Orthopedics
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Randomized Controlled Trial Comparative Study
Efficacy of rhBMP-2 versus iliac crest bone graft for posterior C1-C2 fusion in patients older than 60 years.
Few studies have specifically examined the efficacy of recombinant human bone morphogenetic protein-2 (rhBMP-2)/absorbable collagen sponge (ACS) in posterolateral lumbar spine fusion. The purpose of this study was to report the clinical outcomes in elderly patients treated with posterior C1-C2 fusion with iliac crest bone graft (ICBG) plus rhBMP-2/ACS vs ICBG alone. One hundred forty patients older than 60 years were enrolled in this prospective, randomized trial and underwent instrumented C1- C2 fusion. ⋯ Mean fusion time was 11 days shorter in the rhBMP-2/ACS group (81.8±29.4 days) than in the ICBG group (92.9±23.7 days) (P=.034). There were more wound complications requiring treatment in the rhBMP-2/ACS group (n=6; 8.8%) than in the ICBG group (n=2; 3.0%), although this was not statistically significant (P=.118). The use of rhBMP-2/ACS for posterior C1-C2 fusion appears to result in a relatively shorter fusion time, but there may be an increased risk of posterior cervical wound complications.
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In addition to neurologic injuries such as peripheral nerve palsy, axillary vessel injury should be recognized as a possible complication of reverse total shoulder arthroplasty. Limb lengthening associated with Grammont-type reverse total shoulder arthroplasty places tension across the brachial plexus and axillary vessels and may contribute to observed injuries. The Grammont-type reverse total shoulder arthroplasty prosthesis reverses the shoulder ball and socket, shifts the shoulder center of rotation distal and medial, and lengthens the arm. ⋯ After an unsuccessful attempt at primary repair, a synthetic arterial bypass graft was placed. Reperfusion of the right upper extremity was achieved and has been maintained to date. Postoperative clinical examination and electromyographic studies confirmed ongoing radial, ulnar, and musculocutaneous neuropathies.