Orthopedics
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Randomized Controlled Trial Comparative Study Clinical Trial
The use of cold compression dressings after total knee replacement: a randomized controlled trial.
This prospective, controlled study compared cold compressive dressings with wool and crepe in the postoperative management of patients undergoing total knee replacement (TKR). Forty TKR patients were assessed for blood loss, pain, swelling, and range of motion. ⋯ Mean opiate requirements were lower in the cold compression group (0.57 versus 0.71 mg/kg/48 hours). The cold compression device appeared to reduce blood loss and pain following TKR.
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Randomized Controlled Trial Clinical Trial
The medial trivector approach in total knee arthroplasty.
This study compares the clinical results of the medial trivector approach to the standard parapatellar approach in primary total knee arthroplasty. Ten patients undergoing simultaneous bilateral total knee arthroplasty were included in this study. Right and left knees were randomized for a standard medial parapatellar arthrotomy or a medial trivector approach. ⋯ Subjectively, patients reported less discomfort and more strength in the knees having undergone a medial trivector approach. The medial trivector approach may enhance postoperative recovery without adversely affecting the quadriceps function following total knee arthroplasty. The medial trivector approach to the knee does not weaken quadriceps muscle function or adversely affect clinical results of total knee arthroplasty.
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Comparative Study Clinical Trial
Isolated closed diaphyseal fractures of the femur in children: comparison of effectiveness and cost of several treatment methods.
The effectiveness of several treatment modalities for isolated closed femur fractures in children ages 4 through 16 years is compared based on outcome (clinical results, morbidity, and parents' satisfaction) and cost. Between 1986 and 1993, 30 patients were treated. Treatment methods included immediate hip spica cast application, distal femoral skeletal traction pin to align the fracture followed by early hip spica cast incorporating the pin (6th day), in-hospital traction, primary external fixation, and primary intramedullary nailing. ⋯ Primary external fixation appears most applicable in patients who are unlikely to tolerate early casting and who are at increased risk of avascular necrosis with femoral nailing. Patients treated with an intramedullary nail had the fewest complications. Age, size, and gender of patient, location and type of fracture, as well as social circumstances are all significant factors in choosing the optimal method of treatment.
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This article describes a retrospective study on patients admitted to a level I trauma center between 1989 and 1993 with low-velocity gunshot wounds to the spine. Medical records and imaging studies were reviewed to determine patient demographics, neurologic deficit, prophylactic antibiotic administration, and rate of infection, spine stability, and principle associated injuries. A total of 37 patients with low-velocity gunshot wounds to the spine were identified and comprised 34% of all spinal injury patients. ⋯ In the absence of hollow viscus perforation, antibiotic prophylaxis did not appear beneficial. Spinal instability was noted in three patients with cervical injury and one patient with lumbar injury, and neurologic deficit was variable despite the presence of instability. The major associated injury was vascular occlusion or disruption in 8 of 12 (66%) cervical low-velocity gunshot wounds to the spine.