The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Aug 2012
Randomized Controlled Trial Multicenter Study Comparative StudyThe impact of epidural steroid injections on the outcomes of patients treated for lumbar disc herniation: a subgroup analysis of the SPORT trial.
The Spine Patient Outcomes Research Trial (SPORT) is a prospective, multicenter study of operative versus nonoperative treatment of lumbar intervertebral disc herniation. It has been suggested that epidural steroid injections may help improve patient outcomes and lower the rate of crossover to surgical treatment. ⋯ Patients with lumbar disc herniation treated with epidural steroid injection had no improvement in short or long-term outcomes compared with patients who were not treated with epidural steroid injection. There was a higher prevalence of crossover to nonsurgical treatment among surgically assigned ESI-group patients, although this was confounded by the increased baseline desire to avoid surgery among patients in the ESI group. Given these data, we concluded that more studies are necessary to establish the value of epidural steroid injection for symptomatic lumbar intervertebral disc herniation.
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J Bone Joint Surg Am · Aug 2012
Variability in the definition and perceived causes of delayed unions and nonunions: a cross-sectional, multinational survey of orthopaedic surgeons.
Despite the large number of fracture outcome studies, there remains variability in the definitions of fracture-healing. It is unclear how orthopaedic surgeons are diagnosing and managing delayed unions and nonunions in clinical practice. We aimed to explore the current opinions of orthopaedic surgeons with regard to defining, diagnosing, and treating delayed unions and nonunions in extremity fractures. ⋯ Surgeons use similar prognostic factors to define and assess delayed unions and nonunions, but there is a lack of consensus in the definitions of delayed union and nonunion. The need for standardization and future randomized trials was strongly endorsed.
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J Bone Joint Surg Am · Aug 2012
Levels of evidence in foot and ankle surgery literature: progress from 2000 to 2010?
The focus on evidence-based medicine has led to calls for increased levels of evidence in surgical journals. The purpose of the present study was to review the levels of evidence in articles published in the foot and ankle literature and to assess changes in the level of evidence over a decade. ⋯ There has been a trend toward higher levels of evidence in foot and ankle surgery literature over a decade, but the differences did not reach significance.
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J Bone Joint Surg Am · Aug 2012
Compliance with Surgical Care Improvement Project measures and hospital-associated infections following hip arthroplasty.
Hospital compliance with the Surgical Care Improvement Project (SCIP) measures has increased recently for patients undergoing hip arthroplasty. However, reductions in postoperative infections were less than expected, and concern remains about complications associated with prophylaxis against venous thromboembolism (VTE). We sought to examine the association between hospital adherence to SCIP measures and postoperative infections. ⋯ Targeting complete compliance with SCIP infection prevention measures was not associated with additional reductions in infection outcomes following hip replacement. Furthermore, significant risk of postoperative infections may result from increased perioperative use of VTE prophylactics.
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J Bone Joint Surg Am · Aug 2012
Risk of injury to the superior gluteal nerve when using a proximal incision for insertion of a piriformis-entry reamed femoral intramedullary nail: a cadaveric study.
This cadaveric study evaluated the risk of injury to the superior gluteal nerve when a proximal incision site is used for insertion of an antegrade, reamed femoral intramedullary nail into the piriformis fossa. Based on prior anatomical studies, our hypothesis is that the use of a proximal incision site for intramedullary nail insertion will consistently injure the superior gluteal nerve. ⋯ This anatomic study demonstrated that the superior gluteal nerve is not at risk for injury when a proximal incision site is used to place a reamed intramedullary nail into the piriformis fossa.