Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Mar 2013
Comparative StudyFee-based care is important for access to prompt treatment of hip fractures among veterans.
Hip fracture is a medical emergency for which delayed treatment increases risk of disability and death. In emergencies, veterans without access to a Veterans Administration (VA) hospital may be admitted to non-VA hospitals under fee-based (NVA-FB) care paid by the VA. The affect of NVA-FB care for treatment and outcomes of hip fractures is unknown. ⋯ Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Mar 2013
Does valgus femoral osteotomy improve femoral head roundness in severe Legg-Calvé-Perthes disease?
Many surgeons perform a varus femoral or Salter pelvic osteotomy in patients with Legg-Calvé-Perthes (LCP) disease. However, more severely deformed femoral heads show greater congruency in adduction rather than in abduction. Therefore, a valgus-(flexion) femoral osteotomy (VFO) seems preferable rather than a varus femoral or Salter pelvic osteotomy. ⋯ 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 2013
Lateralized reverse shoulder arthroplasty maintains rotational function of the remaining rotator cuff.
Humeral rotation often remains compromised after nonlateralized reverse shoulder arthroplasty (RSA). Reduced rotational moment arms and muscle slackening have been identified as possible reasons for this impairment. Although several clinical studies suggest lateralized RSA may increase rotation, it is unclear whether this is attributable to preservation of rotational moment arms and muscle pretension of the remaining rotator cuff. ⋯ Our findings could explain clinically improved rotation in lateralized RSA in comparison to nonlateralized RSA.
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Clin. Orthop. Relat. Res. · Mar 2013
Locking buttons increase fatigue life of locking plates in a segmental bone defect model.
Durability of plate fixation is important in delayed union. Although locking plates result in stronger constructs, it is not known if locking affects the fatigue life of a plate. Two locking screws on either side of the nonunion could decrease working length and increase strain in the plate. However, the reinforcing effect of the locking head on the plate may compensate, so that it is unclear whether locking reduces fatigue life. ⋯ Locking buttons in holes adjacent to a defect may improve durability, which is important when delayed union is a possibility.
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Clin. Orthop. Relat. Res. · Mar 2013
A novel imaging system permits real-time in vivo tumor bed assessment after resection of naturally occurring sarcomas in dogs.
Treatment of soft tissue sarcoma (STS) includes complete tumor excision. However, in some patients, residual sarcoma cells remain in the tumor bed. We previously described a novel hand-held imaging device prototype that uses molecular imaging to detect microscopic residual cancer in mice during surgery. ⋯ The ability to assess the tumor bed intraoperatively for residual disease has the potential to improve local control.