Orthopedics
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Randomized Controlled Trial
Randomized prospective evaluation of injection techniques for the treatment of lateral epicondylitis.
Lateral epicondylitis is a commonly made diagnosis for general practitioners and orthopedic surgeons. Corticosteroid injection is a mainstay of early treatment. However, conflicting evidence exists to support the use of steroid injection, and no evidence in the literature supports an injection technique. ⋯ The biomechanical or chemical reason for the distinction is yet unknown, but we postulate that the peppered technique may actually further damage the already compromised tendon. The theory that the peppered injection stimulates blood flow may be overestimated or false. Histochemical studies of the pathologic tissue must be performed to further delineate the reason for improved outcomes with the single-injection technique.
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The authors report an unusual case of flexor tenosynovitis, severe carpal tunnel syndrome, and triggering at the carpal tunnel as the first manifestation of gout. A 69-year-old man presented with digital flexion contracture and severe carpal tunnel syndrome of his right hand and was treated surgically. A flexor tenosynovectomy and a median nerve neurolysis were performed through an extended carpal tunnel approach. ⋯ A high index of suspicion is paramount to the initiation of proper management. Operative treatment of gouty flexor tenosynovitis is mandatory to debulk tophaceous deposits, improve tendon gliding, and decompress nerves. Routine uric acid determination could be helpful in the preoperative evaluation of patients with flexor tenosynovitis.
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Comparative Study
Comparing hook plates and Kirschner tension band wiring for unstable lateral clavicle fractures.
The purpose of this study was to compare outcomes and complications of clavicular hook plate and Kirschner tension band wiring for fixation of unstable lateral clavicle fractures. The surgical outcomes of 92 consecutive patients (mean age, 49.30 ± 15.54 years) with unstable fractures of the lateral clavicle treated using AO clavicle hook plates were compared with those of 24 patients (mean age, 50.67 ± 17.58 years) treated using K-wire tension banding. Patients in the hook plate and K-wire groups were followed up for 22.76 ± 2.22 and 25.67 ± 2.75 months, respectively (P<.001). ⋯ Complications in the K-wire group included 3 K-wire migrations, 3 losses of reduction, and 1 wire breakage. We found that hook plate fixation of unstable lateral clavicle fractures was associated with statistically better shoulder function and earlier implant removal than K-wire tension band fixation, with an equivalent rate of complications. Our findings suggest that hook plates are useful for treating unstable lateral clavicular fractures.
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Randomized Controlled Trial Comparative Study
Results of cervical arthroplasty compared with anterior discectomy and fusion: four-year clinical outcomes in a prospective, randomized controlled trial.
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Comparative Study
Lumbar lordosis restoration following single-level instrumented fusion comparing 4 commonly used techniques.
A major sequelae of lumbar fusion is acceleration of adjacent-level degeneration due to decreased lumbar lordosis. We evaluated the effectiveness of 4 common fusion techniques in restoring lordosis: instrumented posterolateral fusion, translumbar interbody fusion, anteroposterior fusion with posterior instrumentation, and anterior interbody fusion with lordotic threaded (LT) cages (Medtronic Sofamor Danek, Memphis, Tennessee). Radiographs were measured preoperatively, immediately postoperatively, and a minimum of 6 months postoperatively. ⋯ Immediately postoperatively and at follow-up, the LT cage group had a significantly greater amount of lordosis and showed maintenance of anterior and posterior disk space height postoperatively compared with the other groups. Instrumented posterolateral fusion produces a greater loss of lordosis compared with anteroposterior fusion with posterior instrumentation, translumbar interbody fusion, and LT cages. Maintenance of lordosis and anterior and posterior disk space height is significantly better with anterior interbody fusion with LT cages.