Orthopedics
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Deep venous thrombosis (DVT) of the upper extremity is uncommon compared with DVT of the lower extremity. Exertional DVT has been described in some athletes, especially in the dominant arm of baseball players. It is important for health care professionals to recognize the signs and symptoms of upper-extremity DVT, which can occur after exertion or after surgery of the upper extremity. ⋯ This article describes a case of superficial venous thrombosis that mimicked DVT in the surgical (right) arm of a recreational baseball player after suprapectoral biceps tenodesis for a painful superior labrum anterior-posterior lesion. Although the superficial venous system of the upper arm has frequent connections to the deeper basilar system, it is uncommon for superficial venous thrombosis to occur concurrently with DVT. It is important for clinicians to understand the distinction between superficial venous thrombosis and DVT in the upper extremity because the physical findings, treatment, and prognosis for these 2 entities differ in the following ways: (1) superficial venous thrombosis may be accompanied by a cord, but DVT is associated with more generalized swelling; (2) superficial venous thrombosis requires symptomatic treatment only, whereas DVT requires anticoagulation; and (3) superficial venous thrombosis typically resolves with few sequelae, whereas upper-extremity DVT increases the risk of future DVT.
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Femoral head necrosis is a rare but devastating complication following femoral neck fracture. The reported incidence of avascular necrosis after femoral neck fracture fixation varies widely, and there is no consensus regarding its risk factors. The aim of this study was to analyze the risk factors for femoral head necrosis after internal fixation in femoral neck fracture. ⋯ Patient age (P=.990), sex (P=.287), injury-to-surgery interval (P=.360), weight-bearing time (P=.868), and surgical methods (P=.987) were not significantly associated with femoral head necrosis. In multivariate logistic regression analysis, implant removal was not a significant risk factor for femoral head necrosis development (P=.498). Garden classification, reduction quality, and preoperative traction had a significant effect on femoral head necrosis development.
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The purpose of this study was to investigate the factors influencing functional outcomes in elderly patients with united intertrochanteric fractures treated with hip nails and to ascertain whether decreased femoral offset due to lag screw sliding has a negative effect on functional outcomes in these patients. This retrospective study included 65 patients older than 65 years with united intertrochanteric fractures treated with hip nails. Functional outcomes were assessed using the Short Form-36 (SF-36) and a visual analog scale (VAS) 6 months postoperatively. ⋯ A significant positive correlation was observed between the extent of lag screw sliding and VAS. Lag screw sliding affected by fracture type, reduction quality, and BMD has a negative effect on functional outcomes in elderly patients with united intertrochanteric fractures. Therefore, the preservation of anatomical femoral offset as much as possible is needed to obtain better functional outcome through the minimization of lag screw sliding by more accurate reduction, which is a controllable factor, especially in osteoporotic unstable intertrochanteric fractures.
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Comparative Study
BMP-7 versus BMP-2 for the treatment of long bone nonunion.
The authors compared the results of treating nonunion with either bone morphogenetic protein (BMP)-7 or BMP-2. Between 2001 and 2009, 214 limb segments were treated for nonunion with either BMP-7 or BMP-2 at the authors' institution. Sixty-three subjects received 76 units of BMP-7. ⋯ Additionally, healing occurred in more limb segments in the BMP-2 group (93%) than in the BMP-7 group (70%) (P<.001). No difference in the complication rate was seen between groups. Patients who received BMP-2 for the treatment of nonunion had a higher rate of radiographic healing, achieved radiographic healing more quickly, and were able to bear weight sooner than those who underwent treatment with BMP-7.
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Case Reports
Intraprosthetic dislocation of a contemporary dual-mobility design used during conversion THA.
Although dual-mobility sockets have been in clinical use for decades in other parts of the world, they recently gained popularity in the United States as an option for primary and revision total hip arthroplasty (THA). Improvements in dual-mobility socket technology include articulation with a metal insert impacted into a metal shell and a femoral head made of highly cross-linked polyethylene. The results and complications associated with the use of dual-mobility sockets employing these technologic advancements are not known. ⋯ This ultimately led to impingement of the femoral component neck on the retentive ring, which led to the intraprosthetic dislocation. Dual-mobility cups provide an attractive option to decrease wear and improve stability. Further research is needed to establish the ideal construct design and materials.