Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · May 1996
Carpal tunnel release. Correlations with preoperative symptomatology.
Fifty patients (54 hands) who underwent carpal tunnel release for carpal tunnel syndrome were evaluated to determine the relationship between the prominence of specific clinical symptoms and the early results of carpal tunnel release. Patients were evaluated preoperatively, 3 weeks after surgery, and 3 months after surgery by questionnaire, physical examination, and Semmes-Weinstein monofilament pressure testing. The symptoms evaluated included hand/wrist/forearm pain, night pain/paresthesias, intermittent paresthesias, hand clumsiness, hand weakness, constant numbness, and difficulty with work related tasks. ⋯ Overall symptom reduction at 3 months after surgery was 49% +/- 73%. Overall satisfaction at 3 months after surgery was 7.8 +/- 2.8 (0 to 10 scale). the severity of preoperative subjective hand weakness was significantly associated with surgery and with less improvement of function at 3 months after surgery and with less satisfaction with overall symptom relief at 3 months after surgery. Although subjective outcomes in this study were markedly improved after carpal tunnel release regardless of preoperative symptomatology, patients with more preoperative night symptoms and intermittent paresthesias and less preoperative hand/wrist pain, numbness, weakness, clumsiness, and difficulty with work related tasks were the most satisfied with their surgery.
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Clin. Orthop. Relat. Res. · May 1996
Preoperative nutritional status and outcome of elective total hip replacement.
Preoperative malnutrition increases the morbidity rate and length of hospitalization for various types of surgical patients. However, among patients who undergo elective total hip replacement, it is unclear how preoperative nutritional data can be used to detect a high risk subgroup. The purpose of this study was to identify preoperative nutritional factors that could be used to define a subgroup of patients who have undergone elective total hip replacement who are at high risk for poor post-operative outcome. ⋯ Complications were related to the preoperative orthopaedic diagnosis of avascular necrosis of the hip. A subgroup of the patients undergoing elective total hip replacement who are at risk for prolonged recovery can be identified preoperatively by using a serum albumin level of less than 3.9 g/dL. The traditional normal range for albumin may be inappropriate for these patients.
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Clin. Orthop. Relat. Res. · Apr 1996
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialKetorolac versus meperidine for pain relief after orthopaedic surgery.
In this double-blind, randomized, multicenter study, 244 patients with at least moderate pain after major orthopaedic surgery received intramuscular Ketorolac (60 mg followed by 30 mg) or intramuscular meperidine (100 mg or placebo) every 2 to 6 hours as needed for as many as 5 days. Analgesic response was evaluated for 6 hours after initial study drug administration and thereafter each night at bedtime. Both active treatment groups had similar 3-hour summed pain intensity difference and 3-hour total pain relief scores after the first dose that were superior to placebo. ⋯ In both patient and observer evaluations, Ketorolac was significantly better tolerated than meperidine, and the number of patients reporting adverse events was lower with Ketorolac than with meperidine. Following major orthopaedic surgery, Ketorolac provided effective analgesia that was superior to placebo and at least comparable with meperidine. Ketorolac was better tolerated than meperidine.
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Clin. Orthop. Relat. Res. · Apr 1996
The effect of hallux sesamoid excision on the flexor hallucis longus moment arm.
Surgical treatments for chronic, painful hallux sesamoid disorders typically involve partial or complete resection of 1 or both sesamoids. Although these approaches generally result in satisfactory symptom relief, their effect on biomechanical function of the major hallux flexors is not completely understood. The effects of selective sesamoid resections on the effective tendon moment arm of the flexor hallucis longus tendon were evaluated. ⋯ Subsequently, 3 progressively more extensive seasamoid resections were done: (1) distal hemiresection, (2) complete resection, and (3) resection of both sesamoids. Six specimens were tested with the medial sesamoid removed first and 6 with the lateral sesamoid removed first. Statistical analysis showed that significant decreases in the effective tendon moment arms occurred with full medial sesamoid resection, full lateral sesamoid resection, and resection of both the medial and lateral sesamoids.
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Clin. Orthop. Relat. Res. · Mar 1996
Case ReportsBilateral central acetabular fracture dislocations secondary to sustained myoclonus.
This case report presents a patient with bilateral central acetabular fracture dislocations secondary to sustained myoclonus treated with delayed bilateral total hip arthroplasty. This is an unusual mechanism of injury, but is similar to other uncontrolled muscular contractions, such as electroconvulsive therapy and seizures. Because of ongoing myoclonus, the patient initially was treated nonoperatively. ⋯ This case exemplifies that forceful, uncontrolled muscular contraction can cause bilateral symmetric fracture dislocations. In patients with a history of seizure or myoclonic contracture with subsequent pain or loss of function, radiographs are indicated and skeletal fracture or joint dislocation must be ruled out. Secondary reconstruction can be recommended when the patient is medically stable.