The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Mar 2003
Treatment of distal femoral nonunion with internal fixation, cortical allograft struts, and autogenous bone-grafting.
The purpose of this retrospective study was to analyze the results of treatment of nonunions of the distal part of the femur with internal fixation combined with cortical allograft struts and autogenous bone-grafting. ⋯ Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.
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J Bone Joint Surg Am · Feb 2003
Randomized Controlled Trial Comparative Study Clinical TrialUse of a cast compared with a functional ankle brace after operative treatment of an ankle fracture. A prospective, randomized study.
Controversy continues with regard to the optimal postoperative care after open reduction and internal fixation of an ankle fracture. The hypothesis of this study was that postoperative treatment of an ankle fracture with a brace that allows active and passive range-of-motion exercises would improve the functional recovery of patients compared with that after conventional treatment with a cast. Thus, the purpose of this prospective, randomized study was to compare the long-term subjective, objective, and functional outcome after conventional treatment with a cast and that after use of functional bracing in the first six weeks following internal fixation of an ankle fracture. ⋯ The long-term functional outcome after postoperative treatment of an ankle fracture with a cast and that after use of a functional brace are similar. Although early mobilization with use of a functional ankle brace may have some theoretical beneficial effects, the risk of postoperative wound complications associated with this treatment approach is considerably increased compared with that after conventional cast treatment. Thus, the postoperative protocol of treatment with a functional brace requires refinement before it can be generally advocated for use after operative treatment of an ankle fracture.
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Until recently, wrong-site surgery had received little attention and had been considered a random, infrequent event. In 1997, the American Academy of Orthopaedic Surgeons (AAOS) Task Force on Wrong-Site Surgery was formed to determine the incidence of wrong-site surgery and to initiate the "Sign Your Site" campaign. The purpose of our study was to determine the incidence of wrong-site surgery among hand surgeons, elucidate surgeons' practice habits and measures taken to prevent its occurrence, and evaluate the effectiveness of the AAOS "Sign Your Site" campaign. ⋯ Prior to the AAOS "Sign Your Site" campaign, the issue of wrong-site surgery by hand surgeons had not been addressed. Although wrong-site surgery is rare, 21% of hand surgeons reported performing it at least once during their careers. Since the institution of the "Sign Your Site" campaign, 45% of orthopaedic hand surgeons have changed their practice habits, and almost all routinely take some action to prevent wrong-site surgery.
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J Bone Joint Surg Am · Feb 2003
Randomized Controlled Trial Comparative Study Clinical TrialAutologous chondrocyte implantation and osteochondral cylinder transplantation in cartilage repair of the knee joint. A prospective, comparative trial.
Current methods used to restore the joint surface in patients with localized articular cartilage defects include transplantation of an autologous osteochondral cylinder and implantation of autologous chondrocytes. The purpose of this study was to evaluate the clinical and histological outcomes of these two techniques. ⋯ Both treatments resulted in a decrease in symptoms. However, the improvement provided by the autologous chondrocyte implantation lagged behind that provided by the osteochondral cylinder transplantation. Histologically, the defects treated with autologous chondrocyte implantation were primarily filled with fibrocartilage, whereas the osteochondral cylinder transplants retained their hyaline character, although there was a persistent interface between the transplant and the surrounding original cartilage. Limitations of our study included the small number of patients, the relatively short (two-year) follow-up, and the absence of a control group.