Orthopedics
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Acute compartment syndrome remains a challenging problem for orthopedic surgeons because its diagnosis is not always straightforward and it has a high risk of associated limb morbidity if left undiagnosed or untreated. Failure to diagnose and treat acute compartment syndrome is one of the most common causes of successful medical liability claims. The authors review the current literature concerning the diagnosis of acute compartment syndrome and discuss new non-invasive technologies that may allow for earlier and more accurate diagnosis of impending acute compartment syndrome.
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Controlled Clinical Trial
Outcomes of functional weight-bearing rehabilitation of Achilles tendon ruptures.
The introduction of functional rehabilitation for patients with Achilles tendon rupture has dramatically changed treatment programs for this condition. The authors introduced a functional weight-bearing protocol for patients with an acute Achilles tendon rupture treated operatively and nonoperatively in 2002. They hypothesized that no significant differences would exist in the rerupture rates and functional outcomes between the groups. ⋯ Median Victorian Institute of Sports Assessment-Achilles tendinopathy questionnaire scores were 60 and 91 for the nonoperative and operative groups, respectively. Both groups had low rerupture rates. Functional scores, using the newly validated Achilles Tendon Total Rupture Score, were lower in the nonoperative group.
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To date, several strategies have been developed to provide local antibiotic therapy in the treatment of osteomyelitis, such as antibiotic-loaded bone cement, antibiotic-impregnated collagen sponges, polymethylmethacrylate beads, antibiotic-loaded bone graft, antibiotic-loaded synthetic bone substitutes, and antibiotic-coated implants. The optimum carrier for local antibiotic therapy has not been identified. Tibial osteomyelitis using methicillin-sensitive Staphylococcus aureus was created in a rat model. ⋯ No difference was found between treatment groups B and C. No significant difference existed in gross tissue, radiographic, microbiologic, or histopathologic analyses among the 3 groups for osteomyelitis. The results of this study demonstrated that the local application of free antibiotic powder is as effective as local debridement alone in treating soft tissue infection associated with tibial osteomyelitis in a rat model.
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The use of the Internet for health-related information has increased significantly. In 2000, the current authors examined the source and content of orthopedic information on the Internet. At that time, Internet information regarding carpal tunnel syndrome was found to be of limited quality and poor informational value. ⋯ The informational mean score was 53.8 points for nonsponsored sites and 14.5 points for sponsored sites. The informational quality on the Internet on carpal tunnel syndrome has improved over the past decade. Despite this progress, significant room exists for improvement in the quality and completeness of the information available.
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Randomized Controlled Trial
Minimally invasive plating osteosynthesis for mid-distal third humeral shaft fractures.
Mid-distal third humeral shaft fractures can be effectively treated with minimally invasive plating osteosynthesis and intramedullary nailing (IMN). However, these 2 treatments have not been adequately compared. Forty-seven patients (47 fractures) with mid-distal third humeral shaft fractures were randomly allocated to undergo either minimally invasive plating osteosynthesis (n=24) or IMN (n=23). ⋯ Primary union was achieved in 23 of 24 patients in the minimally invasive plating osteosynthesis group and in 22 of 23 in the IMN group. Minimally invasive plating osteosynthesis may have outcomes comparable with IMN for the management of mid-distal third humeral shaft fractures. Minimally invasive plating osteosynthesis is more suitable for complex fractures, especially for radial protection and motion recovery of adjacent joints, compared with IMN for simple fractures.