Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Apr 2016
Smoking is Associated with Increased Blood Loss and Transfusion Use After Lumbar Spinal Surgery.
Little is known about the association between smoking and intraoperative blood loss and perioperative transfusion use in patients undergoing spinal surgery. However, we found that although many of the common complications and deleterious effects of smoking on surgical patients had been well documented, the aspect of blood loss seemingly had been overlooked despite data reported in nonorthopaedic sources to suggest a possible connection. ⋯ Level III, therapeutic study.
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Clin. Orthop. Relat. Res. · Apr 2016
Observational StudyDoes Surgical Approach Affect Patient-reported Function After Primary THA?
Total hip arthroplasty (THA) relieves pain and improves physical function in patients with hip osteoarthritis, but requires a year or more for full postoperative recovery. Proponents of intermuscular surgical approaches believe that the direct-anterior approach may restore physical function more quickly than transgluteal approaches, perhaps because of diminished muscle trauma. To evaluate this, we compared patient-reported physical function and other outcome metrics during the first year after surgery between groups of patients who underwent primary THA either through the direct-anterior approach or posterior approach. ⋯ Level III, therapeutic study.
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Clin. Orthop. Relat. Res. · Apr 2016
What Are the Biomechanical Effects of Half-pin and Fine-wire Configurations on Fracture Site Movement in Circular Frames?
Fine-wire circular frame (Ilizarov) fixators are hypothesized to generate favorable biomechanical conditions for fracture healing, allowing axial micromotion while limiting interfragmentary shear. Use of half-pins increases fixation options and may improve patient comfort by reducing muscle irritation, but they are thought to induce interfragmentary shear, converting beam-to-cantilever loading. Little evidence exists regarding the magnitude and type of strain in such constructs during weightbearing. ⋯ The findings of this study add to the overall understanding of the mechanics of circular frame fixation and, if replicated in the clinical setting, may be applied to the preoperative planning of frame treatment, particularly in unstable fractures or bone transport where control of shear strain is a priority.
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Clin. Orthop. Relat. Res. · Apr 2016
Musculoskeletal Medicine Is Underrepresented in the American Medical School Clinical Curriculum.
Musculoskeletal (MSK) conditions are common, and their burden on the healthcare system is increasing as the general population ages. It is essential that medical students be well prepared to evaluate and treat MSK disorders in a confident manner as they enter the workforce. Recent studies and the American Association of Medical Colleges have raised concern that medical schools may not give sufficient instruction on this topic. Other authors have shown that preclinical instruction has increased over the past decade; however, it is unclear if required clinical instruction also has followed that trend. ⋯ Traditional core clerkships continue to be well represented in the clinical years, whereas three newer specialties have gained a larger presence: family medicine, neurology, and emergency medicine; these comprise the "big eight" of clinical clerkships. Given the high prevalence and burden of MSK disorders, required experience in MSK medicine continues to be underrepresented. Further discussion at a national level is needed to determine appropriate representation of MSK medicine specialties during the clinical years.
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Clin. Orthop. Relat. Res. · Apr 2016
Comparative StudySimulation for Teaching Orthopaedic Residents in a Competency-based Curriculum: Do the Benefits Justify the Increased Costs?
Although simulation-based training is becoming widespread in surgical education and research supports its use, one major limitation is cost. Until now, little has been published on the costs of simulation in residency training. At the University of Toronto, a novel competency-based curriculum in orthopaedic surgery has been implemented for training selected residents, which makes extensive use of simulation. Despite the benefits of this intensive approach to simulation, there is a need to consider its financial implications and demands on faculty time. ⋯ The higher costs and demands on faculty time associated with implementing simulation for teaching and assessment must be considered when it is used to enhance surgical training.