The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Mar 2009
Intrasheath subluxation of the peroneal tendons. Surgical technique.
Dislocation or subluxation of the peroneal tendons out of the peroneal groove under a torn or avulsed superior peroneal retinaculum has been well described. We identified a new subgroup of patients with intrasheath subluxation of these tendons within the peroneal groove and with an otherwise intact retinaculum. ⋯ Patients with retrofibular pain and clicking of the peroneal tendons may not have demonstrable subluxation on physical examination and may have an intact superior peroneal retinaculum. They may have an intrasheath subluxation of the peroneal tendons, which can be confirmed with use of a dynamic ultrasound. Surgical repair of tendon tears combined with a peroneal groove-deepening procedure with retinacular reefing is a reproducibly effective procedure for this condition.
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J Bone Joint Surg Am · Mar 2009
Comparative StudyCost-effectiveness of antibiotic-impregnated bone cement used in primary total hip arthroplasty.
Antibiotic-impregnated bone cement is infrequently used in the United States for primary total hip arthroplasty because of concerns about cost, performance, and the possible development of antibiotic resistance and because it has been approved only for use in revision arthroplasty after infection. The purpose of this study was to model the use of antibiotic-impregnated bone cement in primary total hip arthroplasty for the treatment of osteoarthritis to determine whether use of the cement is cost-effective when compared with the use of cement without antibiotics. ⋯ When revision due to either infection or aseptic loosening is considered to be the primary outcome, the use of antibiotic-impregnated bone cement results in an overall cost decrease. When only revision due to infection is considered, the model is strongly influenced by the cost of the cement and the average age of the patients. With few patients less than seventy years of age undergoing total hip arthroplasty with cement in the United States, the use of antibiotic-impregnated bone cement in primary total hip arthroplasty may be of limited value unless its cost is substantially reduced.
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J Bone Joint Surg Am · Mar 2009
Spinal hemiepiphysiodesis decreases the size of vertebral growth plate hypertrophic zone and cells.
Hemiepiphysiodesis is a potential method to treat idiopathic juvenile scoliosis early. The purpose of the present study was to investigate a mechanism of curve creation in the pig thoracic model of spinal hemiepiphysiodesis by determining whether the structure of the vertebral growth plate varied with distance from the stapled, concave side of the spine. The hypotheses were that the heights of the hypertrophic zone, hypertrophic cells, and disc would be decreased on the treated side of the treated level as compared with both an unstapled control level and the side opposite the staple. ⋯ Unilateral control of intervertebral joint motion decreased growth plate height, cell size, and disc height.
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J Bone Joint Surg Am · Mar 2009
Association between decreased bone mineral density and severity of distal radial fractures.
The role of osteoporosis and osteopenia in the etiology of fractures of the distal part of the radius is well established, but any link between osteoporosis and the severity of the distal radial fracture has not been extensively investigated. The aim of this study was to investigate the association between the degree of osteoporosis and the severity of distal radial fractures. ⋯ There is a definite correlation between bone mineral density and the severity of distal radial fractures.
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J Bone Joint Surg Am · Mar 2009
A nonlocking end screw can decrease fracture risk caused by locked plating in the osteoporotic diaphysis.
Locking plates transmit load through fixed-angle locking screws instead of relying on plate-to-bone compression. Therefore, locking screws may induce higher stress at the screw-bone interface than that seen with conventional nonlocked plating. This study investigated whether locked plating in osteoporotic diaphyseal bone causes a greater periprosthetic fracture risk than conventional plating because of stress concentrations at the plate end. It further investigated the effect of replacing the locked end screw with a conventional screw on the strength of the fixation construct. ⋯ Under bending loads, the focused load transfer of locking plates through fixed-angle screws can increase the periprosthetic fracture risk in the osteoporotic diaphysis compared with conventional plates. Replacing the outermost locking screw with a conventional screw reduced the stress concentration at the plate end and significantly increased the bending strength of the plating construct compared with an all-locked construct (p = 0.001).