Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Sep 2012
Review Meta AnalysisDo femoral or salter innominate osteotomies improve femoral head sphericity in Legg-Calvé-Perthes disease? A meta-analysis.
Recently, the authors of two prospective multicenter observational studies recommended surgery to improve head sphericity in older children, whereas large retrospective observational studies suggest that surgery does not improve head sphericity in older children. Thus, the treatment for Legg-Calvé-Perthes disease (LCPD) remains controversial. ⋯ The data suggest FVO or SIO in patients with LCPD disease who are older than 6 years of age during or before the fragmentation phase should be considered.
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Clin. Orthop. Relat. Res. · Sep 2012
Randomized Controlled Trial Comparative StudyBlood loss in cemented THA is not reduced with postoperative versus preoperative start of thromboprophylaxis.
Thrombin formation commences perioperatively in orthopaedic surgery and therefore some surgeons prefer preoperative initiation of pharmacologic thromboprophylaxis. However, because of the potential for increased surgical bleeding, the postoperative initiation of thromboprophylaxis has been advocated to reduce blood loss, need for transfusion, and bleeding complications. Trials on timing of thromboprophylaxis have been designed primarily to detect thrombotic events, and it has been difficult to interpret the magnitude of blood loss and bleeding events owing to lack of information for bleeding volume and underpowered bleeding end points. ⋯ Our data suggest blood loss is similar with preoperative and postoperative initiation of dalteparin thromboprophylaxis, but indicate a trend toward fewer transfusion requirements which might favor postoperative start of thromboprophylaxis.
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Clin. Orthop. Relat. Res. · Sep 2012
What is the best way to apply the Spurling test for cervical radiculopathy?
A diagnosis of cervical radiculopathy is based largely on clinical examination, including provocative testing. The most common maneuver was described in 1944 by Spurling and Scoville. Since then, several modifications of the original maneuver have been proposed to improve its value in the diagnosis of cervical radiculopathy. ⋯ Whenever cervical radiculopathy is suspected our observations suggest the staged provocative maneuvers that should be included in the physical evaluation are extension and lateral bending first, followed by the addition of axial compression in cases with an inconclusive effect.
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Clin. Orthop. Relat. Res. · Sep 2012
Randomized Controlled Trial Comparative StudyMost effective regimen of tranexamic acid in knee arthroplasty: a prospective randomized controlled study in 240 patients.
The antifibrinolytic tranexamic acid reduces surgical blood loss, but studies have not identified an optimal regimen. ⋯ Single-dose tranexamic acid did not give effective results. The two-dose regimen of POIO was the least amount necessary for effective results. When compared against the control, this regimen produced reduction of drain loss and total blood loss, whereas the IOPO regimen did not. The three-dose regimen of POIOPO produced maximum effective reduction of drain loss and total blood loss.
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Clin. Orthop. Relat. Res. · Sep 2012
Editorial ReviewReviewing for clinical orthopaedics and related research.
Peer review in science was established in the 17th Century and while not without detractors and some controversy, has been a mainstay of high-quality scientific publications ever since. Most believe peer review adds substantially to the value of papers that achieve publication. However, in practice, peer review can be practiced with varying degrees of rigor and the value of the review depends on rigor. ⋯ In this brief review I outline such key questions. An invitation to review is an honor and reflects the confidence of the editor in the reviewer's expertise and accomplishments. Given proper reviews and recommendations, the majority of authors believe peer review adds great value to their papers and the reviewer makes contributions to the community and their own knowledge.