The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Nov 2009
Multicenter Study Comparative StudyComparison of AO Type-B and Type-C volar shearing fractures of the distal part of the radius.
Fractures of the volar articular margin of the distal part of the radius with volar radiocarpal subluxation (volar shearing, or Barton, fractures) can be accompanied by a fracture of the dorsal metaphyseal cortex. We tested the null hypothesis that there is no difference in wrist function or health status after open reduction and plate-and-screw fixation between volar shearing fractures with a dorsal cortical fracture (complete articular, AO Type C) and those without a dorsal cortical fracture (partial articular, AO Type B). ⋯ Volar shearing fractures are usually complete articular, Type-C injuries. Patients with a Type-C volar shearing fracture experience more pain during early recovery, but ultimately their outcome is comparable with that for patients with a Type-B (partial articular) volar shearing fracture.
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J Bone Joint Surg Am · Nov 2009
Bilateral low-energy simultaneous or sequential femoral fractures in patients on long-term alendronate therapy.
While alendronate therapy has been shown to decrease the risk of vertebral and femoral neck fractures in postmenopausal osteoporotic patients, recent reports have associated long-term alendronate therapy with unilateral low-energy subtrochanteric and diaphyseal femoral fractures in a small number of patients. To our knowledge, there has been only one report of sequential bilateral femoral fractures in patients on long-term bisphosphonate therapy. ⋯ In patients on long-term alendronate therapy who present with a subtrochanteric or diaphyseal femoral fracture, we recommend radiographs of the contralateral femur and consideration of discontinuing alendronate in consultation with an endocrinologist. If a contralateral stress fracture is found, prophylactic fixation should be considered.
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J Bone Joint Surg Am · Nov 2009
The role of nitric oxide synthase and heme oxygenase in the protective effect of hypothermia in ischemia-reperfusion injury.
Ischemia-reperfusion injury plays an important role in limb salvage following limb ischemia. The purpose of the present study was to evaluate the effect of local hypothermia and chemical modulators on microvascular permeability following ischemia-reperfusion injury in skeletal muscle. ⋯ Local hypothermia protects skeletal muscle from increased microvascular permeability following ischemia-reperfusion injury. This protective effect is also seen with the induction of the nitric oxide synthase and heme oxygenase systems at physiologic temperature. We also have shown that the protective effects of hypothermia are blocked by giving heme oxygenase and nitric oxide synthase inhibitors while keeping the muscle hypothermic. These findings demonstrate that heme oxygenase and nitric oxide synthase play a combined role in ischemia-reperfusion injury, suggesting possible pathways for clinical intervention to modulate injury seen following trauma, tourniquet use, vascular surgery, and microvascular surgery.
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J Bone Joint Surg Am · Nov 2009
Randomized Controlled TrialEffect of periarticular corticosteroid injections during total knee arthroplasty. A double-blind randomized trial.
Multimodal pain-control protocols that include periarticular injections have been reported to decrease pain and improve early outcomes following total knee arthroplasty. While injections containing a corticosteroid have been demonstrated to be safe and effective, we are not aware of any randomized trials in which the specific effect of the corticosteroid on early postoperative outcomes has been evaluated. The purpose of this double-blind study was to compare the clinical efficacy of periarticular injections consisting of bupivacaine, morphine, epinephrine, clonidine, and cefuroxime as well as a corticosteroid (methylprednisolone acetate) with the efficacy of periarticular injections consisting of the same agents but without the inclusion of a corticosteroid. ⋯ The periarticular injection of a corticosteroid may reduce the length of the hospital stay following total knee arthroplasty, but it does not appear to improve pain relief, motion, or function in the early postoperative period. While we cannot definitively state that the corticosteroid was a causative factor in the development of the infection at the site of the prosthetic joint, we cannot rule it out either, which raises concern regarding the role of corticosteroids in perioperative pain management following total knee arthroplasty.
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J Bone Joint Surg Am · Nov 2009
Comparative StudyComparison of two intraoperative assessment methods for injuries to the ankle syndesmosis. A cadaveric study.
Intraoperative stress testing is required for the detection of syndesmosis instability following an ankle fracture. The present study compared two stress tests for the detection of syndesmotic injury. ⋯ For the detection of syndesmotic instability at the site of ankle fractures on stress radiographs, the lateral stress test appeared to be superior to the external rotation stress test in this cadaver model.