Orthopedics
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The blood loss that accompanies total knee arthroplasty (TKA) can be substantial. Many patients need perioperative blood transfusions. To avoid anemia and transfusion-related complications, the amount of blood loss and need for blood transfusions must be reduced. ⋯ The diminished blood loss resulted in a 50% reduction of allogenic blood transfusions. Hence, computer navigation may be attractive for patients with a high risk of transfusions or uncommon blood groups. Prospective studies are required to verify this potential benefit of computer navigation.
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Randomized Controlled Trial Comparative Study
Treatment of unstable proximal femoral fractures: comparison of the proximal femoral nail antirotation and gamma nail 3.
The goal of this study was to compare the results of proximal femoral nail antirotation (PFNA; Synthes, Oberdorf, Switzerland) fixation with those of Gamma nail 3 (GN-3; Stryker, Mahwah, New Jersey) fixation for unstable proximal femoral fractures. A total of 136 unstable trochanteric fractures were divided into 2 treatment groups: 66 patients were treated with the PFNA and 70 were treated with the GN-3. The 2 groups were comparable with regard to demographic variables. ⋯ Shortening of the femoral shaft was 5.30+/-0.36 mm in PFNA group and 5.49+/-0.39 mm in GN-3 group (P=.73). There was no difference in clinical outcome between the PFNA and GN-3 groups, although the PFNA shows some advantages over the GN-3. We consider these 2 methods to be useful in the treatment of unstable proximal femoral fractures.
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Superior mesenteric artery syndrome is obstruction of the third portion of the duodenum by compression between the abdominal aorta and superior mesenteric artery. Pediatric orthopedists are familiar with this entity, as the association between superior mesenteric artery syndrome and spinal fusion or body casting has been well established. However, patients with spinal deformities usually experience superior mesenteric artery syndrome after orthopedic intervention, with rates after corrective spinal surgery reported between 0.5% and 2.4%. ⋯ Only 2 cases of superior mesenteric artery syndrome in patients with sagittal plane spinal deformity have been described in the literature. In patients with concomitant superior mesenteric artery syndrome and spinal deformity, correction of the deformity may help alleviate the obstruction and result in faster recovery. The contribution of spinal column deformity to the arteriomesenteric angle should not be overlooked.
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The peripheral cortex of a vertebral body affected by Kümmell's disease is not always intact, resulting in high risk for cement leakage. This study used modified techniques to avoid cement extravasation and dislodgment and investigated the feasibility and efficacy of kyphoplasty for treatment of Kümmell's disease. Between May 2006 and May 2008, 21 consecutive patients with Kümmell's disease underwent kyphoplasty with modified techniques. ⋯ This improvement in scores was still present at 6- and 12-month follow-up. At 6- and 12-month follow-up, maintenance of height restoration and kyphotic deformity correction was found. Kyphoplasty may be a relatively safe and effective method for treatment of Kümmell's disease when modified techniques are used to prevent cement leakage and dislodgment.
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Pyoderma gangrenosum is an ulcerative, necrotic dermatosis of unknown etiology. It is frequently associated with inflammatory, hematologic, or neoplastic disease. Clinical and physical evaluation can imitate postoperative wound infections. ⋯ The diagnosis of pyoderma gangrenosum should be considered in patients with wound deterioration who remain culture-negative and fail to respond to debridement and antibiotic treatment. This case report highlights the presentation of pyoderma gangrenosum and its ability to be misdiagnosed as infection. A delay in treatment may result in unnecessary surgery that will further exacerbate this inflammatory condition.