Orthopedics
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Multimodal wound infiltration with local anesthetics, adrenaline, and nonsteroidal anti-inflammatory agents can lower the opiate intake, reduce the length of stay, and enhance early mobilization after total hip arthroplasty (THA). A retrospective review of 204 patients undergoing primary THA was undertaken. One hundred two patients had their wounds infiltrated with ropivacaine, adrenaline, and ketorolac by the operating surgeon intraoperatively. ⋯ The mean length of stay was significantly reduced from 5.2 days (SD, 1.6 days) in the control group to 4 days (SD, 1.3 days) in the treatment group (P<.0001). The time needed by the patients to walk for 3 meters after surgery was significantly reduced in the treatment group (median, 25 vs 46.1 hours; interquartile range, 20.7- 45.1 vs 27.2- 50.9; P<.0001). This is the largest series to demonstrate that a multimodal perioperative wound infiltration technique in primary THA surgery leads to early attainment of immediate postoperative rehabilitation milestones and reduced length of stay along with reduction in postoperative opiate consumption.
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Drug shortages have increasingly been a problem for pharmacists and clinicians over the past decade. Clinicians need to be aware of the various causes of drug shortages and the issues that may arise as a result, particularly as they relate to medication safety. Numerous resources and strategies are available to mitigate the effects of drug shortages, and clinicians should work with their health care team and the patient to determine the best option when faced with a drug shortage that affects patient care.
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Comparative Study
Comparison of MRI and arthroscopy in modified MOCART scoring system after autologous chondrocyte implantation for osteochondral lesion of the talus.
Magnetic resonance imaging (MRI) and arthroscopy have frequently been used to evaluate articular cartilage. Many studies have compared the accuracy of MRI to that of arthroscopy. However, there have been no previous comparison studies between MRI and arthroscopy in the evaluation of repaired cartilage after autologous chondrocyte implantation using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system. ⋯ According to the comparison results of those 5 categories, the agreement between MRI and arthroscopy evaluation results was statistically significant with good reliability in the categories of the degree of defect repair and defect filling, the quality of repaired tissue surface, and synovitis. However, the integration with the border zone and the adhesion category showed poor to moderate reliability. There has been no well-established correlation method between arthroscopy and MRI after autologous chondrocyte implantation of an osteochondral lesion of the talus.
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Fracture fixation of the medial malleolus in rotationally unstable ankle fractures typically results in healing with current fixation methods. However, when failure occurs, pullout of the screws from tension, compression, and rotational forces is predictable. We sought to biomechanically test a relatively new technique of bicortical screw fixation for medial malleoli fractures. ⋯ Bicortical screw fixation was statistically the stiffest construct under tension loading conditions compared to unicortical screw fixation and tension-band techniques with FiberWire or stainless steel wire. In fact, unicortical screw fixation had only 10% of the stiffness as demonstrated in the bicortical technique. In a direct comparison, tension-band fixation using stainless steel wire was statistically stiffer than the FiberWire construct.
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Slipped capital femoral epiphysis is a relatively common disorder of the hip that affects children in late childhood and early adolescence, with an incidence in the United States of approximately 10 per 100,000. Although the diagnosis and treatment of slipped capital femoral epiphysis have been well described, the search for its cause and a method of early identification continues. Recent publications have suggested that there is a familial association among individuals with slipped capital femoral epiphysis, but there is no current genetic marker established for the disorder. ⋯ This is the first report of a series of 3 sisters with slipped capital femoral epiphysis in the United States. Our goals were to document our experience in the identification and treatment of these patients to highlight the complexities of slipped capital femoral epiphysis presentation patterning, to increase the awareness and reporting of familial cases of slipped capital femoral epiphysis by other physicians, and to encourage additional research in this area. As clinicians progress in the ability to diagnose and treat patients with slipped capital femoral epiphysis, they also must be mindful of the varying presentation characteristics.