Orthopedics
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To evaluate the prevalence of neuroma in bilateral upper limb amputees and investigate the effect of level of amputation on their pain, 86 patients with bilateral upper limb amputation were thoroughly examined by an orthopedic surgeon. Of 172 bilateral amputated upper limbs (86 victims of war) 17.1+/-6.1 years after injury, physical examination revealed that 26.2% had moderate to severe stump pain and clinical signs suggestive of neuroma. Statistical analysis showed no relation between level of amputation, prosthesis usage, and occurrence of neuroma. Although high occurrence of neuroma among traumatic bilateral upper limb amputation had no significant effects on wearing prosthesis, its treatment can deeply influence alleviation of their pain and subsequently their quality of life.
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The Emperion femoral component (Smith & Nephew, Memphis, Tenn) is a modern incarnation of the S-ROM femoral component (Depuy, Warsaw, Ind). This fit-and-fill modular design has had great clinical success for more than 20 years. ⋯ The modularity can uniquely weather difficult proximal femoral deformities encountered during THR, including developmental dysplasia of the hip and slipped capital femoral epiphysis. In addition, the nomenclature attached to this implant has made using the device and its instruments user friendly.
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Comparative Study
Locking plate fixation for proximal humerus fractures: a comparison with other fixation techniques.
Various traditional surgical treatment methods for displaced proximal humerus fractures were compared with locking plates. Ninety-eight patients were reviewed and functional outcomes were obtained. After a mean 45-month follow-up, trends were noted toward better fracture reduction with locking plates and greater range of motion (ROM) with percutaneous pinning. ⋯ Method of fixation did not correlate with outcome scores, but functional ROM was associated with better American Shoulder and Elbow Surgeons (ASES) scores. Locking plates are comparable to traditional fixation methods. Functional ROM is associated with better outcome scores.
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Elbow fractures in children can be difficult diagnoses for inexperienced physicians to make. The purpose of this prospective study was to determine the accuracy of radiograph interpretation of elbow fractures in children by emergency room (ER) physicians. Thirty fractures were analyzed. ⋯ Overall accuracy of ER physicians' interpretation was 53% (16/30). This study underscores the importance of educating ER physicians and residents in children's fracture interpretation to optimize patient outcomes. Orthopedists need to be vigilant when taking care of these patients to prevent unnecessary complications.
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We performed a retrospective review study to evaluate the safety and efficacy of iliac screws as a method of pelvic fixation in neuromuscular spinal deformity. All patients with the diagnosis of neuromuscular scoliosis operatively managed with iliac screws undergoing posterior spinal fusion were retrospectively identified over a 32-month period, from December 2002 to August 2005. Evaluation was done for correction of deformity, progression, instrumentation failure, and complications. ⋯ There were 3 postoperative wound infections, which required irrigation and debridement and eventually resulted in fusion. In conclusion, this is one of the largest reports of iliac screw use in the correction of neuromuscular scoliosis. In our series we were able to correct the deformity and maintain the lumbar lordosis without progression or failure with a relatively low complication rate.