Orthopedics
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Editorial Meta Analysis
One-stage total joint arthroplasty for patients with active tuberculosis.
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Necrotizing fasciitis is an aggressive, invasive soft tissue infection. Because it can rapidly progress to patient instability, prompt diagnosis followed by urgent debridement is critical to decreasing mortality. Despite the importance of early diagnosis, necrotizing fasciitis remains a clinical diagnosis, with little evidence in the literature regarding the effectiveness of diagnostic tools or criteria. ⋯ The patient underwent an emergent fasciotomy, irrigation and debridement of the left upper extremity, and intravenous antibiotics for suspected necrotizing fasciitis. Intraoperative findings indicative of infection were absent, and a left apical pneumothorax was later found on postoperative chest imaging. In a stable patient with a normal chest radiograph on presentation who demonstrates upper-extremity crepitus suspicious for necrotizing fasciitis, a chest computed tomography scan may be indicated to rule out an intrathoracic source.
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Comparative Study
Comparison of complication rates between hemiarthroplasty and total hip arthroplasty for intracapsular hip fractures.
Hip fractures are common and have come to represent an increasing burden of disease. As a result, it is critical that cost-effective and evidence-based treatments be used to treat hip fractures. However, with regard to hemiarthroplasty vs total hip arthroplasty (THA), the optimal treatment of displaced femoral neck fractures in elderly patients remains controversial. ⋯ Cox regression analysis demonstrated no statistically significant difference in risk of revision surgery during the 11-year observation period. This study demonstrates similar short-term complication and mid-term revision risks following hemiarthroplasty and THA. This suggests that both procedures are safe alternatives, but further study is needed to clarify differences in functional outcomes and long-term revision rates for patients undergoing these procedures following a hip fracture.
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Patients with pathologic hip fractures or impending pathologic proximal femur fractures are at a high risk for developing bone cement implantation syndrome during cemented femoral arthroplasty. Comorbid conditions of patients who sustain these fractures, including cardiopulmonary compromise and permeable, highly vascular bone related to metastatic disease, put them at risk for sudden death. Reducing intraoperative intramedullary pressure, a modifiable intraoperative intervention, may decrease this risk. ⋯ Low-viscosity cementation may be used to reduce the risk of bone cement implantation syndrome in high-risk patients with pathologic hip fractures or impending pathologic proximal femur fractures. The proposed mechanism of risk reduction is through lower intramedullary pressure with no bone-cement-implant interface pullout strength reduction. Further clinical trials are needed to prove this biomechanical effect.