Orthopedics
-
Wound complications in joint arthroplasty: comparing traditional and modern methods of skin closure.
Various methods of skin closure exist in joint replacement surgery. Although subcuticular skin closure techniques offer an aesthetic advantage over conventional skin stapling, no measurable differences have been reported. Furthermore, newer barbed sutures, such as the V-Loc absorbable suture (Covidien, Mansfield, Massachusetts), theoretically distribute tension evenly through the wound and help decrease knot-related complications. ⋯ Four (7.8%) wound complications occurred in 51 cases closed via subcuticular Biosyn suture. Six (13.0%) wound complications occurred in 46 cases closed with V-Loc suture. The staple group had a lower rate of complications when compared with the suture group as a whole (P=.033) and when compared specifically with the V-Loc suture group (P=.017).
-
Comparative Study
Hemiarthroplasty versus reverse total shoulder arthroplasty for acute proximal humerus fractures in elderly patients.
Proximal humerus fractures are the third most common fracture in elderly patients. Hemiarthroplasty has been the treatment of choice in patients with bone quality and fracture patterns not amenable to open reduction and internal fixation. Reverse total shoulder arthroplasty is a newer option that appears to be less dependent on tuberosity healing than hemiarthroplasty. ⋯ Reverse total shoulder arthroplasty outperformed hemiarthroplasty with regard to forward flexion, American Shoulder and Elbow Society score, University of Pennsylvania shoulder score, and Single Assessment Numerical Evaluation score. Reverse total shoulder arthroplasty is a reliable option for acute, proximal humerus fractures that are not amenable to closed treatment or reconstruction in elderly patients. Improved functional outcomes when compared with hemiarthroplasty must be balanced against the increased cost and limited life expectancy of patients with this injury.
-
Comparative Study
Treatment of femoral neck fractures with bipolar hemiarthroplasty using a modified minimally invasive posterior approach in patients with neurological disorders.
Bipolar hemiarthroplasty is a useful treatment for displaced femoral neck fractures in elderly patients. Although uncommon, dislocation is problematic, particularly in older patients, and those with neurologic disorders are at an increased risk for this complication. Recently, a modified posterior approach to the hip intended to enhance hip joint stability by preserving the short external rotators was described. ⋯ Dislocation rates for the treatment and control groups were 0% and 7.7%, respectively (P<.01). No significant difference existed in postoperative bleeding, operative time, or length of hospital stay between groups. These data suggest a lower dislocation rate after bipolar hemiarthroplasty via the modified, short external rotator-sparing approach for treating displaced femoral neck fractures in elderly patients with neurological disorders.
-
Case Reports
Intraspinal penetrating stab injury to the middle thoracic spinal cord with no neurologic deficit.
The annual incidence of traumatic spinal cord injury worldwide is estimated to be 35 patients per million. Nonmissile penetrating spinal injuries most commonly occur in the thoracic region, and the majority has neurologic deficits on admission. The management of patients who lack neurologic deficits is controversial due to the risk of neurologic status alteration intraoperatively. ⋯ The patient sustained no neurologic sequelae from the penetrating knife injury. He was able to ambulate at discharge and had no complications. To our knowledge, this is the only report of a patient with intradural spinal cord penetration by a foreign object (knife blade) presenting with a normal neurologic preoperative examination that persisted throughout the course of postoperative care.
-
Randomized Controlled Trial Comparative Study
Pain management after total knee arthroplasty using a multimodal approach.
Improvements in pain management techniques over the past decade have had a significant impact on the outcomes of total knee arthroplasty. Of these techniques, multimodal approaches have shown potential. The purpose of this study was to compare the results of periarticular injection (PAI) to a combination of patient-controlled epidural analgesia and femoral nerve block (PCEA/FNB). ⋯ Pain on ambulation was the only category that was statistically lower in the PCEA/FNB group than in the PAI group. Although the study demonstrates similar results between the 2 groups, PAI can play a major role in postoperative pain control in institutions that may not have appropriately trained individuals, equipment, and resources for PCEA/FNB. It also reduces many of the side effects and complications associated with regional anesthesia.