The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Jun 2007
ReviewPreventing the development of chronic pain after orthopaedic surgery with preventive multimodal analgesic techniques.
The prevalences of complex regional pain syndrome, phantom limb pain, chronic donor-site pain, and persistent pain following total joint arthroplasty are alarmingly high. Central nervous system plasticity that occurs in response to tissue injury may contribute to the development of persistent postoperative pain. ⋯ The rationale for this strategy is the achievement of sufficient analgesia due to the additive effects of, or the synergistic effects between, different analgesics. Effective multimodal analgesic techniques include the use of nonsteroidal anti-inflammatory drugs, local anesthetics, alpha-2 agonists, ketamine, alpha(2)-delta ligands, and opioids.
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The Musculoskeletal Function Assessment (MFA) is a validated, reliable, self-administered questionnaire that is useful for determining functional status. The Merle d'Aubigné score is a clinical measure of hip function. The purpose of the present study was to evaluate the outcome information provided by these two instruments after operative treatment of elementary posterior wall fractures of the acetabulum. ⋯ The total MFA scores for patients with a posterior wall fracture of the acetabulum were significantly worse than normative reference values. Thus, complete recovery after a posterior wall fracture of the acetabulum is uncommon, with residual functional deficits involving wide-ranging aspects of everyday living that do not necessarily have an obvious direct connection to hip function. Although the modified Merle d'Aubigné score may be useful for evaluating isolated hip function in patients who have been treated for an acetabular fracture, its shortcomings limit its usefulness as a method for evaluating functional outcome in these patients. Research efforts should be directed toward the identification of the psychosocial and other underlying determinants of functional outcome and potential related treatment interventions.
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J Bone Joint Surg Am · May 2007
Comparative StudyComparison of manual and gravity stress radiographs for the evaluation of supination-external rotation fibular fractures.
Isolated distal fibular fractures most commonly result from a supination-external rotation injury of the ankle. Deltoid ligament ruptures can also be associated with these injuries, resulting in an unstable ankle fracture due to incompetent lateral and medial restraints. We hypothesized that a gravity stress radiograph is equivalent to a manual stress radiograph for the detection of deltoid ligament injury in association with an isolated fibular fracture. ⋯ The gravity stress radiograph is equivalent to the manual stress radiograph for determining deltoid ligament injury in association with an isolated distal fibular fracture, and thus it can be used to determine ankle stability in patients who present with an isolated distal fibular fracture.
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J Bone Joint Surg Am · May 2007
Commercially funded and United States-based research is more likely to be published; good-quality studies with negative outcomes are not.
Prior studies implying associations between receipt of commercial funding and positive (significant and/or pro-industry) research outcomes have analyzed only published papers, which is an insufficiently robust approach for assessing publication bias. In this study, we tested the following hypotheses regarding orthopaedic manuscripts submitted for review: (1) nonscientific variables, including receipt of commercial funding, affect the likelihood that a peer-reviewed submission will conclude with a report of a positive study outcome, and (2) positive outcomes and other, nonscientific variables are associated with acceptance for publication. ⋯ Commercially funded studies submitted for review were not more likely to conclude with a positive outcome than were nonfunded studies, and studies with a positive outcome were no more likely to be published than were studies with a negative outcome. These findings contradict those of most previous analyses of published (rather than submitted) research. Commercial funding and the country of origin predict publication following peer review beyond what would be expected on the basis of study quality. Studies with a negative outcome, although seemingly superior in quality, fared no better than studies with a positive outcome in the peer-review process; this may result in inflation of apparent treatment effects when the published literature is subjected to meta-analysis.
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J Bone Joint Surg Am · May 2007
Radial head arthroplasty with a modular metal spacer to treat acute traumatic elbow instability.
The use of a metal radial head prosthesis to help stabilize an elbow with traumatic instability is appealing because internal fixation of multifragment, displaced fractures of the radial head is susceptible to either early or late failure. The newer modular prostheses are easier to size and implant, but their effectiveness has not been investigated, to our knowledge. ⋯ An intentionally loosely placed modular metal radial head prosthesis can help to restore stability in conjunction with repair of other fractures and reattachment of the lateral collateral ligament to the epicondyle in the setting of traumatic elbow instability with a comminuted fracture of the radial head. While a prosthesis that is too large can cause problems, lucencies around the stem of the intentionally loose prosthesis and most changes in the capitellum do not appear to cause problems, at least in the short term.