Orthopedics
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Odontoid fracture treatment is well documented, but challenges remain in treating these fractures in elderly patients. Issues include identifying the optimal treatment for bony union, determining the stability of a nonunion, and understanding the long-term consequences of nonunion. In elderly patients, the focus tends to shift to morbidity and mortality. ⋯ In elderly patients with odontoid fractures, one should be prepared for a hospital course complicated by medical issues; early mortality rates are significant. These issues appear to exist regardless of the fracture treatment chosen; one must anticipate respiratory, swallowing, balance, and cardiac problems. Management strategies should be individualized to the patients; operative and nonoperative treatments remain viable options.
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Review Meta Analysis
Recombinant human BMP-2 for the treatment of open tibial fractures.
Recombinant human bone morphogenetic protein-2 (rhBMP-2) improves healing of open tibial fractures treated with intramedullary nail fixation. However, routine use has not occurred. The purposes of the current study were to provide a systematic review of the literature using rhBMP-2 in the treatment of acute open tibial fractures treated with intramedullary nail fixation and to provide a meta-analysis of the randomized, controlled trials. ⋯ Recombinant human bone morphogenetic protein-2 added to intramedullary nail fixation of open tibial fractures could reduce the frequency of secondary interventions and total health care costs. For reamed patients, adding rhBMP-2 reduced treatment failure. This analysis supports the clinical efficacy of rhBMP-2/ACS for the treatment of these severe fractures.
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Randomized Controlled Trial
Four treatment strategies for complex regional pain syndrome type 1.
Complex regional pain syndrome (CRPS) poses a dilemma for many clinicians due to its unknown etiology and largely unsuccessful treatment modalities. The purpose of this study was to compare the clinical results of 4 treatment modalities for CRPS type 1. A total of 59 patients were divided into 4 groups based on treatment modality: group A, an oral nonsteroidal anti-inflammatory drug (NSAID) (n=10); group B, oral gabapentin (n=12); group C, intravenous (IV) 10% mannitol and steroid (n=11); group D, a combination of IV 20% mannitol and steroid with oral gabapentin (n=26). ⋯ Patients in group B showed significant improvement in pain level (P<.001), and patients in group C showed improvement in pain, finger range of motion, and swelling (P=.127), which rendered functional impairment unchanged. In comparison, patients in group D showed recovery of grip strength and improvement in pain level, finger range of motion, and (P<.001, P=.016, P=.031, and P=.047, respectively). Based on these results, a protocol including a combination of IV 20% mannitol and steroid with oral gabapentin is an acceptable and effective treatment for CRPS type 1.
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Comparative Study
Open reduction and internal fixation of intra-articular calcaneal fractures in children.
Calcaneal fractures are rare injuries in children and adolescents, and fractures with displaced intra-articular fracture patterns are even more rare. The purpose of this study was to report 9 intra-articular calcaneal fractures in 8 children (mean age, 12.6 years; range,10-15 years) treated with open reduction and internal fixation (ORIF) and to examine cases reported in the literature to better define the classification characteristics and operational outcomes of this uncommon fracture. Preoperative radiographs and computed tomography scans were used to evaluate and classify the fractures. ⋯ Based on the Sanders classification, 62.2% (23/37) of fractures were 2 parts, 32.4% (12/37) were 3 parts, and 5.4% (2/37) showed comminution. No significant difference was found in classification information between children and adults. The authors concluded that the characteristics of intra-articular calcaneal fractures in children are similar to those in adults, and operative treatment of these fractures yields good results with few complications.
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The purpose of this study was to determine the intermediate clinical and radiographic outcomes of Bryan Cervical Disc (Medtronic Sofamor Danek, Inc, Memphis, Tennessee) replacement for the treatment of cervical degenerative disk disease and its effect on adjacent levels. Between November 2004 and December 2007, thirty-four patients (38 disks) underwent Bryan Cervical Disc replacement in the authors' hospital. The authors retrospectively analyzed the records of 32 patients who completed follow-up. ⋯ Prosthesis-related complications were rare, and no reoperations were performed. Bryan Cervical Disc replacement achieves satisfactory mid-term clinical and radiographic outcomes. The authors observed the progression of adjacent segment degeneration postoperatively, although no degradation of clinical outcomes occurred.