The Journal of bone and joint surgery. American volume
-
J Bone Joint Surg Am · Mar 2013
Distal femoral valgus deformity following plate fixation of pediatric femoral shaft fractures.
This study investigated the frequency and potential risk factors associated with the development of distal femoral valgus deformity following plate fixation of diaphyseal femoral fractures in children. ⋯ Distal femoral valgus deformity occurred in 30% of patients with distal diaphyseal fractures and in 12% overall. We advocate long-term monitoring of patients with femoral plate fixation, particularly those in whom the plate is placed ≤20 mm from the distal femoral physis.
-
J Bone Joint Surg Am · Mar 2013
Repair integrity and functional outcomes for arthroscopic margin convergence of rotator cuff tears.
We evaluated the clinical outcomes of arthroscopic margin convergence for rotator cuff tears. ⋯ Reducing tension by margin convergence followed by a repair of the resulting free edge to bone has reasonable short-term clinical results but a substantial retear rate (47.8%). However, the retears tended to be smaller than the original tear size. No significant difference was observed in the short-term clinical results between the groups with or without a retear.
-
J Bone Joint Surg Am · Mar 2013
Fixation, survival, and dislocation of jumbo acetabular components in revision hip arthroplasty.
Acetabular revision of a total hip arthroplasty using jumbo components (Mayo definition, ≥62 mm in women and ≥66 mm in men) offers distinct advantages in patients with notable acetabular bone loss. However, there are little data on the long-term survival and complications associated with use of these components. ⋯ Jumbo acetabular components with screw fixation were associated with low rates of infection and loosening after revision total hip arthroplasty and had high survival at fifteen years. Reoperation for wear and loosening increased in the second decade. Dislocation was the most common complication and was significantly associated with smaller femoral head sizes.
-
J Bone Joint Surg Am · Mar 2013
ReviewReconstruction of the anterior cruciate ligament in the skeletally immature athlete: a review of current concepts: AAOS exhibit selection.
Intrasubstance tears of the anterior cruciate ligament (ACL) were once considered a rare injury in skeletally immature athletes but are now observed with increasing frequency. Treatment strategies have evolved as recent studies have identified unique considerations specific to the skeletally immature patient. The current literature now supports the trend toward early operative treatment to restore knee stability and prevent progressive meniscal and/or articular cartilage damage, but the optimal approach to ACL reconstruction in this age group remains controversial. ⋯ The intent of this review is to (1) highlight the unique anatomic considerations pertaining to ACL reconstruction in the skeletally immature athlete, (2) discuss preoperative clinical and radiographic assessment of the pediatric patient with a suspected ACL injury, (3) review transphyseal and physeal-sparing reconstruction techniques and highlight surgical technical considerations, (4) present clinical outcomes according to patient and technique-specific factors, and (5) review age-specific injury prevention treatment strategies and a novel treatment algorithm based on skeletal maturity. ACL reconstruction in the skeletally immature athlete typically results in a successful clinical outcome, yet the optimal surgical technique is still controversial. This review will help guide the management of ACL injuries in the pediatric athlete.
-
J Bone Joint Surg Am · Mar 2013
Comparative StudyRisk factors for infection and amputation following open, combat-related calcaneal fractures.
High-energy open calcaneal fractures are severe injuries complicated by high rates of infection, uncertain functional outcomes, and frequent need for later amputation. ⋯ Lower-extremity amputation following open calcaneal fractures is predicted by the injury mechanism, wound location and size, and open fracture type and severity. After short-term follow-up, patients with open calcaneal fractures eventually requiring amputation exhibit improved pain and activity levels compared with patients with continued, ostensibly successful limb salvage.