Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Mar 2011
Laminoplasty versus laminectomy and fusion for multilevel cervical spondylotic myelopathy.
Cervical spondylotic myelopathy is increasingly prevalent in the elderly and is the leading cause of spinal cord dysfunction in this population. Laminectomy with fusion and laminoplasty halt progression of myelopathy in these patients; however, both procedures have well-documented complications and associated morbidity and it is unclear which might be most advantageous. ⋯ Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Mar 2011
ReviewSpinal cord injury: a systematic review of current treatment options.
Spinal cord injury (SCI) is a devastating event often resulting in permanent neurologic deficit. Research has revealed an understanding of mechanisms that occur after the primary injury and contribute to functional loss. By targeting these secondary mechanisms of injury, clinicians may be able to offer improved recovery after SCI. ⋯ As our understanding of the fundamental mechanisms of SCI improves, we must keep abreast of these discoveries to translate them into therapies that will hopefully benefit patients. We summarize this process of bench to bedside with regard to SCI.
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Clin. Orthop. Relat. Res. · Mar 2011
An observational study of patient-rated outcome after atlantoaxial fusion in patients with rheumatoid arthritis and osteoarthritis.
Fusion is used to address several types of abnormality of the atlantoaxial segment. Traditionally, outcome has been assessed by achieving solid bony union. Recently, however, patient-rated outcome instruments have been increasingly used, although these may be influenced by concomitant comorbidity. ⋯ Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Mar 2011
Increased in-hospital complications after primary posterior versus primary anterior cervical fusion.
Although anterior (ACDF) and posterior cervical fusion (PCDF) are relatively common procedures and both are associated with certain complications, the relative frequency and severity of these complications is unclear. Since for some patients either approach might be reasonable it is important to know the relative perioperative risks for decision-making. ⋯ Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Mar 2011
ReviewChild abuse: the role of the orthopaedic surgeon in nonaccidental trauma.
Child abuse presents in many different forms: physical, sexual, psychological, and neglect. The orthopaedic surgeon is involved mostly with physical abuse but should be aware of the other forms. There is limited training regarding child abuse, and the documentation is poor when a patient is at risk for abuse. There is a considerable risk to children when abuse is not recognized. ⋯ The role of the orthopaedic surgeon in suspected cases of child abuse includes (1) obtaining a good history and making a thorough physical examination; (2) obtaining the appropriate radiographs and notifying the appropriate services; and (3) participating in and communicating with a multidisciplinary team to manage the patients.