The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Jan 2010
Clinical TrialPredictability of the fulcrum bending radiograph in scoliosis correction with alternate-level pedicle screw fixation.
The fulcrum bending radiograph accurately predicts scoliosis curve correction in patients with thoracic adolescent idiopathic scoliosis who are managed with hooks. We assessed the predictive value of the fulcrum bending radiograph in the context of alternate-level pedicle screw fixation of the scoliotic spine. ⋯ To our knowledge, this is the first study to demonstrate the predictive value of the fulcrum bending radiograph in the context of alternate-level pedicle screw fixation in patients with adolescent idiopathic scoliosis. Curve flexibility may dictate the degree of the fulcrum bending correction index, whereby a curve that is less flexible may achieve a greater fulcrum bending correction index. The fulcrum bending radiograph has potential predictive utility. In addition, pedicle screw constructs appear to have a better ability to correct scoliosis in comparison with hooks and hybrid constructs.
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J Bone Joint Surg Am · Jan 2010
Comparative StudyCognition following computer-assisted total knee arthroplasty: a prospective cohort study.
A substantial number of patients experience postoperative cognitive changes following total joint arthroplasty. The change in mental status may be the result of fat and bone-marrow-debris embolization. We hypothesized that the use of computer-assisted total knee arthroplasty, which does not involve the use of intramedullary alignment rods, would produce less fat and bone-marrow-debris embolization and, hence, fewer changes in mental status. ⋯ Further research is needed to determine if fat and bone-marrow-debris embolization is truly decreased by the use of computer-assisted total knee arthroplasty and if such a reduction has any clinical relevance.
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J Bone Joint Surg Am · Jan 2010
Risk factors for spinal cord injury during surgery for spinal deformity.
Spinal cord monitoring is now considered standard care during surgery for spinal deformity. Combined somatosensory and motor evoked potential monitoring allows the detection of early spinal cord dysfunction in most patients. The purpose of the current study was to identify clinical factors that increase the risk of intraoperative electrophysical changes and to provide management recommendations. ⋯ Combined somatosensory and motor evoked potential monitoring effectively prevents neurologic injury in most children undergoing surgery for spinal deformity. Despite the potential for false-positive results, we recommend setting a low threshold for defining relevant electrophysical changes. Rapid intervention can reverse these changes and avoid potentially serious neurologic complications. Patients with cardiopulmonary comorbidities may be at a higher risk for having relevant electrophysical events.
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J Bone Joint Surg Am · Jan 2010
Should an ulnar styloid fracture be fixed following volar plate fixation of a distal radial fracture?
Ulnar styloid fractures often occur in association with distal radial fractures. The purpose of this study was to determine whether an associated ulnar styloid fracture following stable fixation of a distal radial fracture has any effect on wrist function or on the development of chronic distal radioulnar joint instability. ⋯ An accompanying ulnar styloid fracture in patients with stable fixation of a distal radial fracture has no apparent adverse effect on wrist function or stability of the distal radioulnar joint.
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J Bone Joint Surg Am · Jan 2010
Duration of the increase in early postoperative mortality after elective hip and knee replacement.
There is increased early postoperative mortality after elective joint replacement surgery. However, the magnitude and duration of the increased mortality are uncertain. ⋯ There is an increased, but low, early postoperative mortality following lower extremity joint replacement surgery. The excess mortality persists, but steadily decreases, for approximately the first twenty-six postoperative days.