Orthopedics
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Acute compartment syndrome of the thigh is rare due to the space's ability to accommodate large volumes of fluid and, with the exception of the lateral septum, its thin compliant linings. This article describes a case of bilateral exercise-induced severe compartment syndrome treated with anterior and posterior fasciotomies. A 29-year-old man was admitted to intensive care with myoglobinuria. ⋯ At 6-month follow-up, he ambulated with the assistance of a left ankle foot orthosis. Acute severe compartment syndrome can occur following vigorous exercise. We recommend fasciotomies after exercise-induced acute compartment syndrome rather than initial observation because of the severity of morbidity associated with undertreated compartment syndrome.
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Case Reports
Isolated avulsion fracture of the extensor carpi radialis brevis insertion due to a boxer's injury.
Avulsion fractures involving the radial wrist extensor tendons are extremely rare. Only 8 avulsion fractures of the extensor carpi radialis longus and 7 avulsion fractures of the extensor carpi radialis brevis have been previously reported. We know of no case involving an isolated avulsion fracture of the base of the third metacarpal where the extensor carpi radialis brevis attachment to the fracture fragment was still completely intact. ⋯ The senior author (S. W. B.) of this article is a former Tae Kwon Doe instructor and includes some editorial comments on proper technique for punching to avoid injury.
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Beginning in July 2002, the Accreditation Council for Graduate Medical Education (ACGME) instructed all residency programs to require their residents to demonstrate competency in 6 core areas: patient care, interpersonal and communication skills, medical knowledge, professionalism, practice-based learning, and systems-based practice. The goal was to have objective markers of performance that would serve as a gauge to determine a program's accreditation. To determine the experiences of orthopedic residency programs with regard to the ACGME's core competencies, a national survey was administered to orthopedic program directors and selected orthopedic residents. ⋯ Residents and program directors agreed that their programs would benefit from a definition of each of the core competencies, including a greater commitment to the processes involved in surgical procedures. This study demonstrated a commitment to the core competencies by the programs that responded. The survey also suggested this commitment would be aided by improved definitions of some of the competencies for the orthopedic resident.
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Since King's research on knee degeneration, meniscal-sparing techniques and other significant advances have improved outcomes. The anatomy, classification, and biomechanics of menisci are reviewed. ⋯ If surgery is indicated, open and various arthroscopic techniques are available. Post-operative management and rehabilitation should be considered vital parts to any successful meniscal repair.
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Comparative Study
Comparison of hip and knee arthroplasty outcomes at early and intermediate follow-up.
A common perception among clinicians and patients is that recovery is similar following total hip arthroplasty (THA) and total knee arthroplasty (TKA). Improvement in the outcomes of 337 THAs and 256 TKAs implanted by the same surgeon between April 2003 and November 2005 were compared. Improvement was measured using changes in Oxford hip and knee scores measured preoperatively, at first follow-up, and 1 year postoperatively for each patient. ⋯ While both procedures improve postoperative pain and physical function, as measured by the Oxford score, improvements measured relative to preoperative levels were significantly smaller for TKA compared to THA patients. Despite recent advances in knee arthroplasty surgery, a significant proportion of TKA patients achieve relatively poor outcome scores postoperatively. This study shows that pain and function improve less and more slowly in the early and intermediate postoperative periods for knee compared to hip arthroplasty patients.