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Orthopedic Clinics of North America

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https://www.readbyqxmd.com/read/27886688/controversies-in-fracture-care
#1
EDITORIAL
Frederick M Azar
No abstract text is available yet for this article.
January 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/27886687/current-controversies-in-management-of-calcaneus-fractures
#2
REVIEW
Heather E Gotha, Jacob R Zide
Displaced intraarticular fractures of the calcaneus represent a technically challenging injury. Although there is conflicting evidence regarding advantages and disadvantages of operative versus nonoperative treatment, a growing body of literature suggests operative management with near-anatomic reduction of the posterior facet and restoration of overall calcaneal morphology offers greater potential for superior short- and long-term outcomes. A thorough understanding of calcaneal anatomy, fracture pattern, and associated injuries, along with careful selection of surgical approach and timing to surgery are critical to minimize the risk of complication and maximize potential for optimal outcomes...
January 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/27886686/preoperative-versus-postoperative-initiation-of-warfarin-therapy-in-patients-undergoing-total-hip-and-knee-arthroplasty
#3
REVIEW
Cara Cipriano, Nicholas Erdle, Kai Li, Brian Curtin
The optimal strategy for postoperative deep venous thrombosis prophylaxis remains controversial in hip and knee arthroplasty. Warfarin causes transient hypercoagulability; however, the optimal timing of treatment remains unclear. We evaluated the effects of preoperative versus postoperative warfarin therapy with a primary endpoint of perioperative change in hemoglobin. Warfarin was dosed according to a standard nomogram. No difference in perioperative hemoglobin change was observed. The preoperative group demonstrated higher INRs...
January 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/27886685/posterior-malleolus-fractures
#4
REVIEW
Shay Tenenbaum, Nachshon Shazar, Nathan Bruck, Jason Bariteau
Posterior malleolus fractures vary in morphology. A computed tomography scan is imperative to evaluate fragment size, comminution, articular impaction, and syndesmotic disruption. Despite an increasing body of literature regarding posterior malleolus fractures, many questions remain unanswered. Although, historically, fragment size guided surgical fixation, it is becoming evident that fragment size should not solely dictate treatment. Surgical treatment should focus on restoring ankle joint structural integrity, which includes restoring articular congruity, correcting posterior talar translation, addressing articular impaction, removing osteochondral debris, and establishing syndesmotic stability...
January 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/27886684/controversies-in-fractures-of-the-proximal-ulna
#5
REVIEW
Christopher M Hopkins, James H Calandruccio, Benjamin M Mauck
The olecranon process, coronoid process, and greater sigmoid notch are important components of the complex proximal ulna. Along with providing bony stability to the ulnohumeral joint, the proximal ulna serves as the attachment site of many important muscles and ligaments that impart soft tissue stability to the elbow joint. Management of proximal ulnar fractures continues to evolve as advances in imaging and anatomic and biomechanical studies have led to improvements in available implants; however, controversies remain, as shown in the current relevant literature...
January 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/27886683/complications-of-pediatric-foot-and-ankle-fractures
#6
REVIEW
Jaime R Denning
Ankle fractures account for 5% and foot fractures account for approximately 8% of fractures in children. Some complications are evident early in the treatment or natural history of foot and ankle fractures. Other complications do not become apparent until weeks, months, or years after the original fracture. The incidence of long-term sequelae like posttraumatic arthritis from childhood foot and ankle fractures is poorly studied because decades or lifelong follow-up has frequently not been accomplished. This article discusses a variety of complications associated with foot and ankle fractures in children or the treatment of these injuries...
January 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/27886682/clavicle-shaft-fractures-in-adolescents
#7
REVIEW
Scott Yang, Lindsay Andras
Midshaft clavicle fractures in adolescents are common. Recent literature in adults fractures favors open reduction and plate fixation for significantly displaced and/or shortened midshaft clavicle fractures, although whether this applies to adolescents remains debatable. This article reviews the current literature and controversy in the management of displaced adolescent clavicle fractures.
January 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/27886681/heterotopic-ossification-in-trauma
#8
REVIEW
William R Barfield, Robert E Holmes, Langdon A Hartsock
Better understanding of the biology of heterotopic ossification (HO) formation will lead to treatment and prevention modalities that can be directed specifically at the cellular level. Early identification of HO precursor cells and target genes may provide prognostic value that guides individualized prophylactic treatment. Better understanding of molecular signaling and proteomics variability will allow surgeons to individualize preemptive treatment to suppress inflammation and formation of HO. Careful surgical technique to avoid muscle damage is important...
January 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/27886680/timing-of-operative-debridement-in-open-fractures
#9
REVIEW
Joshua C Rozell, Keith P Connolly, Samir Mehta
The optimal treatment of open fractures continues to be an area of debate in the orthopedic literature. Recent research has challenged the dictum that open fractures should be debrided within 6 hours of injury. However, the expedient administration of intravenous antibiotics remains of paramount importance in infection prevention. Multiple factors, including fracture severity, thoroughness of debridement, time to initial treatment, and antibiotic administration, among other variables, contribute to the incidence of infection and complicate identifying an optimal time to debridement...
January 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/27886679/impact-of-inpatient-versus-outpatient-total-joint-arthroplasty-on-30-day-hospital-readmission-rates-and-unplanned-episodes-of-care
#10
REVIEW
Bryan D Springer, Susan M Odum, David N Vegari, Jeffrey G Mokris, Walter B Beaver
This article describes a study comparing 30-day readmission rates between patients undergoing outpatient versus inpatient total hip (THA) and knee (TKA) arthroplasty. A retrospective review of 137 patients undergoing outpatient total joint arthroplasty (TJA) and 106 patients undergoing inpatient (minimum 2-day hospital stay) TJA was conducted. Unplanned hospital readmissions and unplanned episodes of care were recorded. All patients completed a telephone survey. Seven inpatients and 16 outpatients required hospital readmission or an unplanned episode of care following hospital discharge...
January 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/27886678/role-of-patellofemoral-offset-in-total-knee-arthroplasty-a-randomized-trial
#11
REVIEW
Louis S Stryker, Susan M Odum, Bryan D Springer, Thomas K Fehring
Total knee arthroplasty occasionally does not meet expectations. This randomized clinical trial assessed the effect of restoration of the native patellofemoral height on clinical outcomes. Group I underwent standard patellar bone resection; group II underwent modified patellar bone resection that adjusted the amount of anterior condylar bone removed and the anterior flange thickness. There were no differences in anterior knee pain, Western Ontario and McMaster Universities Arthritis Index scores, or Knee Injury and Osteoarthritis Outcome Score scores...
January 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/27637668/sports-related-injuries
#12
EDITORIAL
Jennifer Flynn-Briggs
No abstract text is available yet for this article.
October 2016: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/27637667/foot-and-ankle-stress-fractures-in-athletes
#13
REVIEW
Michael C Greaser
The incidence of stress fractures in the general athletic population is less than 1%, but may be as high as 15% in runners. Stress fractures of the foot and ankle account for almost half of bone stress injuries in athletes. These injuries occur because of repetitive submaximal stresses on the bone resulting in microfractures, which may coalesce to form complete fractures. Advanced imaging such as MRI and triple-phase bone scans is used to evaluate patients with suspected stress fracture. Low-risk stress fractures are typically treated with rest and protected weight bearing...
October 2016: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/27637666/thumb-ligament-injuries-in-the-athlete
#14
REVIEW
F Patterson Owings, James H Calandruccio, Benjamin M Mauck
Hand injuries account for up to 15% of sports injuries and are common in contact sports and in sports with a high risk of falling. Appropriate management requires knowledge of the type of injury, demands of the sport and position, competitive level of the athlete, future athletic demands and expectations, and the role of rehabilitation and protective splints for return to play. Management of the athlete requires aggressive and expedient diagnostic intervention and treatment. This article describes ligamentous injuries to the thumb, including thumb carpometacarpal dislocations, thumb metacarpophalangeal dislocations, collateral ligament injuries and interphalangeal dislocations, their evaluation, treatment and outcomes...
October 2016: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/27637665/ulnar-sided-wrist-pain-in-the-athlete
#15
REVIEW
Chance J Henderson, Ky M Kobayashi
Ulnar-sided wrist pain can be a challenging entity for the hand surgeon and even more so in the athletic population. The authors present 8 causes of ulnar-sided wrist pain in an athlete (hook of hamate fracture, pisiform fracture, hypothenar hammer syndrome, triangular fibrocartilage complex injuries, ulnocarpal impaction syndrome, lunotriquetral ligament tears, extensor carpi ulnaris tendinitis, subluxation of extensor carpi ulnaris) and their associated imaging and treatment options.
October 2016: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/27637664/anterior-cruciate-ligament-injuries-in-children-and-adolescents
#16
REVIEW
Peter D Fabricant, Mininder S Kocher
Dramatic increases in youth competitive athletic activity, early sport specialization, and year-round training and competition, along with increased awareness of anterior cruciate ligament (ACL) injuries in children, have led to a commensurate increase in the frequency of ACL tears in the skeletally immature. Recent understanding of the risks of nonoperative treatment and surgical delay have supported a trend toward early operative treatment. This article discusses treatment strategies for ACL injuries in children and adolescents, and offers our preferred treatment strategy for skeletally immature youth athletes with ACL tears...
October 2016: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/27637663/pediatric-knee-osteochondritis-dissecans-lesions
#17
REVIEW
Aristides I Cruz, Kevin G Shea, Theodore J Ganley
Osteochondritis dissecans (OCD) can cause knee pain and dysfunction in children. The etiology of OCD remains unclear; theories on causes include inflammation, ischemia, ossification abnormalities, genetic factors, and repetitive microtrauma. Most OCD lesions in skeletally immature patients will heal with nonoperative treatment. The success of nonoperative treatment decreases once patients reach skeletal maturity. The goals of surgical treatment include maintenance of articular cartilage congruity, rigid fixation of unstable fragments, and repair of osteochondral defects with cells or tissues that can adequately replace lost or deficient cartilage...
October 2016: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/27637662/shoulder-injuries-in-pediatric-athletes
#18
REVIEW
James E Moyer, Jennifer M Brey
Shoulder injuries in pediatric athletes are typically caused by acute or overuse injuries. The developing structures of the shoulder lead to injury patterns that are distinct from those of adult athletes. Overuse injuries often affect the physeal structures of the proximal humerus and can lead to pain and loss of sports participation. Shoulder instability is common in pediatric athletes, and recurrence is also a concern in this population. Fractures of the proximal humerus and clavicle are typically treated with conservative management, but there is a trend toward surgical intervention...
October 2016: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/27637661/pediatric-elbow-and-wrist-pathology-related-to-sports-participation
#19
REVIEW
Matthew D Ellington, Eric W Edmonds
Pediatric overuse injuries are becoming more prevalent in today's society with more children competitively playing year-round sports at a younger age. The importance of prompt diagnosis and treatment is paramount to the treatment for these injuries, second only to rest and activity modification. This article will focus on overuse injuries of the upper extremity, specifically: little league elbow, elbow osteochondritis dissecans, and gymnast wrist. It will also discuss the pathophysiology, diagnosis, imaging, and treatment of each of these entities...
October 2016: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/27637660/tibial-stress-fractures-in-athletes
#20
REVIEW
John J Feldman, Eric N Bowman, Barry B Phillips, John C Weinlein
Tibial stress fractures are common in the athlete. There are various causes of these fractures, the most common being a sudden increase in training intensity. Most of these injuries are treated conservatively; however, some may require operative intervention. Intervention is mostly dictated by location of the fracture and failure of conservative treatment. There are several surgical options available to the treating surgeon, each with advantages and disadvantages. The physician must understand the nature of the fracture and the likelihood for it to heal in a timely manner in order to best treat these fractures in this patient subset...
October 2016: Orthopedic Clinics of North America
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