Orthopedics
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Indoor rock climbing is becoming more popular for people of all ages. Despite the tremendous interest in this competitive sport, participants are made aware of the dangers associated with participating. The authors present the first reported case of a clay-shoveler's fracture at the T1 spinous process during indoor rock climbing. ⋯ He continued to have focal upper back pain at the level of the fracture over the next 4 months. He was unable to climb for 4 months until his pain resolved after conservative treatment of climbing restriction, pain control, and rest. This is the first documented case of a clay-shoveler's fracture sustained in a pediatric patient directly attributable to indoor rock climbing.
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Acetabular labral tears or paralabral cysts in the hip are frequently detected using magnetic resonance imaging or arthrography. Unlike parameniscal cysts in the knee and paralabral cysts in the shoulder, reports of the outcomes of surgical treatment for paralabral cysts in the hip recalcitrant to conservative management are limited in the literature. The authors report 2 cases of paralabral cysts in the hip that were treated with arthroscopic surgery. ⋯ Clinical outcomes, determined by the Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index score, and University of California, Los Angeles activity score, were satisfactory for the 2 patients at 2 and 3 years postoperatively, respectively. Magnetic resonance imaging obtained for 1 patient at 6 months postoperatively showed complete decompression of the paralabral cyst. The authors believe that arthroscopic treatment for symptomatic hip paralabral cysts is a safe and effective procedure with excellent clinical outcomes.
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Distal tibiofibular syndesmosis injuries are complex injuries that often result in extended loss of playing time for athletes. Unstable syndesmosis injuries are uniformly reduced and stabilized by numerous methods. Controversy arises from syndesmosis injuries that are stable on stress radiographs but functionally unstable with loading of the ankle during athletic activity. The authors present a case of operative fixation of a dynamically unstable syndesmosis and detail the postoperative course.
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Randomized Controlled Trial Comparative Study
InterTan nail versus Proximal Femoral Nail Antirotation-Asia in the treatment of unstable trochanteric fractures.
The goal of this study was to compare the outcomes of unstable trochanteric fractures treated with the InterTan nail (Smith & Nephew, Memphis, Tennessee) and the Proximal Femoral Nail Antirotation (PFNA-II) (Synthes, Solothurn, Switzerland). A total of 132 consecutive patients with unstable trochanteric fractures of the femur were enrolled in the study. The only intervention was InterTan nail or PFNA-II fixation of the unstable trochanteric fractures. ⋯ Patients treated with the PFNA-II experienced shorter fluoroscopy and operative times, less intraoperative blood loss, and less femoral neck shortening. The incidence of thigh pain was significantly higher in the PFNA-II group (30.4%) than in the InterTan group (10.3%) (P=.001). No statistically significant differences existed in general complications, local complications, walking ability, Harris Hip Scores, or hip range of motion at final follow-up.