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https://www.readbyqxmd.com/read/28437494/patellofemoral-pain-an-enigma-explained-by-homeostasis-and-common-sense
#1
William R Post, Scott F Dye
We present a rational, scientific, low-risk approach to patellofemoral pain (anterior knee pain) based on an understanding of tissue homeostasis. Loss of tissue homeostasis from overload and/or injury produces pain. Bone overload and synovial inflammation are common sources of such pain. Chondromalacia and malalignment are findings that almost always do not need to be "corrected" to relieve pain. Patience and persistence in nonoperative care results in consistent success. Surgery should be rare and done only after extensive nonoperative management and in the setting of clearly defined pathology...
March 2017: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28437492/clinical-rehabilitation-of-anterior-knee-pain-current-concepts
#2
Laurie A Hiemstra, Sarah Kerslake, Elizabeth A Arendt
Rehabilitation is the hallmark of the nonoperative treatment of anterior knee pain (AKP). Whether a patient has had appropriate rehabilitation can be assessed in the office with a selection of basic and advanced screening tests. Most important, providing specific instructions in your referral to a therapist skilled in treating patients with AKP can ensure that any identified deficits are appropriately addressed. The etiology of AKP is multifactorial. Whatever its "cause," AKP alters neuromuscular function, and correcting these altered body movement patterns will benefit the patient...
March 2017: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28437491/correct-positioning-of-the-medial-patellofemoral-ligament-troubleshooting-in-the-operating-room
#3
M Tyrrell Burrus, Brian C Werner, Jourdan M Cancienne, David R Diduch
Medial patellofemoral ligament (MPFL) reconstruction is often required after failed nonoperative management of lateral patellar instability. It is important to properly re-create the native ligament to avoid altering patellofemoral biomechanics. Such alterations can cause knee stiffness, anterior knee pain, and patellofemoral chondrosis. Incorrect femoral location is the most common mistake that affects MPFL graft biomechanics. Authors have described multiple radiographic and anatomical landmarks that assist in determining the appropriate location, and time should be taken to accurately localize this position...
March 2017: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28437490/the-diagnosis-and-initial-treatment-of-patellofemoral-disorders
#4
Alan C Merchant, John P Fulkerson, Wayne Leadbetter
Our purpose is to provide simple guidelines for the diagnosis and early care of patellofemoral disorders. Any clinician who treats knee problems, including family practitioners, rheumatologists, orthopedic surgeons, or physical therapists, must know how to make the correct diagnosis, or at least a presumptive diagnosis, at the initial visit. This can avoid unneeded and costly tests, ineffective treatment, and even damaging exercises and unnecessary surgery. The diagnosis of patellofemoral disorders is confusing because they can have many causes...
March 2017: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28430746/serial-radiographs-do-not-change-the-clinical-course-of-nonoperative-stable-ota-ao-44-b1-ankle-fractures
#5
Lucas S Marchand, Zachary M Working, Ajinkya A Rane, Lance G Jacobson, Erik N Kubiak, Thomas F Higgins, David L Rothberg
OBJECTIVE: To assess radiographic markers of ankle stability in stable OTA/AO 44-B1 ankle fractures. DESIGN: Retrospective review. SETTING: Academic Level-I trauma hospital. PATIENTS: One hundred thirty-four patients with stable OTA/AO 44-B1 (Danis-Weber B, Supination-External Rotation-II) ankle fractures. INTERVENTION: Analysis of mortise view radiographs at the time of initial evaluation and final follow-up...
May 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28427775/nonoperative-management-of-atypical-endometrial-hyperplasia-and-grade-1-endometrial-cancer-with-the-levonorgestrel-intrauterine-device-in-medically-ill-post-menopausal-women
#6
William D Baker, Stuart R Pierce, Anne M Mills, Paola A Gehrig, Linda R Duska
OBJECTIVE: To assess the endometrial response rates to treatment with the levonorgestrel intrauterine device in post-menopausal women with atypical hyperplasia/endometrial intraepithelial neoplasia and grade 1 endometrioid (AH/EC) endometrial carcinoma who are not surgical candidates. METHODS: Chart review was undertaken of patients with AH/EC who underwent levonorgestrel intrauterine device insertion by a gynecologic oncologist within two academic health systems between 2002 and 2013...
April 18, 2017: Gynecologic Oncology
https://www.readbyqxmd.com/read/28422848/teriparatide-as-a-nonoperative-treatment-for-tibial-and-femoral-fracture-nonunion-a-case-report
#7
Li Xiaofeng, Xu Daxia, Chen Yunzhen
RATIONALE: Fracture nonunion is a great challenge for orthopedic surgeons. Many surgical interventions are associated with significant pain and heavy economic burden. Therefore, our aim was to evaluate the outcomes of a new nonoperative treatment for fracture nonunion. PATIENT CONCERNS: A 44-year-old man suffered closed fractures of the right tibia and left femur. Eleven months after surgery, there was no radiographic healing between fracture fragments. DIAGNOSES: Fracture nonunion of the right tibia and left femur...
April 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28418573/trends-in-surgical-management-and-costs-for-operative-treatment-of-proximal-humerus-fractures-in-the-elderly
#8
Eddie K Hasty, Edward W Jernigan, Adrianne Soo, Dax T Varkey, Ganesh V Kamath
Proximal humerus fractures in the elderly are increasing in frequency as the population ages. The purpose of this study was to investigate surgical and cost trends in the Medicare population. The PearlDiver database was queried using diagnosis codes to identify Medicare recipients with proximal humerus fractures from 2005 to 2012. Surgical trends, demographics, and charge/reimbursement data were analyzed. There were 750,426 proximal humerus fractures in Medicare recipients during the 8-year period. Eighty-five percent of the fractures were treated nonoperatively; however, the percentage of operative vs nonoperative management increased significantly over time for all fractures, isolated fractures, and fracture dislocations...
April 18, 2017: Orthopedics
https://www.readbyqxmd.com/read/28413226/grade-v-acromioclavicular-joint-separation-in-a-57-year-old-mountain-biker
#9
Peter C Emary, Kylie M Watkins, John A Taylor
Patients rarely present to a chiropractic office setting during the acute stage of a high-grade (i.e. Rockwood types IV-VI) separation of the acromioclavicular (AC) joint. Moreover, such cases are non-existent in the peer-reviewed chiropractic literature. Some controversy exists over the optimal (surgical vs. non-surgical) treatment of severe AC joint injuries. Published reports of nonoperative management for grade V injuries of the AC joint are also scarce. This case review highlights the plain film imaging and conservative management of a 57-year-old patient diagnosed with an acute Rockwood type V AC joint separation...
March 2017: Journal of the Canadian Chiropractic Association
https://www.readbyqxmd.com/read/28413130/arthroscopic-treatment-of-labral-tears-of-the-hip-in-adolescents-patterns-of-clinical-presentation-intra-articular-derangements-radiological-associations-and-minimum-2-year-outcomes
#10
Sivashankar Chandrasekaran, Nader Darwish, Edwin O Chaharbakhshi, Parth Lodhia, Carlos Suarez-Ahedo, Benjamin G Domb
PURPOSE: To report on patterns of clinical presentation, intra-articular derangements, radiological associations, and minimum 2-year outcomes after hip arthroscopy (HA) in patients 18 years or younger. METHODS: This study was a retrospective case series on patients 18 years or younger who had undergone HA for labral tears that had failed nonoperative management from April 2008 to April 2013 with a minimum 2-year follow-up. Exclusion criteria were previous hip conditions or surgery...
April 13, 2017: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/28403427/new-persistent-opioid-use-after-minor-and-major-surgical-procedures-in-us-adults
#11
Chad M Brummett, Jennifer F Waljee, Jenna Goesling, Stephanie Moser, Paul Lin, Michael J Englesbe, Amy S B Bohnert, Sachin Kheterpal, Brahmajee K Nallamothu
Importance: Despite increased focus on reducing opioid prescribing for long-term pain, little is known regarding the incidence and risk factors for persistent opioid use after surgery. Objective: To determine the incidence of new persistent opioid use after minor and major surgical procedures. Design, Setting, and Participants: Using a nationwide insurance claims data set from 2013 to 2014, we identified US adults aged 18 to 64 years without opioid use in the year prior to surgery (ie, no opioid prescription fulfillments from 12 months to 1 month prior to the procedure)...
April 12, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28400669/minimally-invasive-surgical-technique-for-tethered-surgical-drains
#12
Shane R Hess, Jibanananda Satpathy, Andrew C Waligora, Obinna Ugwu-Oju
A feared complication of temporary surgical drain placement is from the technical error of accidentally suturing the surgical drain into the wound. Postoperative discovery of a tethered drain can frequently necessitate return to the operating room if it cannot be successfully removed with nonoperative techniques. Formal wound exploration increases anesthesia and infection risk as well as cost and is best avoided if possible. We present a minimally invasive surgical technique that can avoid the morbidity associated with a full surgical wound exploration to remove a tethered drain when other nonoperative techniques fail...
March 2017: Indian Journal of Orthopaedics
https://www.readbyqxmd.com/read/28399051/clubfoot-infants-initially-thought-to-be-idiopathic-but-later-found-not-to-be-how-do-they-do-with-nonoperative-treatment
#13
B Stephens Richards, Shawne Faulks
BACKGROUND: Infants thought to be normal with idiopathic clubfeet when nonoperative treatment begins may later be found to have other complicating diagnoses. The purpose of this study was to determine the incidence of this occurrence, and to compare the clinical outcomes of these "nonidiopathic" patients with idiopathic clubfoot patients. METHODS: Infants below 3 months old with clubfeet who were thought to be normal (idiopathic) at presentation and had ≥2-year follow-up were studied...
April 10, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28399048/pediatric-femoral-shaft-fractures-a-multicenter-review-of-the-aaos-clinical-practice-guidelines-before-and-after-2009
#14
John D Roaten, Derek M Kelly, Joseph L Yellin, John M Flynn, Micaela Cyr, Sumeet Garg, Alexander Broom, Lindsay M Andras, Jeffrey R Sawyer
BACKGROUND: To determine if the AAOS clinical practice guidelines (CPG) for the treatment of pediatric femoral shaft fractures (2009) changed treatment, we analyzed pediatric femoral shaft fractures at 4 high-volume, geographically separated, level-1 pediatric trauma centers over a 10-year period (2004 to 2013). METHODS: Consecutive series of pediatric femoral shaft fractures (ages, birth to 18 y) treated at the 4 centers were reviewed. Treatment methods were analyzed by age and treatment method for each center and in aggregate...
April 10, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28398820/magnetic-resonance-imaging-predictors-of-failure-in-the-nonoperative-management-of-ulnar-collateral-ligament-injuries-in-professional-baseball-pitchers
#15
Salvatore J Frangiamore, T Sean Lynch, Michael D Vaughn, Lonnie Soloff, Michael Forney, Joseph F Styron, Mark S Schickendantz
BACKGROUND: A medial ulnar collateral ligament (UCL) injury of the elbow is an increasingly common injury in professional baseball pitchers. Predictors of success and failure are not well defined for the nonoperative management of these injuries. PURPOSE: To evaluate the efficacy of objective measures to predict failure of the nonoperative management of UCL injuries. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Thirty-two professional pitchers (82%) met inclusion criteria and underwent an initial trial of nonoperative treatment for UCL tears based on clinical and radiological findings...
April 1, 2017: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/28391752/low-intensity-pulsed-ultrasound-for-nonoperative-treatment-of-scaphoid-nonunions-a-meta-analysis
#16
Edward W Seger, Julio J Jauregui, Steven A Horton, Gerardo Davalos, Erika Kuehn, Michael A Stracher
BACKGROUND: Scaphoid fractures progress to nonunion rates of up to 15% when non-displaced, and are even more frequent when the fracture is displaced. Standard treatment in these cases is surgery; however, individuals unable to undergo this operation, or for those who wish to try more conservative measures, there may be benefit from nonoperative options. Of these, low-intensity pulsed ultrasound (LIPUS) has been shown to improve fracture nonunion healing. The purpose of this study was to perform a comprehensive meta-analysis of relevant literature to determine success of the use of LIPUS for treatment of scaphoid nonunion...
April 1, 2017: Hand: Official Journal of the American Association for Hand Surgery
https://www.readbyqxmd.com/read/28390767/management-and-outcomes-of-carotid-artery-extension-of-aortic-dissections
#17
Adriana Laser, Charles B Drucker, Donald G Harris, Tanya Flohr, Shahab Toursavadkohi, Rajabrata Sarkar, Bradley Taylor, Robert S Crawford
BACKGROUND: Aortic dissection (AD) is the most common aortic catastrophe. Carotid artery dissection due to extension of AD (CAEAD) is one severe complication of this condition. Despite years of refinement in the techniques for repair of AD, the optimal management strategy for CAEAD remains yet to be described. We hypothesized that CAEAD eventually resolves on antiplatelet therapy with a low but not insignificant risk of cerebrovascular accident (CVA). METHODS: This was a single-institution retrospective review of patients admitted with nontraumatic coincident aortic and carotid dissection between 2001 and 2013...
April 5, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28384005/outcomes-after-arthroscopic-bankart-repair-patients-with-first-time-versus-recurrent-dislocations
#18
Tyler Marshall, Jose Vega, Marcelo Siqueira, Robert Cagle, Jonathan D Gelber, Paul Saluan
BACKGROUND: The young athletic population makes up the largest portion of shoulder instability and, when treated nonoperatively, has a recurrent dislocation rate as high as 71%. It is unknown how the outcomes of those who have a recurrent dislocation are affected versus those who have a stabilization procedure after a first-time dislocation. PURPOSE: To report the postoperative outcomes of patients with first-time dislocations versus patients with recurrent dislocations before surgery...
April 1, 2017: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/28382259/traumatic-tension-pneumocephalus-two-cases-and-comprehensive-review-of-literature
#19
REVIEW
Promod Pillai, Rohit Sharma, Larami MacKenzie, Eugene F Reilly, Paul R Beery, Thomas J Papadimos, Stanislaw Peter A Stawicki
Although traumatic pneumocephalus is not uncommon, it rarely evolves into tension pneumocephalus (TP). Characterized by the presence of increasing amounts of intracranial air and concurrent appearance or worsening neurological symptoms, TP can be devastating if not recognized and treated promptly. We present two cases of traumatic TP and a concise review of literature on this topic. Two cases of traumatic TP are presented. In addition, a literature search revealed 20 additional cases, of which 18 had sufficient information for inclusion...
January 2017: International Journal of Critical Illness and Injury Science
https://www.readbyqxmd.com/read/28382258/trends-in-nonoperative-management-of-traumatic-injuries-a-synopsis
#20
REVIEW
Stanislaw P A Stawicki
Nonoperative management of both blunt and penetrating injuries can be challenging. During the past three decades, there has been a major shift from operative to increasingly nonoperative management of traumatic injuries. Greater reliance on nonoperative, or "conservative" management of abdominal solid organ injuries is facilitated by the various sophisticated and highly accurate noninvasive imaging modalities at the trauma surgeon's disposal. This review discusses selected topics in nonoperative management of both blunt and penetrating trauma...
January 2017: International Journal of Critical Illness and Injury Science
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