Orthopedics
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Randomized Controlled Trial
Gelatin matrix use reduces postoperative bleeding after total knee arthroplasty.
Bleeding after total knee arthroplasty can result in significant morbidity and increases the need for blood transfusion. The proper use of intraoperative adjunctive topical hemostatic agents can enhance hemostasis perioperatively, potentially reducing blood transfusions. In this prospective study, 157 consecutive patients undergoing primary total knee arthroplasty received FLOSEAL (FLOSEAL Hemostatic Matrix; Baxter Healthcare Corporation, Hayward, California), a gelatin thrombin hemostatic matrix, 5 mL (74 patients) or 10 mL (83 patients). ⋯ Within the FLOSEAL 10 mL group, application of FLOSEAL either before or after tourniquet release had a similarly significant effect on drainage volume and predicted probability of blood transfusion. No differences in outcomes were observed by type of anesthesia used. No adverse events occurred related to FLOSEAL use.
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Comparative Study
Comparison of open and percutaneous lumbar pedicle screw revision rate using 3-D image guidance and intraoperative CT.
Complications arising from a malpositioned screw can be both devastating and costly. The incidence of neurologic injury secondary to a malpositioned screw is reported to be as high as 7% to 12%. The advancement of image-guided technology has allowed surgeons to place screws more accurately and confirm correct placement prior to leaving the operating room. ⋯ No patients underwent reoperation for a malpositioned screw. This technology has virtually eliminated the need for reoperation for screw malposition. It may suggest a more cost-effective way of preventing neurovascular injuries and revision surgeries.
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Nonunion and C1-C2 instability of odontoid fractures usually result from delayed diagnosis and inappropriate treatment. However, the available treatment options for odontoid fractures remain controversial. The authors evaluated the effectiveness of internal screw fixation via the C1 and C2 pedicle in cases of old odontoid fractures. ⋯ The Japanese Orthopaedic Association score in patients with cervical spinal injury (n=14) was 9.2±1.9 and also significantly improved to 13.8±1.9 at the last follow-up examination (P<.001), with an average improvement rate of 61.0%. No iatrogenic vertebral artery injury or severe spinal cord injury occurred. Screw fixation via the C1 and C2 pedicle was found to be an effective and safe surgical approach for the treatment of old odontoid fractures with C1-C2 dislocation or instability.
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Current literature proposes relative and absolute indications for surgical treatment of clavicle fractures in adults. However, few studies have evaluated these fractures in children. The current study examined short- and long-term outcomes of pediatric patients with displaced clavicle fractures. ⋯ Average Disabilities of the Arm, Shoulder and Hand (DASH) score was 0.04 in the nonoperative group (range, 0-0.08) and 1.17 in the operative group (range, 0-8.3), with no significant difference between groups. No significant difference between operative treatment and nonoperative treatment was found in any of the authors' outcome measures. Thus, the authors propose that unless the patient's injury is an absolute indication for surgery, conservative management provides equivalent immediate and long-term clinical results.
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As a result of reading this article, physicians should be able to: 1. Describe the concept of bundled payments and the potential applications of bundled payments in orthopedic surgery. 2. For specific situations, outline a clinical episode of care, determine the participants in a bundling situation, and define care protocols and pathways. 3. ⋯ The idea of bundled payments has recently gained significant momentum as a financial model with the potential to decrease the significant current costs of health care. Orthopedic surgery as a field of medicine is uniquely positioned for success in an environment of bundled payments. This article reviews the history, logistics, and implications of the bundled payment model relative to orthopedic surgery.