Orthopedics
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Hip arthroscopy is being used with increasing frequency as the understanding of arthroscopic management of groin pain improves. To access the hip joint arthroscopically, traction must be placed on the leg. In most cases, countertraction is provided with a padded post in the groin. ⋯ No significant complications related to traction occurred during follow-up. The described technique has been used in more than 2000 hip arthroscopies without a documented groin or perineal complication. It allows easy positioning and access to the central compartment.
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Subscapularis tendon tears are a well-established cause of shoulder pain. The objective of the current study was to evaluate the associated shoulder pathology in patients with full-thickness subscapularis tendon tears using magnetic resonance imaging. Forty-seven magnetic resonance imaging studies taken between 2008 and 2009 with a diagnosis of full-thickness subscapularis tendon tears were reviewed. ⋯ Average coracaohumeral distance was 14.8 vs 8.1 mm in patients with a Goutallier grade of 0 vs 3 or 4, resepectively, and 13.6 vs 8.5 mm in patients with no rotator cuff tear vs those with a supra- and infraspinatus tear, respectively. Increased age, dislocated biceps tendons, and concomitant rotator cuff tears in patients with full-thickness subscapularis tendon tears are associated with larger subscapularis tendon tear size, higher Goutallier grades, and increased subscapularis muscle volume loss. Decreased coracohumeral distance is associated with a higher Goutallier grade and rotator cuff tears.
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Meta Analysis Comparative Study
Subvastus versus medial parapatellar approach in total knee arthroplasty: meta-analysis.
The subvastus and medial parapatellar approaches are 2 commonly performed techniques in total knee arthroplasty, but the optimal approach for total knee arthroplasty remains controversial. The purpose of this study was to compare the effectiveness and safety of the subvastus vs medial parapatellar approach. The PubMed, Embase, Cochrane Library, Inter-Services Intelligence Web of Knowledge, and Chinese Biomedical Literature databases were searched for eligible quasi-randomized, controlled and randomized, controlled trials. ⋯ Eight randomized, controlled trials and 1 quasi-randomized, controlled trial involving 940 primary total knee arthroplasties were included for meta-analysis. Meta-analysis revealed significant differences favoring the subvastus group in Knee Society Score in terms of function at 4 to 6 weeks (weighted mean difference [WMD]=5.09; 95% confidence interval [CI], 3.08 to 7.09; P<.01) and knee score at 12 months (WMD=2.17; 95% CI, 0.01 to 4.34; P=.05) and lateral retinacular release (odds ratio=0.34; 95% CI, 0.14 to 0.79; P=.01) when compared with the medial parapatellar approach. However, both groups showed similar results in range of motion (P>.05), operative time (WMD=2.15; 95% CI, -3.61 to 7.35; P=.42), blood loss (WMD= -31.07; 95% CI, -91.89 to 29.75; P=.32), hospital stay (WMD= -0.18; 95% CI, -0.67 to 0.31; P=.47), and postoperative complications (P>.05).
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The closure of the distal tibial physis occurs over an 18-month period between ages 12 and 15 years. During this time period, children are susceptible to several transitional fractures, so labeled because they are transitioning to skeletal maturity. In the setting of an external rotation force, triplane and Tillaux fractures can occur. ⋯ Computed tomography scans are required to optimally assess these fractures and to determine the need for closed vs open treatment. Regardless of which treatment modality is chosen, anatomic reduction is the goal. This article discusses the approach to these unique fractures.
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Locally administered corticosteroids are a common therapy in many hand and wrist disorders. Corticosteroids pose a theoretical risk to patients with diabetes mellitus by potentially raising blood glucose to hyperglycemic levels. Although oral corticosteroids are known to have an effect on blood glucose control, limited data exist on extra-articular administration. ⋯ These results suggest that local corticosteroid injections are a clinically safe treatment option for inflammatory processes of the hand and wrist in patients with diabetes mellitus. On average, patients experienced slight increases in blood glucose after receiving an injection. Most experienced isolated increases substantially beyond baseline and isolated hyperglycemic effects, but these did not pose an apparent clinical risk.