The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Aug 2008
Trigger finger: prognostic indicators of recurrence following corticosteroid injection.
Corticosteroid injections are commonly used in the treatment of flexor tenosynovitis in adults. The present study was performed in an attempt to identify prognostic indicators of symptom recurrence one year after corticosteroid injection for the treatment of trigger digits. ⋯ At one year following injection, 56% of the digits had a recurrence of symptoms. Younger age, insulin-dependent diabetes mellitus, involvement of multiple digits, and a history of other tendinopathies of the upper extremity were associated with a higher rate of treatment failure. Symptoms often recurred several months after the injection.
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J Bone Joint Surg Am · Aug 2008
Multicenter StudyAbility of lower-extremity injury severity scores to predict functional outcome after limb salvage.
Lower-extremity injury severity scoring systems were developed to assist surgeons in decision-making regarding whether to amputate or perform limb salvage after high-energy trauma to the lower extremity. These scoring systems have been shown to not be good predictors of limb amputation or salvage. This study was performed to evaluate the clinical utility of the five commonly used lower-extremity injury severity scoring systems as predictors of final functional outcome. ⋯ Currently available injury severity scores are not predictive of the functional recovery of patients who undergo successful limb reconstruction.
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J Bone Joint Surg Am · Aug 2008
Multicenter StudyResults of internal fixation of Pauwels type-3 vertical femoral neck fractures.
It has been postulated that femoral neck fractures with a more vertical fracture line (i.e., a high Pauwels angle) may experience more shear forces and therefore may be predisposed to nonunion or loss of fixation. Although there is controversy regarding which fixation method is ideal, we are aware of no large clinical series in which the treatment outcomes of these fractures were evaluated. The purpose of this multicenter study was to evaluate a large consecutive series of high shear angle (>70 degrees) femoral neck fractures to learn more about the outcomes, complications, and performance of various internal fixation strategies. ⋯ Despite timely, excellent reduction and accurate implant placement in the vast majority of cases, the nonunion rate was 19% for fractures treated with cannulated screws alone and 8% for those treated with a fixed-angle device. Although these failure rates are not significantly different, we believe that this study documents the challenging nature of this fracture pattern and the ideal fixation device remains undefined.
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J Bone Joint Surg Am · Aug 2008
The future of the orthopaedic clinician-scientist. Part I: The potential role of MD-PhD students considering orthopaedic surgery.
There is currently a severe shortage of clinician-scientists, who fill a vital role in musculoskeletal care. One way to address this shortage is to recruit more MD-PhD students into orthopaedics. We analyzed data from a national survey of MD-PhD students to assess this potential. ⋯ This study suggests that there is a relatively strong interest in orthopaedic surgery (patient care and research) among MD-PhD students nationally, creating the potential to recruit approximately 100 new orthopaedic clinician-scientists every eight years (the average MD-PhD training period). Extrapolation indicates that there is the ability to double the number of orthopaedic clinician-scientists in the United States over the next fifty years. Therefore, efforts should be made to attract these students (especially women and those in underrepresented minority groups) to orthopaedic surgery. The study further suggests recruiting broadly-we should not be biased toward students late in training and just those with surgical interests.
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J Bone Joint Surg Am · Aug 2008
Comparative StudyGeographic variation in epidural steroid injection use in medicare patients.
The rates of epidural steroid injections have increased dramatically over time, with conflicting evidence regarding the efficacy of epidural steroid injections for the treatment of various low-back pain disorders. Given the uncertainty about their role, we sought to evaluate the geographic variation in the use of epidural steroid injections for low back pain within the United States. We also sought to determine whether greater rates of epidural steroid injections are associated with lower rates of lumbar surgery. ⋯ There is substantial geographic variation in the rates of epidural steroid injections within the United States. Southern states tend to have the highest procedure rates, whereas northeastern states have the lowest. Injection rates are positively correlated with lumbar surgery rates; therefore, epidural steroid injections do not appear to be substituting for lumbar surgeries or reducing overall rates of lumbar surgery.