The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Sep 2012
Randomized Controlled Trial Comparative StudySling compared with plate osteosynthesis for treatment of displaced midshaft clavicular fractures: a randomized clinical trial.
Few randomized controlled trials have compared operative with nonoperative treatment of clavicular fractures. ⋯ One year after a displaced midshaft clavicular fracture, nonoperative treatment resulted in a higher nonunion rate but similar function and disability compared with operative treatment.
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J Bone Joint Surg Am · Sep 2012
ReviewResident duty-hour restrictions-who are we protecting?: AOA critical issues.
As advocated by Nasca, our teaching programs must nurture professionalism and the effacement of self interest that is the core of the practice of medicine and the profession. The evidence to date suggests that work-hour restrictions based solely on clock-defined time limits discourage, rather than promote, the professional behavior that we desire in tomorrow's physicians. Notwithstanding any issues related to duty hours or fitness for duty, a competency-based system of medical education is both desirable and necessary in the current environment of medical education. In the absence of evidence to suggest that duty-hour limits reduce medical errors and enhance patient safety, and until we have evolved to a competency-based system of resident education, a misguided and overzealous focus on limiting work hours should not be allowed to exert the unintended consequence of eroding the ethos of professionalism that we, and our patients, have come to expect of a physician.
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J Bone Joint Surg Am · Sep 2012
Multicenter Study Comparative StudyWound complications following rivaroxaban administration: a multicenter comparison with low-molecular-weight heparins for thromboprophylaxis in lower limb arthroplasty.
The oral anticoagulant rivaroxaban is recommended for venous thromboembolic prophylaxis following lower limb arthroplasty. Concerns regarding high rates of wound complications following its use have prompted this multicenter comparison with low-molecular-weight heparins. ⋯ The rivaroxaban group had a higher wound complication rate and a lower deep venous thrombosis rate; there were no differences in symptomatic pulmonary embolism or all-cause mortality. Longer follow-up is needed to assess any potential relationship between wound complications and joint stiffness, latent infection, and limb consequences of deep venous thrombosis.
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J Bone Joint Surg Am · Sep 2012
Comparative StudyRevision for unexplained pain following unicompartmental and total knee replacement.
Unicompartmental knee arthroplasty has been associated with consistently worse implant survival rates than total knee arthroplasty in worldwide arthroplasty registers. The rate of revision and the proportion of revisions performed for unexplained knee pain after either a unicompartmental or total knee arthroplasty were studied to assess if there is evidence to support the hypothesis that the numbers of revisions performed for unexplained knee pain differ between these two implant types. ⋯ While more unicompartmental knee implants than total knee implants were revised for unexplained pain, when these revisions for unexplained pain were discounted, unicompartmental knee arthroplasty still had a significantly greater risk of revision from other reasons than did total knee arthroplasty. The revision rate in isolation may not be a reliable way to compare different implant designs and should instead be considered in the context of the reason for failure.
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J Bone Joint Surg Am · Sep 2012
Comparative StudyCementless metaphyseal fitting anatomic total hip arthroplasty with a ceramic-on-ceramic bearing in patients thirty years of age or younger.
The number of midterm or long-term studies on the current generation of cementless total hip replacements with alumina-on-alumina ceramic bearings in patients younger than thirty years of age is limited. The purpose of this study was to evaluate the midterm results of the cementless metaphyseal fitting anatomic total hip prosthesis in patients younger than thirty years of age, with a particular emphasis on the prevalence of thigh pain, resorption of bone due to stress-shielding of the proximal part of the femur, aseptic loosening, and osteolysis. ⋯ These results in patients thirty years of age or younger suggest that the cementless metaphyseal fitting anatomic total hip prosthesis provides outstanding midterm fixation and substantial pain relief well into the second decade postoperatively. Moreover, the alumina-on-alumina ceramic bearing provides a high rate of survivorship without osteolysis.