Orthopedics
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The literature is inconclusive on the development of adjacent-level vertebral fracture after initial cement augmentation. A preliminary hypotheses is that cement injection exaggerates force transmission to the adjacent vertebral bodies, thereby predisposing those levels to future fractures. A sandwich vertebra is an intact vertebral body located between 2 previously cemented vertebrae. ⋯ Only preoperative kyphotic angulation was the variable positively associated with sandwich vertebral fracture at follow-up (P=.021). Although subjected to double load shifts, the sandwich vertebra was not prone to structural failure. Thus, cement augmentation protocol does not increase the incidence of adjacent vertebral fracture.
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Case Reports
Arthroscopically assisted percutaneous fixation and bone grafting of a glenoid fossa fracture nonunion.
Arthroscopy is commonly used for evaluating intra-articular fracture patterns and assessing postfixation reduction; however, the use of arthroscopy for the definitive treatment of articular fracture nonunion has not been reported. This article describes a case of symptomatic glenoid fossa fracture nonunion that was successfully treated with arthroscopically assisted percutaneous screw fixation and bone grafting. A 48-year-old laborer sustained a glenoid fossa fracture following a fall from a height. ⋯ A computed tomography scan 4 months postoperatively showed osseous union at the fracture site. To the authors' knowledge, this is the first report in the literature of definitive arthroscopically assisted bone grafting and percutaneous fixation of a diarthrodial joint nonunion. Advantages of arthroscopic fixation of glenoid fossa fracture nonunion include avoiding potential axillary nerve injury and preserving the native subscapularis insertion, which may be important if subsequent procedures require access to the anterior access to the joint.
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Perioperative management of antiplatelet agents is a common challenge with the increased number of patients requiring long-term therapy following coronary stenting. Debate currently exists regarding if and when to discontinue antiplatelet therapy prior to elective surgery. The delicate balance between decreasing the risk of bleeding intraoperatively and minimizing the risk of stent thrombosis in patients who are already at a high thrombotic risk is a major concern. This article summarizes the information available for perioperative management of common antiplatelet agents, as well as antiplatelet agents in development.
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Since 1963, the Orthopaedic In-Training Examination (OITE) has been administered to orthopedic residents to assess residents' knowledge and measure the quality of teaching within individual programs. The OITE currently consists of 275 questions divided among 12 domains. This study analyzed all OITE basic science questions between 2006 and 2010. ⋯ The Journal of Bone & Joint Surgery (American Volume) and the American Academy of Orthopaedic Surgeons' Orthopaedic Basic Science were the most commonly and consistently cited journal and review book, respectively. This study provides the first review of the question content and recommended references of the OITE basic science section. This information will provide orthopedic trainees, orthopedic residency programs, and the American Academy of Orthopaedic Surgeons Evaluation Committee valuable information related to improving residents' knowledge and performance and optimizing basic science educational curricula.