Bulletin of the NYU hospital for joint diseases
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Bull NYU Hosp Jt Dis · Jan 2008
ReviewOrthopaedic anesthesia - part 2. Common techniques of regional anesthesia in orthopaedics.
Anesthesia may be considered in terms of two categories: general and regional. The aim of general anesthesia is to induce analgesia, sedation, amnesia, suppression of autonomic reflexes, and relaxation of muscles. ⋯ Although neuraxial blocks comprise an important part of regional anesthesia, they are typically performed by anesthesiologists in an operative setting for major procedures of the lower extremities. The intent of this article is to familiarize the orthopaedist with techniques that have implications for emergency rooms and other ambulatory settings in which regional techniques are sometimes favored over general alternatives because they entail less risk of systemic side effects and may involve more cost-effective use of resources.
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Bull NYU Hosp Jt Dis · Jan 2008
Predictors of mortality after hip fracture: a 10-year prospective study.
The role of medical, social, and functional covariates on mortality after hip fracture was examined over a 16-year period. A total of 1109 patients with hip fractures were included in a prospective database. The inclusion criteria were patients who were age 65 years or older, ambulatory prior to fracture, cognitively intact, living in their own home at the time of the fracture, and had sustained a nonpathological femoral neck or intertrochanteric chip fracture. ⋯ The predictors of mortality were advanced age, male gender, high American Society of Anesthesiologists (ASA)classification, the presence of a major postoperative complication, a history of cancer, chronic obstructive pulmonary disorder, a history of congestive heart failure,ambulating with an assistive device, or being a household ambulator prior to hip fracture. The increased mortality risk was highest during the first year after hip fracture and returned to the risk of the standard population 3 years postoperatively. Males who are 65 to 84 years had the highest mortality risk.
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The p-value is a widely used tool for inference in clinical studies. However, despite the numerous books and papers published on the basics of statistical inference and, thus, on the p-value, there still seems to be a need to highlight what message the p-value exactly contains (and what it does not). In this article, the basic concepts and the different misconceptions regarding the p-value will be highlighted and illustrated with a clinical trial in osteoarthritis. It will also be shown that the (95%) confidence interval is to be preferred over the p-value as a statistical inference tool.
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When the aim of the randomized controlled trial (RCT) is to show that one treatment is superior to another, a statistical test is employed and the trial (test) is called a superiority trial (test). Often a nonsignificant superiority test is wrongly interpreted as proof of no difference between the two treatments. Proving that two treatments are equal in performance is impossible with statistical tools; at most, one can show that they are equivalent. ⋯ In this report, the three types of trials are compared, but the main focus is on the non-inferiority trial. Special attention is paid to the practical implications when setting up a non-inferiority trial. Illustrations are taken from a clinical trial in osteoarthritis and from thrombolytic research.
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Bull NYU Hosp Jt Dis · Jan 2008
Does a traction-internal rotation radiograph help to better evaluate fractures of the proximal femur?
The standard radiographic series for evaluation of a suspected hip fracture in most centers includes an anteroposterior (AP) radiograph of the pelvis, as well AP and cross-table lateral views of the hip. The natural femoral neck anteversion, as well as the fracture deformity, however, may make accurate fracture classification difficult. We have noted that inexperienced physicians sometimes misclassify hip fractures based on the initial radiographic series, which may lead to errors both in surgical planning and implant choice. At our institution, we routinely obtain a physician-assisted traction-internal rotation radiograph of the affected hip in all fractures of the proximal femur. The purpose of the current study was to examine the usefulness of the traction-internal rotation radiograph for the classification of hip fractures by junior residents in our department. ⋯ The routine addition of a traction-internal rotation radiograph increased the ability to accurately classify proximal femur fractures by junior residents in our department. This has a direct impact in accurate surgical planning and implant choice.