Orthopedics
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With respect to VTE prevention, several steps can be taken by orthopedic surgeons to ensure the best standard of patient care. All patients should be assessed for VTE risk and appropriate prophylaxis should be provided. ⋯ In cases where guidelines offer no direct recommendations, or disagree, standardized care may need to be tempered by clinical judgment and individual patient considerations. Improved health care and better outcomes can be achieved for orthopedic surgery patients by considering VTE prophylaxis from the viewpoint of the clinical guidelines and patient-specific factors.
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Review Case Reports Meta Analysis
Surgical treatment of an infant with Bacille Calmette-Guérin osteomyelitis extending across the growth plate.
Bacille Calmette-Guérin osteomyelitis in infants is a known complication of Bacille Calmette-Guérin vaccination. Treatment consists of antituberculosis chemotherapy after biopsy/curettage; however, in cases of Bacille Calmette-Guérin osteomyelitis extending to the growth plate and epiphysis, the extent and time of surgical treatment such as curettage/biopsy is unknown because of bone growth disturbances. This article presents a case of an infant with this type of Bacille Calmette-Guérin osteomyelitis at the proximal tibia. ⋯ Although statistical analysis showed no significant risk factors associated with the recurrence, these cases showed high recurrence rate in approximately 55.6%, requiring reoperation. Generally, the smaller damage to the growth plate can minimize bone growth disturbance. Taken together, it is suggested that Bacille Calmette-Guérin osteomyelitis extending to the growth plate and epiphysis is associated with high recurrence rate, and early curettage of the entire lesion should be performed to eradicate it and avoid resulting complications.
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The purpose of this study was to determine if the use of screw hole inserts in empty locking screw holes improves the strength and failure characteristics of locking plates. Twenty 5-hole 1/3 tubular locking plates (Synthes, Paoli, Pennsylvania) were mounted on an oak dowel with a 1-cm gap simulating a fracture with comminution and bone loss. Ten of the 1/3 tubular plates had a screw hole insert placed in the center hole (centered over the simulated fracture), while 10 of the 1/3 tubular plates remained empty in the center hole. ⋯ The evolution of new and varied applications and implants continues. Persistent, fundamental questions exist concerning the basic locking plate design. This study demonstrates that the addition of screw hole inserts does not significantly change the stiffness, torsional strength, or axial loading strength of 1/3 tubular locking plates.
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Subtrochanteric fractures of the femur below an arthritic hip are uncommon and challenging to orthopedic surgeons. Most of these fractures occur in elderly patients with advanced osteoporosis. The treatment choices consist of treatment of the fracture and the above hip joint versus treatment of the fracture alone. ⋯ Radiographic findings demonstrated stable ingrowth of the femoral prosthesis with no evidence of subsidence in 11 hips (92%). The average Engh score for all femora was 20.2 (range, 10-26). There was no relationship between the bone morphology (Dorr type) of the femoral medullary canal and the bone ingrowth scores of Engh (P=.639).
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Chondral fractures of the patella are associated with acute dislocation of the patella. Osteochondral fracture in patellar dislocation is located in the medial facet of the patella. This article presents a case of a 15-year-old female ballerina with isolated displaced osteochondral fracture of the patella without patellar dislocation. ⋯ It is unusual that the osteochondral patellar defect site in this patient was in the inferior and central areas of the patella. Patellar chondral fractures without dislocation or patella fracture are rare. Therefore, the possibility of a trivial trauma leading to an osteochondral fracture should be kept in mind in adolescent and young adults who present with knee pain and hemarthrosis.