Orthopedics
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Multicenter Study
Mixing implants of differing metallic composition in the treatment of upper-extremity fractures.
Mixing implants with differing metallic compositions has been avoided for fear of galvanic corrosion and subsequent failure of the implants and of bone healing. The purpose of this study was to evaluate upper-extremity fractures treated with open reduction and internal fixation with metallic implants that differed in metallic composition placed on the same bone. The authors studied the effects of using both stainless steel and titanium implants on fracture healing, implant failure, and other complications associated with this method of fixation. ⋯ This study implies that mixing implants with differing metallic compositions on the same bone for the treatment of fractures does not adversely affect bone healing. No evidence existed of corrosion or an increase in complications with this method of treatment. Contrary to prior belief, small modular hand stainless steel plates can be used to assist in reduction of smaller fracture fragments in combination with anatomic titanium plates to obtain anatomic reduction of the fracture without adversely affecting healing.
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Increased knee flexion after total knee arthroplasty (TKA) may contribute to patients' increased satisfaction and more active lifestyles. This study evaluated a TKA component designed for high flexion (more than 125°). The design features an anatomic sagittal femoral radius with short, flared femoral condyles to allow for femoral rollback. ⋯ Mean Knee Society knee and function scores and the Short Form 12 physical component scores were 52, 55, and 32 preoperatively, respectively, and 89, 77, and 40 one year postoperatively, respectively. Of the 50 knees, 84% had improvement in their Knee Society function scores, and 76% had improvement in their Short Form 12 physical component scores. The study revealed evidence of increased early postoperative flexion with the use of a cruciate-retaining high-flexion TKA design.
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Ankylosing spondylitis (AS) is a chronic inflammatory spondyloarthropathy with the potential for progressive spinal stiffness that ultimately makes patients susceptible to spinal fractures with traumatic spinal cord injury from even low-energy trauma. Treatment of patients with AS and spinal fractures (AS+FX) is controversial because, although these patients need especially rigorous stabilization, surgery has been associated with an increased risk of complications and persistent neurological deficits. The purpose of this retrospective case series was to profile patients with AS+FX from a 19-year period within the authors' county hospital system, including differences of neurological status in patients treated operatively vs nonoperatively. ⋯ The most common complications in all patients were pneumonia and urinary tract infection. Operative and nonoperative management produced acceptable outcomes in most patients. The authors recommend individualized treatment, accounting for patient preferences and comorbidities.
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Randomized Controlled Trial
Intra-articular morphine versus bupivacaine for postoperative pain management.
The purpose of this study was to determine whether morphine would be as effective as bupivacaine for postoperative pain control after knee arthroscopy with no worsening of the side effect profile. Eighty-two patients who underwent partial meniscectomy, chondral debridement, or both were prospectively randomized to receive 10 mg of morphine (10-cc volume) or 10 cc of .5% bupivacaine immediately postoperatively. Visual analog scale scores and side effect profiles were recorded in the postanesthesia care unit, in the transitional care unit, and then every 4 hours postoperatively until 24 hours. ⋯ Four patients in the morphine group and 1 patient in the bupivacaine group experienced side effects. This study indicates that 10 mg of intra-articular morphine is as effective as 10 cc of .5% bupivacaine for postoperative pain control for partial meniscectomy and chondral debridement of the knee. It minimally increases side effects initially and circumvents the issue of chondral toxicity of bupivacaine.
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Health care-related costs have been the focus of intense scrutiny in politics and in the media. However, public perception of physician reimbursement is poorly understood. The purpose of this study was to determine patient perception of physician reimbursement for 2 common hand surgery procedures: carpal tunnel release and open reduction and internal fixation of a distal radius fracture. ⋯ Higher level of education, annual household income, and insurance status had no statistically significant effect on patient estimates of reimbursement. Patients in an outpatient hand and upper extremity practice believe that surgeons are reimbursed at a rate 3.6 to 4.7 times greater than actual reimbursement. These misperceptions highlight the lack of understanding and transparency in health care costs and may interfere with the ability of patients to make well-informed decisions about health care.