The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · May 2015
Detection of a traumatic arthrotomy in the pediatric knee using the saline solution load test.
The objective of this study was to quantify the load volume needed for a positive diagnosis of a traumatic arthrotomy in the pediatric knee with use of the saline solution load test (SLT). ⋯ On the basis of our findings, a saline solution load volume of 47 mL is required to detect 90% of superolateral traumatic arthrotomies of 5 mm in the pediatric knee with use of the SLT.
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J Bone Joint Surg Am · May 2015
Randomized Controlled TrialPatient-controlled epidural analgesia or multimodal pain regimen with periarticular injection after total hip arthroplasty: a randomized, double-blind, placebo-controlled study.
The optimal postoperative analgesia after primary total hip arthroplasty remains in question. This randomized, double-blind, placebo-controlled study compared the use of patient-controlled epidural analgesia (PCEA) with use of a multimodal pain regimen including periarticular injection (PAI). We hypothesized that PAI would lead to earlier readiness for discharge, decreased opioid consumption, and lower pain scores. ⋯ PAI did not decrease the time to discharge and was associated with higher pain scores and greater opioid consumption but lower ORSDS scores compared with PCEA. The choice for analgesic regimen may depend on a particular patient's threshold for pain and the potential side effects.
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J Bone Joint Surg Am · May 2015
Randomized Controlled Trial Multicenter Study Comparative StudyVolar locking-plate and Kirschner-wire fixation did not differ in terms of functional outcomes after dorsally displaced distal radial fracture.
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J Bone Joint Surg Am · May 2015
Observational StudyHealth economic implications of perioperative delirium in older patients after surgery for a fragility hip fracture.
Patients who experience a fragility hip fracture are at high risk for perioperative delirium. The purpose of the present study was to evaluate the impact, from a hospital perspective, of perioperative delirium on the length of the hospital stay and episode-of-care costs for elderly patients who underwent surgical treatment of a fragility hip fracture. ⋯ Nearly 50% of elderly patients who underwent surgery for a fragility hip fracture developed perioperative delirium, which was associated with a significant incremental in-hospital length of stay and significant incremental episode-of-care costs. These findings highlight the importance of implementing cost-effective interventions to reduce the prevalence of perioperative delirium in elderly patients with a low-energy hip fracture.
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J Bone Joint Surg Am · May 2015
ReviewAcetabular fractures in the elderly: evaluation and management.
Acetabular fracture patterns in the elderly, with increased involvement of the anterior column, quadrilateral plate comminution, medialization of the femoral head, and marginal impaction, differ from those noted among a younger cohort. Poor prognostic factors for open reduction and internal fixation (ORIF) are posterior wall comminution, marginal impaction of the acetabulum, a femoral head impaction fracture, a so-called gull sign, and hip dislocation. The rate of conversion to total hip arthroplasty following formal ORIF has been reported to be 22% at a mean of twenty-nine months. Total hip replacement after an acetabular fracture generally yields good clinical results; however, in the acute setting, it must be combined with proper stable fracture fixation.