The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Jan 2008
Patient risk factors, operative care, and outcomes among older community-dwelling male veterans with hip fracture.
Although more than 1200 hip fracture repairs are performed in United States Department of Veterans Affairs hospitals annually, little is known about the relationship between perioperative care and short-term outcomes for veterans with hip fracture. The purpose of the present study was to test whether perioperative care impacts thirty-day outcomes, with patient characteristics being taken into account. ⋯ In addition to recognizing the importance of patient-related factors, we identified operative factors that were related to thirty-day surgical outcomes. It will be important to investigate whether modifying operative factors, such as reducing surgical delays to less than four days, can directly improve the outcomes of hip fracture repair.
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Reherniation within the first year following subtotal lumbar discectomy is a rare but noteworthy event. We performed a retrospective, case-controlled study to evaluate the clinical outcomes after early recurrent lumbar disc reherniation. ⋯ The rate of early reherniation after subtotal lumbar discectomy is low (1%). It is important to consider the possibility of iatrogenic instability during surgery on the lumbar spine for the treatment of reherniation. Patients who undergo reoperation because of early recurrent lumbar disc herniation can have clinical outcomes comparable with those of patients undergoing an uncomplicated subtotal lumbar discectomy.
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J Bone Joint Surg Am · Jan 2008
Comparative StudyAssessment of lower limb alignment: supine fluoroscopy compared with a standing full-length radiograph.
While a full-length standing anteroposterior radiograph of the lower extremity provides the best radiographic method for assessing limb alignment, other methods must be used intraoperatively. We have employed intraoperative fluoroscopy with use of an electrocautery cord to assess limb alignment in the supine patient. ⋯ Intraoperative fluoroscopy with use of the electrocautery cord method is a useful tool for assessing lower limb alignment in patients with a normal body mass index and
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J Bone Joint Surg Am · Dec 2007
Randomized Controlled TrialFemoral nerve block for diaphyseal and distal femoral fractures in the emergency department.
Diaphyseal and distal femoral fractures are painful injuries that are frequently seen in patients requiring a trauma work-up in the hospital emergency department prior to definitive management. The purpose of this study was to determine whether a femoral nerve block administered in the emergency department could provide better pain relief for patients with femoral fractures than currently used pain management practices. ⋯ The acute pain of a diaphyseal or distal femoral fracture can be significantly decreased through the use of a femoral nerve block which can be administered safely in the hospital emergency department.
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J Bone Joint Surg Am · Dec 2007
Multimodal thromboprophylaxis for total hip and knee arthroplasty based on risk assessment.
Orthopaedic surgeons are increasingly challenged to find a prophylaxis regimen that protects patients from thromboembolism while minimizing adverse clinical outcomes such as bleeding. We used a multimodal approach in which the treatment regimen is selected according to patient risk factors. ⋯ A multimodal thromboembolic prophylactic regimen is consistent with protecting patients while limiting adverse clinical outcomes secondary to thromboembolic, vascular, and bleeding complications.