The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Feb 2014
Meta AnalysisStructural integrity after rotator cuff repair does not correlate with patient function and pain: a meta-analysis.
The correlation between the structural integrity of rotator cuff repair and the clinical outcome for the patient remains controversial. The purpose of this study was to assess the relationship between patient function and structural integrity of the rotator cuff after repair. ⋯ The results of this study suggest that there is not a clinically important difference in validated functional outcome scores or pain for patients who have undergone rotator cuff repair regardless of the structural integrity of the repair. Patients with intact repairs do have significantly greater strength than those with retears.
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J Bone Joint Surg Am · Dec 2013
ReviewUpper-extremity peripheral nerve blocks in the perioperative pain management of orthopaedic patients: AAOS exhibit selection.
Over the past twenty-five years, peripheral nerve blocks have become increasingly common for the management of perioperative pain of the upper extremity. Several factors have led to increasing acceptance and use of these peripheral nerve blocks, including a greater awareness and measurement of patient pain and a greater emphasis on decreasing the duration of hospital stays and associated costs. ⋯ The use of peripheral nerve blocks in upper-extremity surgery is common. To actively participate with the patient and anesthesiologist to ensure the best possible outcomes, the orthopaedic surgeon must be well informed regarding the benefits and limitations of this modality.
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J Bone Joint Surg Am · Dec 2013
Review Comparative StudyLateral mass screw fixation in the cervical spine: a systematic literature review.
Lateral mass screw fixation with plates or rods has become the standard method of posterior cervical spine fixation and stabilization for a variety of surgical indications. Despite ubiquitous usage, the safety and efficacy of this technique have not yet been established sufficiently to permit "on-label" U.S. Food and Drug Administration approval for lateral mass screw fixation systems. The purpose of this study was to describe the safety profile and effectiveness of such systems when used in stabilizing the posterior cervical spine. ⋯ The risks of complications were low and the fusion rate was high when lateral mass screw fixation was used in patients undergoing posterior cervical subaxial fusion. Nerve root injury attributed to screw placement occurred in only 1% of 1041 patients. No cases of vertebral artery injury were identified in 758 patients. Screw or rod pullout, screw or plate breakage, and screw loosening occurred in <1% of the screws inserted.
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J Bone Joint Surg Am · Dec 2013
ReviewThe surgical anatomy of the infrapatellar branch of the saphenous nerve in relation to incisions for anteromedial knee surgery.
Iatrogenic injury to the infrapatellar branch of the saphenous nerve is a common complication of surgical approaches to the anteromedial side of the knee. A detailed description of the relative anatomic course of the nerve is important to define clinical guidelines and minimize iatrogenic damage during anterior knee surgery. ⋯ These findings suggest that iatrogenic damage of the infrapatellar branch of the saphenous nerve can be minimized in anteromedial knee surgery when both the location and the location-dependent direction of the nerve are considered when making the skin incision.
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When possible, direct repair remains the current standard of care for the repair of peripheral nerve lacerations. In large nerve gaps, in which direct repair is not possible, grafting remains the most viable option. Nerve scaffolds include autologous conduits, artificial nonbioabsorbable conduits, and bioabsorbable conduits and are options for repair of digital nerve gaps that are <3 cm in length. Experimental studies suggest that the use of allografts may be an option for repairing larger sensory nerve gaps without associated donor-site morbidity.