Orthopedics
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Comparative Study
Comparison of dynamic and locked compression plates for treating midshaft clavicle fractures.
The purpose of this study was to compare the parameters of perioperative course and cost-effectiveness for patients with midshaft clavicle fractures treated by dynamic compression plates or locked compression plates. This retrospective, case-controlled study involved 54 patients with midshaft clavicle fractures who received dynamic compression plates (n=21) or locked compression plates (n=33) between January 2002 and December 2008. Indications for surgery included displacement or shortening >2 cm, comminuted fractures, and skin tenting. ⋯ The only statistically significant difference was a higher rate of plate removal requests in the dynamic compression plate group. Considering medical expenditure, locked compression plates cost 6 times more than dynamic compression plates in the authors' institution (US $600 vs $100, respectively). Other than more plate removal requests in the dynamic compression plate group and greater expense in the locked compression plate group, dynamic compression plates and locked compression plates achieved satisfactory operative outcomes in treating midshaft clavicle fractures, with no statistically significant difference between perioperative course and eventual fracture union observed between the 2 groups.
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Randomized Controlled Trial Comparative Study
Pain management after total knee arthroplasty using a multimodal approach.
Improvements in pain management techniques over the past decade have had a significant impact on the outcomes of total knee arthroplasty. Of these techniques, multimodal approaches have shown potential. The purpose of this study was to compare the results of periarticular injection (PAI) to a combination of patient-controlled epidural analgesia and femoral nerve block (PCEA/FNB). ⋯ Pain on ambulation was the only category that was statistically lower in the PCEA/FNB group than in the PAI group. Although the study demonstrates similar results between the 2 groups, PAI can play a major role in postoperative pain control in institutions that may not have appropriately trained individuals, equipment, and resources for PCEA/FNB. It also reduces many of the side effects and complications associated with regional anesthesia.
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Case Reports
Anatomical reconstruction of reverse hill-sachs lesions using the underpinning technique.
Posterior glenohumeral joint dislocation is an uncommon injury and is associated with bony and ligamentous disruption. It requires prompt diagnosis and early treatment to prevent acute or recurrent instability and subsequent dysfunction. Reverse Hill-Sachs lesions associated with this injury are challenging to treat, and optimal treatment is controversial. ⋯ No evidence of collapse, osteonecrosis, or osteoarthritis progression was seen at latest follow-up. Functional results were excellent, with a minimum follow-up of 2 years. This technique is an alternative method of restoring humeral head sphericity in patients with acute posterior glenohumeral joint dislocations with medium (20%-40%) reverse Hill-Sachs lesions.
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Comparative Study
Hemiarthroplasty versus reverse total shoulder arthroplasty for acute proximal humerus fractures in elderly patients.
Proximal humerus fractures are the third most common fracture in elderly patients. Hemiarthroplasty has been the treatment of choice in patients with bone quality and fracture patterns not amenable to open reduction and internal fixation. Reverse total shoulder arthroplasty is a newer option that appears to be less dependent on tuberosity healing than hemiarthroplasty. ⋯ Reverse total shoulder arthroplasty outperformed hemiarthroplasty with regard to forward flexion, American Shoulder and Elbow Society score, University of Pennsylvania shoulder score, and Single Assessment Numerical Evaluation score. Reverse total shoulder arthroplasty is a reliable option for acute, proximal humerus fractures that are not amenable to closed treatment or reconstruction in elderly patients. Improved functional outcomes when compared with hemiarthroplasty must be balanced against the increased cost and limited life expectancy of patients with this injury.
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Wound complications in joint arthroplasty: comparing traditional and modern methods of skin closure.
Various methods of skin closure exist in joint replacement surgery. Although subcuticular skin closure techniques offer an aesthetic advantage over conventional skin stapling, no measurable differences have been reported. Furthermore, newer barbed sutures, such as the V-Loc absorbable suture (Covidien, Mansfield, Massachusetts), theoretically distribute tension evenly through the wound and help decrease knot-related complications. ⋯ Four (7.8%) wound complications occurred in 51 cases closed via subcuticular Biosyn suture. Six (13.0%) wound complications occurred in 46 cases closed with V-Loc suture. The staple group had a lower rate of complications when compared with the suture group as a whole (P=.033) and when compared specifically with the V-Loc suture group (P=.017).