A retrospective study of 133 open tibial fractures in 129 patients treated at the Hennepin County Medical Center between 1986 and 1993 was done. The results of the treatment protocol in this patient group is presented and the current classification schemes, prevention of infection, debridement, antibiotics, soft tissue reconstruction, fracture stabilization methods, bone grafting, and exchange nailing are discussed. ⋯ Despite repetitive and aggressive debridement, a certain number of fractures will remain contaminated and become infected. Infection after these severe injuries is probably multifactorial, and its prevention requires that the surgeon diligently adhere to the imperatives of open fracture care.
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Clin. Orthop. Relat. Res. · May 1998
Comparative StudyBiomechanical assessment of compression screws.
A series of mechanical tests on anatomic specimen cancellous bone and cancellous bonelike foam were conducted to evaluate and compare an Acutrak compression screw with an AO 4-mm cancellous screw and the Herbert screw. The Acutrak and AO screws produced similar fragment compression in foam and bone; Acutrak and AO compression were significantly greater than that of the Herbert screw. However, Acutrak was able to maintain compression after cyclic loading significantly better than were the AO and Herbert screws. ⋯ The results of this analysis show the Acutrak screw is capable of producing and maintaining compression between bone fracture fragments. In addition, the Acutrak screw was shown to have superior mechanical characteristics than did Herbert screw in every mode tested. The Acutrak screw did not surpass the fragment compression achieved by the AO screw in foam, but it did not overtighten or experience degradation of compression after 500 cycles of simulated physiologic loading.
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Clin. Orthop. Relat. Res. · May 1998
Use of the Gamma nail in the treatment of fractures of the proximal femur.
Fractures of the proximal femur are, more than ever, an important challenge in the field of traumatology. The Gamma nail, a combination of advantages of the sliding screw with the intramedullary nail, represents an efficient technique in the management of these fractures. A series of 224 fractures of the proximal femur in which this nail was used is reported. ⋯ Seven cases of migration of a proximal screw, six shaft fractures, and one broken nail were the most important complications. The device allowed for early mobilization and full weightbearing of the affected hip regardless of the type of fracture. With adequate surgical technique and experience, the advantages of the Gamma nail increases as the complication rate diminishes.
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Clin. Orthop. Relat. Res. · May 1998
Can specialists reduce costs? The case of referrals to orthopaedic surgeons.
This study investigates whether timely referral to specialists, in this case orthopaedic surgeons, potentially can reduce the costs of a health care episode. Five musculoskeletal diagnoses were chosen, and the diagnostic and treatment history of approximately 2500 persons with these five diagnoses was traced to determine when in the course of their treatment episode they were referred from nonorthopaedist to orthopaedist care and how much their episode of care cost. ⋯ The implication is that there are likely to be numerous identifiable health conditions that should be flagged for early referral to specialists to reduce costs. It also questions the validity of the presumption that specialist care is necessarily more expensive.