Orthopedics
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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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Since 1963, the Orthopaedic In-Training Examination (OITE) has been administered to orthopedic residents to assess residents' knowledge and measure the quality of teaching within individual programs. The OITE currently consists of 275 questions divided among 12 domains. This study analyzed all OITE basic science questions between 2006 and 2010. ⋯ The Journal of Bone & Joint Surgery (American Volume) and the American Academy of Orthopaedic Surgeons' Orthopaedic Basic Science were the most commonly and consistently cited journal and review book, respectively. This study provides the first review of the question content and recommended references of the OITE basic science section. This information will provide orthopedic trainees, orthopedic residency programs, and the American Academy of Orthopaedic Surgeons Evaluation Committee valuable information related to improving residents' knowledge and performance and optimizing basic science educational curricula.
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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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Review Meta Analysis
Review of medicolegal cases for cauda equina syndrome: what factors lead to an adverse outcome for the provider?
Cauda equina syndrome is 1 of a few true surgical emergencies involving the lumbar spine. Although treatment within 48 hours has been found to correlate with improved outcomes, recovery of bowel and bladder control does not always occur, and loss of these functions can be distressing to patients. An understanding of factors affecting the legal outcome can aid the clinician in determining risk management for medicolegal cases of cauda equina syndrome. ⋯ Based on our study of court cases involving cauda equina syndrome, a positive association was found between time to surgery >48 hours and an adverse decision (P<.05). The actual degree of functional loss did not appear to affect the verdicts. Because 26.7% of the cases involved an initial presentation that included loss of bowel or bladder control, this study emphasizes the importance of cautioning all patients with spinal complaints of the potential risk for cauda equina syndrome.
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Review Meta Analysis Comparative Study
Systematic review and meta-analysis of randomized controlled trials: comparison of total disk replacement with anterior cervical decompression and fusion.
The authors performed a systematic review and meta-analysis to evaluate whether there is a beneficial clinical effect of total disk replacement compared with anterior cervical diskectomy and fusion for the treatment of single-level symptomatic cervical disk disease. A comprehensive literature search of multiple databases, including PubMed (1966-2011), Cochrane Controlled Trials Register (CENTRAL; issue 1, 2011), and Embase (1984-2011), was conducted to identify studies that met the inclusion criteria. Methodologic quality was assessed and relevant data were retrieved, and if appropriate, meta-analysis was performed. ⋯ Other outcomes, including Neck Disability Index scores (SMD, -.02; CI, -.44 to .27; P=.67) and visual analog scale arm pain scores (SMD, -.21; CI, -.63 to .22; P=.34), demonstrated no differences between the 2 groups. For patients with single-level symptomatic cervical disk disease, total disk replacement was found to be more effective than anterior cervical diskectomy and fusion in the 2 outcomes of overall success rate and overall reoperation rate at 24 months. Long-term results also showed total disk replacement trended to be more effective than anterior cervical diskectomy and fusion in some aspects.