Orthopedics
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Comparative Study
Comparison of complication rates between hemiarthroplasty and total hip arthroplasty for intracapsular hip fractures.
Hip fractures are common and have come to represent an increasing burden of disease. As a result, it is critical that cost-effective and evidence-based treatments be used to treat hip fractures. However, with regard to hemiarthroplasty vs total hip arthroplasty (THA), the optimal treatment of displaced femoral neck fractures in elderly patients remains controversial. ⋯ Cox regression analysis demonstrated no statistically significant difference in risk of revision surgery during the 11-year observation period. This study demonstrates similar short-term complication and mid-term revision risks following hemiarthroplasty and THA. This suggests that both procedures are safe alternatives, but further study is needed to clarify differences in functional outcomes and long-term revision rates for patients undergoing these procedures following a hip fracture.
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Patients with pathologic hip fractures or impending pathologic proximal femur fractures are at a high risk for developing bone cement implantation syndrome during cemented femoral arthroplasty. Comorbid conditions of patients who sustain these fractures, including cardiopulmonary compromise and permeable, highly vascular bone related to metastatic disease, put them at risk for sudden death. Reducing intraoperative intramedullary pressure, a modifiable intraoperative intervention, may decrease this risk. ⋯ Low-viscosity cementation may be used to reduce the risk of bone cement implantation syndrome in high-risk patients with pathologic hip fractures or impending pathologic proximal femur fractures. The proposed mechanism of risk reduction is through lower intramedullary pressure with no bone-cement-implant interface pullout strength reduction. Further clinical trials are needed to prove this biomechanical effect.
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Acute peroneal nerve palsy is a well-known complication of total knee arthroplasty (TKA) that causes a neurological deficit typically seen within hours or days postoperatively. Peroneal nerve dysfunction presents more subtlely than peroneal nerve palsy, with decreased knee range of motion, lateral knee pain, or both following TKA. The diagnosis of peroneal nerve dysfunction may not be suspected for weeks, months, or even years after TKA. ⋯ Approximately 10 years after the TKA, she underwent surgical decompression of the peroneal nerve and has done well since, with significant pain relief and an increased activity level. This case supports the recent literature describing peroneal nerve dysfunction as an uncommon but surgically treatable cause of lateral knee pain following TKA. Increased awareness of the condition and its facile treatment via surgical decompression may result in improved outcomes years after TKA.
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Olecranon fractures are intra-articular injuries that require anatomic restoration of the articular surface. For most simple noncomminuted transverse olecranon fractures, tension band wire fixation can provide a stable construct to allow for early joint range of motion. ⋯ Therefore, plate fixation is the standard fixation method, but wide skin exposure and symptomatic plate irritation on the skin are common complications. The authors' technique uses tension band wire fixation with miniplate augmentation for patients with comminuted olecranon fractures.
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This article describes the independent factors that affect kyphotic angle reduction in the treatment of osteoporotic vertebral compression fractures with kyphoplasty. Between January 2008 and September 2011, one hundred twenty-six patients with a single-level osteoporotic compression fracture who underwent kyphoplasty were evaluated for a minimum of 1 year postoperatively. Nine independent variables related to patient characteristics (age, sex, bone mineral density [BMD], and body mass index), fracture characteristics (fracture level, fracture age, and preoperative kyphotic angle), and surgical variables (total injected cement volume and cement leakage) were assessed. ⋯ Univariate analyses indicated correlations between kyphotic angle reduction with BMD, fracture age, preoperative kyphotic angle, and cement volume. The final multiple linear regression model resulted in a formula that accounted for 23.3% of the variability in kyphotic angle reduction: preoperative kyphotic angle (b=0.260; P=.002), BMD (b=-0.249; P=.004), and fracture age (b=-0.226; P=.009). Kyphoplasty is a safe and effective treatment for osteoporotic compression fractures.