Orthopedics
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Comparative Study
Treatment of complicated tibial plateau fractures with dual plating via a 2-incision technique.
The operative treatment of complicated bicondylar fractures of the tibial plateau remains a challenge to most surgeons. This retrospective study was designed to evaluate the clinical and radiological outcomes of dual plating via a 2-incision technique for the repair of complicated bicondylar tibial plateau fractures. A series of consecutive patients with bicondylar tibial plateau fractures treated by open reduction and internal fixation with a double buttress plate or a combination of locking plate and buttress plate via a 2-incision technique between March 2004 and March 2008 were retrospectively analyzed. ⋯ No significant differences in clinical or radiographic outcomes were found between the 2 groups, except that the combination group needed less bone graft. Dual plating with 2 incisions provided good exposition for the reduction and fixation of complicated bicondylar tibial plateau fractures. Using a combination of locking plate and buttress plate reduced the amount of bone graft compared with the double buttress plate technique.
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Posttraumatic clavicle nonunion is rare, particularly in children. Four cases of clavicle fracture nonunion in patients aged 10 years and younger have been reported. A variety of techniques have been used to treat pediatric clavicle nonunions. ⋯ M. S.) prefers to remove hardware in young children, but the family declined removal. Pediatric posttraumatic nonunion of the clavicle is rare but can be safely treated with plate fixation, with excellent results.
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Review Meta Analysis
Review of medicolegal cases for cauda equina syndrome: what factors lead to an adverse outcome for the provider?
Cauda equina syndrome is 1 of a few true surgical emergencies involving the lumbar spine. Although treatment within 48 hours has been found to correlate with improved outcomes, recovery of bowel and bladder control does not always occur, and loss of these functions can be distressing to patients. An understanding of factors affecting the legal outcome can aid the clinician in determining risk management for medicolegal cases of cauda equina syndrome. ⋯ Based on our study of court cases involving cauda equina syndrome, a positive association was found between time to surgery >48 hours and an adverse decision (P<.05). The actual degree of functional loss did not appear to affect the verdicts. Because 26.7% of the cases involved an initial presentation that included loss of bowel or bladder control, this study emphasizes the importance of cautioning all patients with spinal complaints of the potential risk for cauda equina syndrome.
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Clinical Trial
Percutaneous radiofrequency denervation in patients with contraindications for total hip arthroplasty.
Multiple comorbidities sometimes represent a contraindication for total hip arthroplasty (THA). Major symptoms of patients with hip pain include groin, thigh, and trochanteric pain. Groin and thigh pain arise from sensory branches of the obturator nerve, whereas trochanteric pain arises from sensory branches of the femoral nerve. ⋯ No side effects were reported. Use of this technique for hip pain control is controversial. In our experience, percutaneous radiofrequency lesioning of the sensory branches of the nerves innervating the hip joint can be an option for patients with intractable hip joint pain.
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Randomized Controlled Trial Comparative Study
Patelloplasty versus traditional total knee arthroplasty for osteoarthritis.
The purpose of this study was to compare the clinical effects of patelloplasty and traditional patellar management in total knee arthroplasty (TKA) for osteoarthritis. A total of 152 patients with osteoarthritis treated with TKA between January 2004 and December 2005 were retrospectively studied. The patients were randomly divided into 2 groups: the patelloplasty group (group A; n=76) and the traditional treatment group (group B; n=76). ⋯ Group A obtained higher KSS scores and patient satisfaction than group B, with no significant difference in postoperative anterior knee pain. Postoperative radiographs revealed a significant difference in patellofemoral congruence between the groups. Patelloplasty relieves pain, enhances patient satisfaction, and improves function better than traditional patellar management in TKA with patellar nonresurfacing.