Bulletin (Hospital for Joint Diseases (New York, N.Y.))
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Chronic disability generates most of the costs associated with occupational low back pain, so the search for interventions that can reduce disability has been extensive. Outcome studies have been complicated by multiple study design and execution issues, as well as by the discrepancies between pain, impairment, and disability inherent in chronic pain populations. ⋯ These differences suggest strategies for improving our future approach to reducing disability from occupational low back pain. Overall, functional restoration programs administered by well-integrated, multidisciplinary staffs can be very effective in reducing disability from occupational low back pain.
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Distributing educational material about low back pain to patients is increasingly seen as a possible adjunct to clinical management and a potential means of reducing the risk of the progression of the disorder toward chronic disability. Most back pain is managed in the primary care setting, where such material could save time and support the efforts of these practitioners. Recent evidence-based clinical guidelines for acute low back pain in U. ⋯ A new booklet has been developed which is evidence-based, in line with recent guidelines, and states its messages in a firm, uncluttered, and unambiguous manner. Preliminary studies show that it is readily accepted by patients, that they understand the messages, and that it creates a positive shift in beliefs about low back pain. Further studies regarding the use of this booklet are required to determine its effect on clinical outcomes.
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A 74-year-old male involved in a pedestrian-automobile collision sustained a comminuted supracondylar-diaphyseal femur fracture. The fracture was stabilized by retrograde intramedullary fixation with a Synthes unreamed tibial nail. ⋯ Twelve months after his injury, his knee motion was symmetric to his uninjured side and he had resumed full preinjury activities, including martial arts training. Although antegrade intramedullary nailing remains the treatment of choice for fractures of the femur, this case highlights the usefulness of retrograde nailing and demonstrates the adjunctive application of an existing implant, the tibial nail, in certain special trauma situations.