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clinical orthopaedic

Sergio Barroso Rosa, Zaid Bahho, Kenji Doma, Kaushik Hazratwala, Peter McEwen, Varaguna Manoharan, Brent Matthews, Matthew Wilkinson
INTRODUCTION: Patella alta (PA) is one of the primary correctable risk factors for patellofemoral instability (PFI). Both an accurate diagnosis of PA and a clinically relevant target for correction are necessary for optimal treatment. An ideal test for PA should relate the position of the patella to the femur rather than tibia, should do so with the quadriceps contracted and the patellar tendon under tension and should have good sensitivity and specificity. None of the currently used radiographic tests PA meet these criteria, most of which are based on the position of the patella relative to the tibia with diagnostic cutoffs based on 2 standard deviations from the mean rather than optimal sensitivity and specificity...
March 15, 2018: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Valerio Pace, Omar Farooqi, James Kennedy, Chang Park, Joseph Cowan
As a tertiary referral centre of spinal surgery, the Royal National Orthopaedic Hospital (RNOH) handles hundreds of spinal cases a year, often with complex pathology and complex care needs. Despite this, issues were raised at the RNOH following lack of sufficient documentation of preoperative and postoperative clinical findings in spinal patients undergoing major surgery. This is not in keeping with guidelines provided by the Royal College of Surgeons. The authors believe that a standardised clerking pro forma for surgical spinal patients admitted to RNOH would improve the quality of care provided...
March 14, 2018: Postgraduate Medical Journal
Kwang Hwan Park, Yeokgu Hwang, Seung Hwan Han, Yoo Jung Park, Dong Woo Shim, Woo Jin Choi, Jin Woo Lee
BACKGROUND: Recent studies have reported promising clinical results after osteochondral autograft transplantation (OAT) for the treatment of large osteochondral lesions of the talus (OLT). However, no study has yet compared clinical outcomes between primary and secondary OAT for large OLT. PURPOSE: The purpose is to compare clinical outcomes among patients with large OLT who receive primary OAT versus those who receive secondary OAT after failure of marrow stimulation and to identify factors associated with clinical failure...
March 1, 2018: American Journal of Sports Medicine
T Liu, F L Bao, S J Kang, T Jiang, D S Huang, W Gao, L J Geng, Y M Hu
Objective: To explore a standard procedure for the treatment of combined dorsal and palmar internal fixation for complex four part distal radius fractures and assess its clinical results. Methods: From May 2009 to October 2016, 38 patients(39 sides)who suffered from complex four part distal radius fractures were performed operatively with open reduction and internal fixation via combined dorsal and palmar approach in Department of Orthopaedic Trauma, Qilu Hospital of Shandong University(Qingdao). The series included 22 males(22 sides) and 16 females(17 sides)...
March 1, 2018: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Kevin Taliaferro, Alexander Crawford, Justin Jabara, Jonathan Lynch, Edward Jung, Raimonds Zvirbulis, Trevor Banka
BACKGROUND: Intraarticular steroid injections are a common first-line therapy for severe osteoarthritis, which affects an estimated 27 million people in the United States. Although topical, oral, intranasal, and inhalational steroids are known to increase intraocular pressure in some patients, the effect of intraarticular steroid injections on intraocular pressure has not been investigated, to the best of our knowledge. If elevated intraocular pressure is sustained for long periods of time or is of sufficient magnitude acutely, permanent loss of the visual field can occur...
March 9, 2018: Clinical Orthopaedics and related Research
Lester W M Chan, Antony W Gardner, Merng Koon Wong, Kenon Chua, Ernest B K Kwek
INTRODUCTION: Non-prosthetic peri-implant fractures (NPPIFs) are an under-reported entity. Management is challenging because of alterations in anatomy, the presence of orthopaedic implants and phenomena such as stress shielding, disuse osteopenia and fracture remodeling. The aims of this paper were to review patterns of injury, management and outcomes and to propose a classification system to aid further research. MATERIALS AND METHODS: This study is a multi-centered retrospective case series...
March 12, 2018: Archives of Orthopaedic and Trauma Surgery
Venkataramana Kandi, Parimala Reddy Basireddy
Introduction Medical education involves training necessary to become a physician or a surgeon. This includes various levels of training like undergraduate, internship, and postgraduate training. Medical education can be quite complex, since it involves training in pre-clinical subjects (anatomy, physiology, biochemistry), the para-clinical subjects (microbiology, pathology, pharmacology, and forensic medicine), and a discrete group of clinical subjects that include general medicine, surgery, obstetrics and gynaecology, ear, nose and throat specialization, paediatrics, cardiology, pulmonology, dermatology, ophthalmology, and orthopaedics, and many other clinical specializations and super specialities (cardio-thoracic surgery, neurosurgery, etc...
January 5, 2018: Curēus
Elif Turgut, Volga Bayrakci Tunay
OBJECTIVE: Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score (KJOC-SES) is a subjective assessment tool to measure functional status of the upper extremities in overhead athletes. The aim was to translate and culturally adapt the KJOC-SES and to evaluate the psychometric properties of the Turkish version (KJOC-SES-Tr) in overhead athletes. METHODS: The forward and back-translation method was followed. One hundred and twenty-three overhead athletes completed the KJOC-SES-Tr, the Disabilities of the Arm, Shoulder, and Hand (DASH), and the American Shoulder and Elbow Surgeons Evaluation Form (ASES)...
March 9, 2018: Acta Orthopaedica et Traumatologica Turcica
Graham McGeoch, Kieran Holland, Melissa Kerdemelidis, Nikki Elliot, Brett Shand, Catherine Fink, Anne Dixon, Carolyn Gullery
INTRODUCTION Unmet needs are a key indicator of the success of a health system. Clinicians and funders in Christchurch, Canterbury, New Zealand were concerned that unmet health need was hidden. AIM The aim of this survey was to estimate the proportion of patients attending general practice who were unable to access clinically indicated referred services. METHODS The survey used a novel method to estimate unserviced health needs. General practitioners (GPs, n = 54) asked their patients (n = 2135) during a consultation about any health needs requiring a referred service...
December 2017: Journal of Primary Health Care
Anton Khlopas, Morad Chughtai, Randa K Elmallah, David Hip-Flores, Arthur L Malkani, Steven F Harwin, Michael A Mont, Michael D Ries
BACKGROUND: Bone loss in patients undergoing revision THA poses a considerable challenge for orthopaedic surgeons. Often, to achieve better fixation in remaining bone, larger diameter acetabular components and reaming superiorly may be necessary. However, this is likely to raise the hip center of rotation, which may lead to altered biomechanics, specifically, insufficiency of the abductor muscles, altered gait, and increased risk of dislocation from impingement. More recently, a newer acetabular shell has been designed to more closely replicate the native hip center of rotation in these circumstances while maintaining adequate fixation...
February 2018: Clinical Orthopaedics and related Research
Nicholas A Bedard, Andrew J Pugely, Michael McHugh, Nathan Lux, Jesse E Otero, Kevin J Bozic, Yubo Gao, John J Callaghan
BACKGROUND: Use of large clinical and administrative databases for orthopaedic research has increased exponentially. Each database represents unique patient populations and varies in their methodology of data acquisition, which makes it possible that similar research questions posed to different databases might result in answers that differ in important ways. QUESTIONS/PURPOSES: (1) What are the differences in reported demographics, comorbidities, and complications for patients undergoing primary TKA among four databases commonly used in orthopaedic research? (2) How does the difference in reported complication rates vary depending on whether only inpatient data or 30-day postoperative data are analyzed? METHODS: Patients who underwent primary TKA during 2010 to 2012 were identified within the National Surgical Quality Improvement Programs (NSQIP), the Nationwide Inpatient Sample (NIS), the Medicare Standard Analytic Files (MED), and the Humana Administrative Claims database (HAC)...
January 2018: Clinical Orthopaedics and related Research
Megan H M Kuba, Byron H Izuka
BACKGROUND: Previous studies have showed the efficacy of removable brace treatment for distal radius buckle fractures in children, whereas others have independently suggested that these injuries do not require additional radiographic imaging. However, no study has sought to collectively determine whether treating pediatric distal radius buckle fractures with a removable brace and no follow-up visit or imaging after the initial visit is a safe and satisfactory protocol. METHODS: In total, 42 consecutive patients with a distal forearm buckle fracture seen by a single fellowship trained pediatric orthopaedic surgeon were eligible to participate...
March 9, 2018: Journal of Pediatric Orthopedics
Christopher T Born, Joseph A Gil, Joey P Johnson
Periprosthetic fractures around total knee arthroplasty have become an increasingly common and challenging orthopaedic problem. Appropriate management of these fractures depends on careful scrutiny of radiographs and a thorough clinical history to exclude the diagnosis of a periprosthetic infection. In a periprosthetic tibial fracture with a stable, well-aligned tibial component and well-aligned mechanical tibial axis, the fracture can be successfully managed with closed reduction and cast immobilization; meticulous follow-up is essential to ensure that the alignment is maintained...
March 9, 2018: Journal of the American Academy of Orthopaedic Surgeons
Meletis Rozis, Ioannis Benetos, Panagiotis Karampinas, Vasilios Polyzois, John Vlamis, Spyros Pneumaticos
BACKGROUND: Conservative treatment of an acute Achilles rupture remains a viable and acceptable option as does surgical fixation, with open and percutaneous repair consisting the main operative techniques. The purpose of this study was to compare the outcomes and complication rates of open versus percutaneous surgical procedures. METHODS: From 2009 to 2016, 131 patients were admitted to our department with clinically and radiologically confirmed acute Achilles tendon ruptures...
March 1, 2018: Foot & Ankle International
Christian Jung, Lena Tepohl, Reina Tholen, Knut Beitzel, Stefan Buchmann, Thomas Gottfried, Casper Grim, Bettina Mauch, Gert Krischak, Hans Ortmann, Christian Schoch, Frieder Mauch
Background: Tears and lesions of the rotator cuff are a frequent cause of shoulder pain and disability. Surgical repair of the rotator cuff is a valuable procedure to improve shoulder function and decrease pain. However, there is no consensus concerning the rehabilitation protocol following surgery. Objectives: To review and evaluate current rehabilitation contents and protocols after rotator cuff repair by reviewing the existing scientific literature and providing an overview of the clinical practice of selected German Society of Shoulder and Elbow Surgery e...
2018: Obere Extremität
A Nascimento Osorio, J Medina Cantillo, A Camacho Salas, M Madruga Garrido, J J Vilchez Padilla
INTRODUCTION: Duchenne muscular dystrophy (DMD) is the most common myopathy in children, with a worldwide prevalence of approximately 0.5 cases per 10,000 male births. It is characterised by a progressive muscular weakness manifesting in early childhood, with the subsequent appearance of musculoskeletal, respiratory, and cardiac complications, causing disability, dependence, and premature death. Currently, DMD is mainly managed with multidisciplinary symptomatic treatment, with favourable results in terms of the progression of the disease...
March 8, 2018: Neurología: Publicación Oficial de la Sociedad Española de Neurología
Akio Kanda, Kazuo Kaneko, Osamu Obayashi, Atsuhiko Mogami, Itaru Morohashi
INTRODUCTION: In total hip arthroplasty via a direct anterior approach, the femur must be elevated at the time of femoral implant placement. For adequate elevation, division of the posterior soft tissues is necessary. However, if we damage and separate the posterior muscle tissue, we lose the benefits of the intermuscular approach. Furthermore, damage to the posterior soft tissue can result in posterior dislocation. We investigate that protecting the posterior soft tissue increases the joint stability in the early postoperative period and results in a lower dislocation rate...
March 9, 2018: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Jen-Ta Shih, Chun-Lin Kuo, Tsu-Te Yeh, Hsain-Chung Shen, Ru-Yu Pan, Chia-Chun Wu
BACKGROUND: The ideal treatment for comminuted intraarticular calcaneal fractures is still debated. Open reduction and internal fixation (ORIF) is the most popular surgical procedure; however, wound complications, implant choice, and infection remain major concerns. This study aimed to demonstrate the results of an innovative, minimally invasive surgical procedure, namely, a closed reduction technique using large-diameter Steinmann pins and percutaneous calcaneoplasty using injectable calcium sulfate cement (MIIG X3, Wright Medical Technology, Inc...
March 9, 2018: BMC Musculoskeletal Disorders
Kolja Gelse, Peter Angele, Peter Behrens, Peter Brucker, Jakob Fay, Daniel Günther, Peter Kreuz, Jörg Lützner, Henning Madry, Peter E Müller, Philipp Niemeyer, Geert Pagenstert, Thomas Tischer, Markus Walther, Wolfgang Zinser, Gunter Spahn
BACKGROUND: In clinical practice, there is still no definite treatment algorithm for focal, partial thickness cartilage lesions (grade II - III). It is well-established that debridement (shaving/lavage) of large degenerative cartilage lesions is not recommended, but there is no such recommendation in the case of focal, partial thickness cartilage defects. MATERIALS AND METHODS: The scientific rationale of cartilage shaving and joint lavage was investigated and a systematic analysis was performed of the literature on the clinical effect of cartilage debridement...
March 9, 2018: Zeitschrift Für Orthopädie und Unfallchirurgie
Jasmina Sterz, Vanessa Britz, Matthias Münzberg, Martina Kadmon, Iris Schleicher, Adrian Meder, Rainer Kamp, Maren Janko, Ingo Marzi, Miriam Rüsseler
BACKGROUND: The national competence-based catalogue of learning-goals in surgery (NKLC) defines competence levels for each of its 230 goals, including "competence level in 1: factual knowledge" up to "competence level 3: independent action". Aside from the cumulative examinations influencing the learning behaviour of students, those teaching targets do not affect the second state examination. This study analyses the extent to which the questions of the German second medical licensing examination compiled by the IMPP (central German institute for medical and pharmaceutical examinations) are congruent with the trauma-surgical and orthopaedic learning goals in the NKLC, in which this thematic focus is emphasised...
March 9, 2018: Zeitschrift Für Orthopädie und Unfallchirurgie
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