The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Dec 2007
The influence of insurance status on the transfer of femoral fracture patients to a level-I trauma center.
The aim of the present study was to evaluate transfer patterns and insurance status for patients with a femoral fracture who were definitively managed within a six-hospital health-care system. We hypothesized that insurance status significantly influenced transfer of these patients to the level-I trauma center and that the level-I center provided definitive care for a disproportionate percentage of uninsured femoral fracture patients. ⋯ The majority (71%) of the patients with a femoral fracture who had been managed definitively within our health-care system, regardless of injury severity, had been taken directly to the trauma center. This finding suggests over-triage, which errs on the side of patient well-being. Because there was a significant difference in insurance status between patients who had been transferred to the level-I center and those who had not been transferred as well as between patients who had been definitively managed at the level-I center and those who had been managed in community hospitals, it can be assumed that insurance status as well as injury severity and orthopaedic surgeon availability influence the decision to transfer femoral fracture patients to a level-I trauma center.
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J Bone Joint Surg Am · Dec 2007
Legg-calve-perthes disease: a review of cases with onset before six years of age.
The prognosis for children in whom Legg-Calvé-Perthes disease develops before the age of six years was initially reported to be good, but later studies demonstrated a less favorable prognosis. To assess the natural history of this condition in this age group, we reviewed a large cohort of children who had received minimal treatment for the disease. ⋯ The prognosis for patients with the onset of Legg-Calvé-Perthes disease before the age of six years is favorable, with 80% having a good result. Only children between the ages of four years and five years and eleven months with a B/C or C lateral pillar classification of involvement have a less favorable prognosis. Treatment was not found to influence outcome. Simultaneous bilateral disease, which had a more favorable prognosis, may represent a unique disorder.
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The effect of obesity on the outcomes of metal-on-metal resurfacing arthroplasty is not currently known. In this study, we assessed the influence of body mass index on the survival of a metal-on-metal hybrid hip resurfacing prosthesis by comparing the clinical results of patients with a body mass index of >or=30 with those of patients with a body mass index of <30. ⋯ Metal-on-metal resurfacing hip arthroplasty is performing well in patients with a high body mass index, although the function scores are reduced compared with those for patients with a body mass index of <30. The protective effect of a high body mass index on survivorship results may be explained by a reduced activity level and a greater component size in this patient population.
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J Bone Joint Surg Am · Nov 2007
Multicenter StudyNon-neurologic complications following surgery for adolescent idiopathic scoliosis.
The reported prevalence of non-neurologic complications following corrective surgery for adolescent idiopathic scoliosis ranges from 0% to 10%. However, most studies were retrospective evaluations of treatment techniques and did not focus solely on complications. The purpose of this study was to determine the prevalence of non-neurologic complications following surgery for adolescent idiopathic scoliosis and to identify preoperative and operative factors that can increase this risk. ⋯ The prevalence of non-neurologic postoperative complications following surgery for correction of adolescent idiopathic scoliosis in this study was 15.4%. The few factors noted to significantly increase the rate of complications include a history of renal disease, increased operative blood loss, prolonged posterior surgery time, and prolonged anesthesia time.
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J Bone Joint Surg Am · Nov 2007
Comparative StudyDisease-specific gender differences among total knee arthroplasty candidates.
Women with knee osteoarthritis are less likely to undergo joint replacement despite greater self-reported disability. The primary aim of the present study was to assess gender differences in the type and magnitude of osteoarthritis-related impairment prior to knee arthroplasty. ⋯ Observed gender differences in strength and function appear to be inherent but are magnified in arthroplasty candidates. Strength and functional decline should be closely monitored in women with knee osteoarthritis to serve as an indicator of worsening condition, and preoperative interventions should reflect these gender-specific impairments.