The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Jul 2007
Are outcomes of bimalleolar fractures poorer than those of lateral malleolar fractures with medial ligamentous injury?
Recommendations for surgical treatment and expected outcomes differ for two unstable patterns of supination-external rotation ankle injuries. We compared the demographic characteristics and functional outcome following surgical stabilization between the two types of supination-external rotation type-4 fractures: distal fibular fracture with a deltoid ligament rupture and bimalleolar fracture. ⋯ At one year after surgical stabilization of an unstable ankle fracture, most patients experience little or mild pain and have few restrictions in functional activities. However, the functional outcome for those with a bimalleolar fracture is worse than that for those with a lateral malleolar fracture and disruption of the deltoid ligament, possibly because of the injury pattern and the energy expended.
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J Bone Joint Surg Am · Jul 2007
Complex posterior fracture-dislocation of the shoulder. Epidemiology, injury patterns, and results of operative treatment.
Complex posterior fracture-dislocations of the shoulder are rare and often associated with poor long-term function regardless of the choice of treatment. The purposes of this study were to evaluate the epidemiology and pathological anatomy of posterior fracture-dislocations of the shoulder and to assess the clinical and radiographic outcomes of a specific treatment protocol of open reduction and internal fixation. ⋯ Acute complex posterior fracture-dislocations of the shoulder are rare, but they occur in patients who are younger than the majority of other patients who sustain a proximal humeral fracture. The use of open reduction and internal fixation to treat these fractures is associated with a relatively low risk of postoperative complications, and the functional outcome is generally favorable.
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J Bone Joint Surg Am · Jul 2007
Timely fracture-healing requires optimization of axial fixation stability.
Bone-healing is known to be sensitive to the mechanical stability of fixation. However, the influence on healing of the individual components of fixation stiffness remains unclear. The aim of this study was to investigate the relationship between the initial in vitro fixation stiffness and the strength and stiffness of the callus after nine weeks. We hypothesized that axial stiffness would determine the healing outcome. ⋯ In this study, a clear relationship between the stability of fixation and the mechanical strength of the healing tibia was seen. Moderate levels of axial stability were associated with the highest callus strength and stiffness.
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J Bone Joint Surg Am · Jun 2007
Randomized Controlled TrialEarly pain relief and function after posterior minimally invasive and conventional total hip arthroplasty. A prospective, randomized, blinded study.
Few prospective randomized studies have demonstrated benefits of minimally invasive total hip arthroplasty when compared with conventional total hip arthroplasty. We hypothesized that patients treated with a posterior mini-incision would have better results than those treated with a posterior long incision with regard to the achievement of established goals for pain relief and functional recovery permitting hospital discharge by the second postoperative day. ⋯ Therapeutic Level I.
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J Bone Joint Surg Am · Jun 2007
Multicenter StudyImpact of psychological distress on pain and function following knee arthroplasty.
Preoperative psychological distress has been reported to be an important risk factor for poor outcome following lower-extremity arthroplasty. We determined the independent impact of preoperative psychological distress on three, twelve, and twenty-four-month WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) pain and function scores and on change scores over those time periods. ⋯ Prognostic Level I.