MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Orthopedic Clinics of North America' source. Thu, 09 Feb 2012 00:02:40 +0100 http://www.medworm.com/index.php?rid=5411414&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811001222%2Fabstract%3Frss%3Dyes (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5411414 Thu, 17 Nov 2011 07:42:16 +0100 5411414 http://www.medworm.com/index.php?rid=5411413&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811001143%2Fabstract%3Frss%3Dyes In Issue 42:3 of Orthopedic Clinics, the article entitled “Prognostic Factors and Outcome Measures in Perthes Disease” included a mislabeled figure. Figure 4 (page 306) is presented correctly below. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5411413 Thu, 17 Nov 2011 07:42:16 +0100 5411413 http://www.medworm.com/index.php?rid=5411411&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811001076%2Fabstract%3Frss%3Dyes This article provides the spine care provider with an understanding of how to appropriately evaluate and manage the most common cervical conditions that require revision cervical spine surgery. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5411411 Thu, 17 Nov 2011 07:42:16 +0100 5411411 http://www.medworm.com/index.php?rid=5411410&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS003058981100112X%2Fabstract%3Frss%3Dyes This article focuses on the surgical treatment of complex spinal deformity. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5411410 Thu, 17 Nov 2011 07:42:16 +0100 5411410 http://www.medworm.com/index.php?rid=5411408&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000952%2Fabstract%3Frss%3Dyes Although the management of cervical spine trauma is relatively complex, multiple classification systems have attempted to simplify it through the use of descriptive terms. Most historical classification systems failed to yield sufficient prognostic information to guide clinical treatment until the Subaxial Injury Classification system was developed. This classification system takes into account the injury morphology, discoligamentous complex, and the most important prognostic factor, neurologic status. The early results of this classification system have been encouraging and it is expected to improve spinal trauma care through enhancing more uniform nomenclature and communication for surgeons managing spinal trauma. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5411408 Thu, 17 Nov 2011 07:42:16 +0100 5411408 http://www.medworm.com/index.php?rid=5411404&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811001088%2Fabstract%3Frss%3Dyes Cervical spondylotic myelopathy (CSM) is a slowly progressive disease resulting from age-related degenerative changes in the spine that can lead to spinal cord dysfunction and significant functional disability. The degenerative changes and abnormal motion lead to vertebral body subluxation, osteophyte formation, ligamentum flavum hypertrophy, and spinal canal narrowing. Repetitive movement during normal cervical motion may result in microtrauma to the spinal cord. Disease extent and location dictate the choice of surgical approach. Anterior spinal decompression and instrumented fusion is successful in preventing CSM progression and has been shown to result in functional improvement in most patients. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5411404 Thu, 17 Nov 2011 07:42:16 +0100 5411404 http://www.medworm.com/index.php?rid=5411403&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811001106%2Fabstract%3Frss%3Dyes This article details the controversies associated with the different treatment strategies in patients with cervical spondylotic myelopathy. The natural history, incidence, pathophysiology, physical examination, and imaging findings are discussed followed by the indications, techniques, and outcomes of patients treated with posterior cervical decompression via decompressive laminectomy, laminectomy and instrumented fusion, and laminoplasty. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5411403 Thu, 17 Nov 2011 07:42:16 +0100 5411403 http://www.medworm.com/index.php?rid=5411401&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811001118%2Fabstract%3Frss%3Dyes The atlantoaxial motion segment, which is responsible for half of the rotational motion in the cervical spine, is a complex junction of the first (C1) and second (C2) cervical vertebrae. Destabilization of this joint is multifactorial and can lead to pathologic motion with neurologic sequelae. Posterior spinal fixation of the C1-C2 articulation in the presence of instability has been well described in the literature. Early reports of interspinous/interlaminar wiring have evolved into modern-day pedicle screw/translaminar constructs, with excellent results. The success of a C1-C2 posterior fusion rests on appropriate indications and surgical techniques. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5411401 Thu, 17 Nov 2011 07:42:16 +0100 5411401 http://www.medworm.com/index.php?rid=5411400&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS003058981100099X%2Fabstract%3Frss%3Dyes The evolution of occipitocervical fixation and new rigid universal screw-rod construct technology has allowed secure anchorage at each level of the occipitocervical junction with the elimination of rigid external orthoses. Rigid occipitocervical instrumentation constructs have achieved higher fusion rates and less postoperative immobilization-associated complications. Outcomes have improved compared with former nonrigid instrumentation techniques; however, with advances of rigid occipitocervical stabilization capability have come new challenges, risks, and operative techniques. A thorough understanding of the relevant cervical bony and soft tissue anatomy is essential for safe implantation and a successful outcome. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5411400 Thu, 17 Nov 2011 07:42:16 +0100 5411400 http://www.medworm.com/index.php?rid=5411399&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811001131%2Fabstract%3Frss%3Dyes It has been an incredible honor to serve as guest editors of the January 2012 edition of the Orthopedic Clinics of North America titled “Treatment of Complex Cervical Spine Disorders.” This has, no doubt, been a labor of love and we have had the great fortune of collaborating with multiple thought leaders in the field of cervical spine surgery. As our understanding of the etiology and pathogenesis of complex cervical disorders has improved, so has the stringency of evaluation of surgical treatment of these conditions. Modern diagnostic evaluations coupled with evidence-based algorithms have changed the way we approach patients with these challenging conditions and we hope that the articles contained within this issue will educate and inspire members of the orthopedic community who take... Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5411399 Thu, 17 Nov 2011 07:42:16 +0100 5411399 http://www.medworm.com/index.php?rid=5411398&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811001210%2Fabstract%3Frss%3Dyes (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5411398 Thu, 17 Nov 2011 07:42:16 +0100 5411398 http://www.medworm.com/index.php?rid=5411397&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811001209%2Fabstract%3Frss%3Dyes (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5411397 Thu, 17 Nov 2011 07:42:16 +0100 5411397 http://www.medworm.com/index.php?rid=5411396&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811001192%2Fabstract%3Frss%3Dyes (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5411396 Thu, 17 Nov 2011 07:42:16 +0100 5411396 http://www.medworm.com/index.php?rid=5411409&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000964%2Fabstract%3Frss%3Dyes Anterior cervical diskectomy and fusion for neurologic deficits, radicular arm pain, and neck pain refractory to conservative management are successful. The approach and procedure were first described in 1955 and have become the anterior cervical standard of care for orthopedic surgeons and neurosurgeons. Advancements and innovations have addressed disease processes of the cervical spine with motion-preserving technology. The possibility of obtaining anterior cervical decompression while maintaining adjacent segment motion led to the advent of cervical total disk replacement. The Food and Drug Administration has approved 3 cervical devices with other investigational device exemption trials under way. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5411409 Mon, 24 Oct 2011 04:00:00 +0100 5411409 http://www.medworm.com/index.php?rid=5411407&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000940%2Fabstract%3Frss%3Dyes The bony spine is overall the third most common site for distant cancer metastasis, with the cervical spine involved in approximately 8 to 20% of metastatic spine disease cases. Diagnosis and management of metastatic spine disease requires disease categorization into the compartment involved, pathology of the lesion, and anatomic region involved. The diagnostic approach should commence with careful physical examination, and the workup should include plain radiographs, magnetic resonance imaging, computed tomography, and bone scintigraphy. Management ranges from palliative nonoperative to aggressive surgical treatment. Optimal management requires proper patient selection to individualize the most appropriate treatment modality. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5411407 Mon, 24 Oct 2011 04:00:00 +0100 5411407 http://www.medworm.com/index.php?rid=5411406&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000988%2Fabstract%3Frss%3Dyes Vertebral artery and esophageal injuries are rare but feared complications of cervical spine surgery. Appropriate understanding of treatment algorithms for prompt intervention in the event of a vertebral artery injury minimizes the risk of exsanguination and/or profound neurologic consequences. Esophageal injuries are often more subtle, and although intraoperative injuries can sometimes be diagnosed at the time of surgery, they frequently do not present until the week after surgery. They can additionally be seen as a late complication of instrumentation usage and/or failure. Expedient diagnosis and management of these injuries minimize their impact and allow for optimal treatment outcome. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5411406 Mon, 24 Oct 2011 04:00:00 +0100 5411406 http://www.medworm.com/index.php?rid=5411402&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000927%2Fabstract%3Frss%3Dyes This article addresses the relevant surgical anatomy, pitfalls, and pearls associated with each of these fixation techniques. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5411402 Wed, 19 Oct 2011 04:00:00 +0100 5411402 http://www.medworm.com/index.php?rid=5411412&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000976%2Fabstract%3Frss%3Dyes This article explains in detail minimally invasive approaches to the posterior spine, the techniques for posterior cervical foraminotomy and arthrodesis via lateral mass screw placement, and anterior cervical foraminotomy. Complications are also discussed. Additionally, illustrated cases are presented detailing the use of minimally invasive surgical techniques. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5411412 Fri, 14 Oct 2011 04:00:00 +0100 5411412 http://www.medworm.com/index.php?rid=5411405&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000939%2Fabstract%3Frss%3Dyes Adjacent segment disease (ASD) was described after long-term follow-up of patients treated with cervical fusion. The term describes new-onset radiculopathy or myelopathy referable to a motion segment adjacent to previous arthrodesis and often attributed to alterations in the biomechanical environment after fusion. Evidence suggests that ASD affects between 2% and 3% of patients per year. Although prevention of ASD was one major impetus behind the development of motion-sparing surgery, the literature does not yet clearly distinguish a difference in the rate of ASD between fusion and disk replacement. Surgical techniques during index surgery may reduce the rate of ASD. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5411405 Fri, 14 Oct 2011 04:00:00 +0100 5411405 http://www.medworm.com/index.php?rid=5263289&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000873%2Fabstract%3Frss%3Dyes (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5263289 Thu, 29 Sep 2011 17:30:20 +0100 5263289 http://www.medworm.com/index.php?rid=5263288&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000708%2Fabstract%3Frss%3Dyes Intervertebral disks are biologically regulated by the maintenance of a balance between the anabolic and catabolic activities of disk cells. Therapeutic agents, initially evaluated using in vitro studies on disk cells and explants, have been used as intradiscal injections in preclinical settings to test in vivo efficacy. These include anabolic growth factors, other biostimulatory agents, and antagonistic agents against matrix-degrading enzymes and cytokines. Additional work is needed to identify patient populations, using methods such as MRI, and to better understand the mechanism of healing. Clinical trials are underway for a few of these agents and other promising candidates are on the horizon. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5263288 Thu, 29 Sep 2011 17:30:20 +0100 5263288 http://www.medworm.com/index.php?rid=5263287&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000691%2Fabstract%3Frss%3Dyes Many challenges confront intervertebral disk engineering owing to complexity and the presence of extraordinary stresses. Rebuilding a disk of native function could be useful for removal of the symptoms and correction of altered spine kinematics. Improvement in understanding of disk properties and techniques for disk engineering brings promise to the fabrication of a functional motion segment for the treatment of disk degeneration. Increasing sophistication of techniques available in biomedical sciences will bring its application into clinics. This review provides an account of current progress and challenges of intervertebral disk bioengineering and discusses means to move forward and toward bedside translation. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5263287 Thu, 29 Sep 2011 17:30:20 +0100 5263287 http://www.medworm.com/index.php?rid=5263286&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS003058981100068X%2Fabstract%3Frss%3Dyes Intervertebral disk degeneration is a common and potentially debilitating disease process affecting millions of Americans and other populations each year. Current treatments address resultant symptoms and not the underlying pathophysiology of disease. This has spawned the development of biologic treatments, such as gene therapy, which attempt to correct the imbalance between catabolism and anabolism within degenerating disk cells. The identification of therapeutic genes and development of successful delivery systems have resulted in significant advances in this novel treatment. Continued investigation of the pathophysiology of disk degeneration, however, and safety mechanisms for the application of gene therapy are required for clinical translation. (Source: Orthopedic Clinics of North Ame... Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5263286 Thu, 29 Sep 2011 17:30:20 +0100 5263286 http://www.medworm.com/index.php?rid=5263285&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS003058981100071X%2Fabstract%3Frss%3Dyes This article reviews the current status of stem cell research as applied to the intervertebral disk. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5263285 Thu, 29 Sep 2011 17:30:20 +0100 5263285 http://www.medworm.com/index.php?rid=5263284&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000745%2Fabstract%3Frss%3Dyes This article is a one-to-one comparison of the evolution of total hip and total lumbar disk replacement from “skunk works” to scientific evidence. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5263284 Thu, 29 Sep 2011 17:30:20 +0100 5263284 http://www.medworm.com/index.php?rid=5263283&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000721%2Fabstract%3Frss%3Dyes This article summarizes the existing biomechanical and clinical literature on the causes and clinical impact of ASD, as well as possible risk factors. Further, the theoretical advantage of motion-preserving technologies that aim to preserve the adjacent segment is discussed. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5263283 Thu, 29 Sep 2011 17:30:20 +0100 5263283 http://www.medworm.com/index.php?rid=5263282&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000757%2Fabstract%3Frss%3Dyes Degenerative disk disease is a strong etiologic risk factor of chronic low back pain (LBP). A multidisciplinary approach to treatment is often warranted. Patient education, medication, and cognitive behavioral therapies are essential in the treatment of chronic LBP sufferers. Surgical intervention with a rehabilitation regime is sometimes advocated. Prognostic factors related to the outcome of different treatments include maladaptive pain coping and genetics. The identification of pain genes may assist in determining individuals susceptible to pain and in patient selection for appropriate therapy. Biologic therapies show promise, but clinical trials are needed before advocating their use in humans. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5263282 Thu, 29 Sep 2011 17:30:20 +0100 5263282 http://www.medworm.com/index.php?rid=5263281&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000733%2Fabstract%3Frss%3Dyes This article reviews new and evolving MRI disk-imaging techniques, including grading, relaxation-time measurements, diffusion, and contrast perfusion. In addition, high-resolution magic-angle spinning methods to correlate in vitro disk degeneration (with pain, etc) and in vivo spectroscopic results are discussed. With the potential for morphologic and biochemical characterization of the intervertebral disk, MRI shows promise as a tool to quantitatively assess disk health. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5263281 Thu, 29 Sep 2011 17:30:20 +0100 5263281 http://www.medworm.com/index.php?rid=5263280&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000678%2Fabstract%3Frss%3Dyes Degenerative changes in the material properties of nucleus pulposus and anulus fibrosus promote changes in viscoelastic properties of the whole disc. Volume, pressure and hydration loss in the nucleus pulposus, disk height decreases and fissures in the anulus fibrosus, are some of the signs of the degenerative cascade that advances with age and affect, among others, spinal function and its stability. Much remains to be learned about how these changes affect the function of the motion segment and relate to symptoms such as low back pain and altered spinal biomechanics. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5263280 Thu, 29 Sep 2011 17:30:20 +0100 5263280 http://www.medworm.com/index.php?rid=5263279&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000770%2Fabstract%3Frss%3Dyes This article reviews the main research strategies that have been used to study the genetics of LDD, and the genes that thus far have been identified to influence susceptibility to LDD. With the rapid progress in genomic technologies, further advances in the genetics of LDD are expected in the next few years. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5263279 Thu, 29 Sep 2011 17:30:20 +0100 5263279 http://www.medworm.com/index.php?rid=5263278&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000769%2Fabstract%3Frss%3Dyes This article reviews pathways of nutrient supply to these cells; examines factors that may interrupt these pathways, and discusses consequences for disk cell survival, disk degeneration, and disk repair. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5263278 Thu, 29 Sep 2011 17:30:20 +0100 5263278 http://www.medworm.com/index.php?rid=5263277&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000782%2Fabstract%3Frss%3Dyes This article focuses on various aspects of intervertebral disk biology and disruptions that could lead to diseases such as intervertebral disk degeneration. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5263277 Thu, 29 Sep 2011 17:30:20 +0100 5263277 http://www.medworm.com/index.php?rid=5263276&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000794%2Fabstract%3Frss%3Dyes It has been our immense honor to serve as guest editors for this focus issue addressing lumbar intervertebral disk degeneration for the Orthopedic Clinics of North America. Throughout the years, we have come to appreciate and understand that disk degeneration is a complex, multifactorial condition that intrigues as well as perplexes. As such, disk degeneration continues to captivate the imagination and creativity of many physicians and researchers alike striving to understand its etiology and function, its role in the development of pain, and various treatment modalities. It is due to such devotion by many throughout the years that we are at an age where unique and novel therapies, such as artificial disk replacement, tissue engineering, molecular and genetic interventions, and stem cell u... Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5263276 Thu, 29 Sep 2011 17:30:20 +0100 5263276 http://www.medworm.com/index.php?rid=5263275&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000861%2Fabstract%3Frss%3Dyes (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5263275 Thu, 29 Sep 2011 17:30:20 +0100 5263275 http://www.medworm.com/index.php?rid=5263274&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS003058981100085X%2Fabstract%3Frss%3Dyes (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5263274 Thu, 29 Sep 2011 17:30:20 +0100 5263274 http://www.medworm.com/index.php?rid=5263273&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000848%2Fabstract%3Frss%3Dyes (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5263273 Thu, 29 Sep 2011 17:30:20 +0100 5263273 http://www.medworm.com/index.php?rid=5012653&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000514%2Fabstract%3Frss%3Dyes (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5012653 Thu, 30 Jun 2011 23:00:00 +0100 5012653 http://www.medworm.com/index.php?rid=5012652&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS003058981100040X%2Fabstract%3Frss%3Dyes Early in the course of the disease: this first and most vital frame is from the onset of the disease to the early fragmentation stage (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5012652 Thu, 30 Jun 2011 23:00:00 +0100 5012652 http://www.medworm.com/index.php?rid=5012651&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000320%2Fabstract%3Frss%3Dyes Core decompression may be used as adjunct for treatment in some cases of Legg-Calvé-Perthes disease (LCPD). The primary application is for patients with onset at 12 years of age or older. We recommend classifying these older patients as idiopathic juvenile osteonecrosis and treating them similarly to adults with avascular necrosis. Juvenile osteonecrosis may benefit from core decompression combined with shelf acetabuloplasty during the early stages of necrosis. Younger children with LCPD may benefit from decompression by fenestration of the femoral head. Experience in adult-onset osteonecrosis and our early experience suggest that some patients may benefit from these adjunctive treatments. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5012651 Thu, 30 Jun 2011 23:00:00 +0100 5012651 http://www.medworm.com/index.php?rid=5012650&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000253%2Fabstract%3Frss%3Dyes This article presents a current pathophysiological model of Perthes disease, reviews experimental strategies in pharmaceutical treatments, and suggests future areas for research. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5012650 Thu, 30 Jun 2011 23:00:00 +0100 5012650 http://www.medworm.com/index.php?rid=5012648&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000423%2Fabstract%3Frss%3Dyes This article outlines the range of deformities possible in a Perthes hip, and treatment strategies to surgically address these deformities. For Perthes disease good preoperative clinical and radiographic assessment is essential, and intraoperative assessment vital. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5012648 Thu, 30 Jun 2011 23:00:00 +0100 5012648 http://www.medworm.com/index.php?rid=5012646&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000411%2Fabstract%3Frss%3Dyes This article describes the Morscher osteotomy—a unique femoral neck-lengthening technique. The outcomes of this successful and predictable technique are resolution of symptoms of fatigue and hip discomfort; the absence of nonunion, infection, or hardware failure; and restoration of normal proximal femoral morphology and biomechanics. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5012646 Thu, 30 Jun 2011 23:00:00 +0100 5012646 http://www.medworm.com/index.php?rid=5012644&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000381%2Fabstract%3Frss%3Dyes Articular hip distraction can be applied either by using a monolateral articulated distractor or a circular fixator. The fixator should be aligned such that its axis is aligned with the transverse axis of the hip joint. Following distraction, the range of motion is maintained with regular physiotherapy. It is a useful salvage procedure in older children with hip stiffness, when other methods of containment are not applicable. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5012644 Thu, 30 Jun 2011 23:00:00 +0100 5012644 http://www.medworm.com/index.php?rid=5012642&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000332%2Fabstract%3Frss%3Dyes Failure of the enlarged and deformed anterolateral portion of the femoral head to roll into the acetabulum during abduction alters hip joint mechanics. The resultant hinge abduction is associated with pain, and the patient often has restricted movement. A valgus osteotomy removes the deformed portion of the femoral head away from the weight-bearing area and ensures there is pain-free congruent range of movement around the weight-bearing position. The concomitant improvement in lever arm function and leg length results in a better gait pattern. In immature patients, abolition of hinge abduction allows the lateral acetabular ossification center to grow more normally. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5012642 Thu, 30 Jun 2011 23:00:00 +0100 5012642 http://www.medworm.com/index.php?rid=5012641&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000435%2Fabstract%3Frss%3Dyes This article summarizes the definition of hinge abduction, pathoanatomy of hinge segment, assessment of hinge abduction, determination of reducible and irreducible hinge abduction, and treatment strategies for containable and uncontainable hips in the transitional stage. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5012641 Thu, 30 Jun 2011 23:00:00 +0100 5012641 http://www.medworm.com/index.php?rid=5012640&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000368%2Fabstract%3Frss%3Dyes This article identifies the various methods of containment and the technical aspects of each method. Choice of method depends on the experience of the surgeon and the psychosocial needs of the patient and family. Failure is more commonly a result of inappropriate patient selection for a particular method, delay in management, or technical errors rather than to the method that was selected. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5012640 Thu, 30 Jun 2011 23:00:00 +0100 5012640 http://www.medworm.com/index.php?rid=5012636&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000356%2Fabstract%3Frss%3Dyes This article focuses on the current knowledge of the pathophysiology, classifications, and natural history of LCPD. Although the cause of LCPD remains largely unknown, some insight has been gained on its pathophysiology through experimental studies using animal models of ischemic necrosis. The few available clinical studies on the natural history of LCPD suggest that femoral head deformity is well tolerated in short and intermediate terms, but 50% of patients develop disabling arthritis in the sixth decade of life. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5012636 Thu, 30 Jun 2011 23:00:00 +0100 5012636 http://www.medworm.com/index.php?rid=5012634&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000393%2Fabstract%3Frss%3Dyes A hundred years after the description of Legg-Calvé-Perthes disease, the aetiology remains elusive and a great deal of confusion abounds regarding issues related to the treatment of this enigmatic disease. It is against this unenviable background that we set out to put together this symposium on Legg-Calvé-Perthes disease. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5012634 Thu, 30 Jun 2011 23:00:00 +0100 5012634 http://www.medworm.com/index.php?rid=5012633&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000502%2Fabstract%3Frss%3Dyes (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5012633 Thu, 30 Jun 2011 23:00:00 +0100 5012633 http://www.medworm.com/index.php?rid=5012632&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000496%2Fabstract%3Frss%3Dyes (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5012632 Thu, 30 Jun 2011 23:00:00 +0100 5012632 http://www.medworm.com/index.php?rid=5012631&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000484%2Fabstract%3Frss%3Dyes (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5012631 Thu, 30 Jun 2011 23:00:00 +0100 5012631 http://www.medworm.com/index.php?rid=5012637&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000319%2Fabstract%3Frss%3Dyes Imaging in Legg-Calvé-Perthes disease should help assess the severity and the stage of the disease, detect severe forms earlier, and provide guidance to therapy. However, due to the complexity of the disease, not all examinations can be performed at the same time with the same goals. The scope of this work is to provide an overview of all imaging techniques available today, and to help understand when to use a particular examination. Advantages and limitations of plain radiographs, bone scintigraphy, magnetic resonance imaging, arthrography, computed tomography, and ultrasonography are identified. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5012637 Sun, 05 Jun 2011 23:00:00 +0100 5012637 http://www.medworm.com/index.php?rid=5012647&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000344%2Fabstract%3Frss%3Dyes The aspherical coxa magna femoral head can be made more spherical by intra-articular osteotomy. The Ganz technique of femoral head reduction osteotomy to reduce the size and restore the spherical shape of the femoral head has been performed in 20 patients over the past 5 years. A good or excellent functional and radiographic result was obtained in 14 of the 20. A fair result (decreased pain but no improvement in range of motion) occurred in 3, and a poor result (stiffness and pain) occurred in 3. The preliminary results of this technique are therefore very promising. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5012647 Sun, 15 May 2011 23:00:00 +0100 5012647 http://www.medworm.com/index.php?rid=5012645&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS003058981100037X%2Fabstract%3Frss%3Dyes This article outlines an approach to these patients. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5012645 Sun, 15 May 2011 23:00:00 +0100 5012645 http://www.medworm.com/index.php?rid=5012643&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000277%2Fabstract%3Frss%3Dyes Hinge abduction occurs early in the fragmentation stage of Legg-Calvé-Perthes disease and should be suspected when abduction and internal rotation are lost. It can be confirmed by an AP radiograph in abduction and internal rotation in which the ossific nucleus is not covered by the acetabulum. An arthrogram can then yield greater information regarding the reversibility of the hinge abduction. Hinge abduction should be considered a contraindication to containment by redirectional pelvic or femoral varus osteotomy. However, good results have been reported with acetabular augmentation via shelf procedures or Chiari osteotomies. Valgus femoral osteotomies have also been beneficial in the treatment of the Legg-Calvé-Perthes hip with hinge abduction. (Source: Orthopedic Clinics of North Americ... Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5012643 Sun, 15 May 2011 23:00:00 +0100 5012643 http://www.medworm.com/index.php?rid=5012638&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000289%2Fabstract%3Frss%3Dyes The shape of the femoral head at the time when Perthes disease heals is the most important determinant of the risk for degenerative arthritis; hence, the shape of the femoral head and congruence of the hip are the most useful outcome measures. Although several prognostic factors that predict femoral head deformation may be identified during the course of Perthes disease, only two prognostic factors may be identified early enough to institute preventive intervention: femoral head extrusion and the age at onset of the disease. Femoral head extrusion is the only factor that may be influenced by treatment. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5012638 Thu, 12 May 2011 23:00:00 +0100 5012638 http://www.medworm.com/index.php?rid=5012635&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000265%2Fabstract%3Frss%3Dyes The incidence of Perthes disease varies markedly both between countries and within countries down to a local level. The disease is more common in white than in Asian or black African children. The disease is associated with deprivation; with a steep disease gradient across social class groups. This epidemiology alongside the lack of concordance in twins suggests a strong environmental etiology, with little evidence to suggest a genetic predisposition. Children are frequently short, with a growth pattern described as “rostral-sparing”. A propensity to associated congenital anomalies suggests an intrauterine cause. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5012635 Thu, 12 May 2011 23:00:00 +0100 5012635 http://www.medworm.com/index.php?rid=5012639&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000290%2Fabstract%3Frss%3Dyes The aim of treatment of Perthes in the early part of the disease is to prevent the femoral head from getting deformed by muscular forces and weight-bearing stresses transmitted across the acetabular margin. To achieve this, femoral head extrusion must be preempted in children who are older than 8 years at onset of the disease by ensuring containment as soon as the disease is diagnosed. In children younger than 8 years in whom femoral head extrusion occurs, containment must be obtained by the early stage of fragmentation. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5012639 Sun, 08 May 2011 23:00:00 +0100 5012639 http://www.medworm.com/index.php?rid=5012649&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000307%2Fabstract%3Frss%3Dyes This article focuses on the results and unique technical considerations of resurfacing and THA for patients who have severe hip osteoarthritis after resolved Legg-Calvé-Perthes disease. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=5012649 Thu, 05 May 2011 23:00:00 +0100 5012649 http://www.medworm.com/index.php?rid=4647206&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000174%2Fabstract%3Frss%3Dyes (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4647206 Tue, 29 Mar 2011 20:55:14 +0100 4647206 http://www.medworm.com/index.php?rid=4647205&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810001070%2Fabstract%3Frss%3Dyes With experience in metal-metal resurfacing, several opportunities to improve resurfacing technology have been identified. There is a need for better education on hip resurfacing in residency training programs. The majority of short-term complications associated with resurfacing are related to surgical technique or component position. Innovations to improve acetabular component position and femoral-acetabular mating are needed. Although the majority of high wear and adverse local tissue reactions (ALTR) can be prevented by proper component positioning, the variable exposure to metal particles and ions associated with metal-metal resurfacing components continues to be a concern and bearing surface technology will evolve. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4647205 Tue, 29 Mar 2011 20:55:14 +0100 4647205 http://www.medworm.com/index.php?rid=4647204&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000046%2Fabstract%3Frss%3Dyes This retrospective, consecutive case series of a single surgeon performed between 2001 and 2010 assesses the outcome following revision of metal-on-metal hip resurfacing arthroplasties (N = 113). Mean time to revision was 31 months (0–101) after primary hip resurfacing. Malpositioning of the components with associated wear-induced soft tissue fluid collections was the most frequent factor leading to failure of a hip resurfacing arthroplasty. The mid-term outcome of the revisions was satisfactory; complications occurred in 11 patients (9.7%). Six of these patients underwent a re-revision. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4647204 Tue, 29 Mar 2011 20:55:13 +0100 4647204 http://www.medworm.com/index.php?rid=4647203&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS003058981100006X%2Fabstract%3Frss%3Dyes The current study measured ion release among large-head metal-on-metal hip bearings. Twenty-six patients with a modular, Profemur® TL with A-Class® big femoral head total hip replacement were matched (gender, femoral size, BMI) with a group of 26 patients with the Conserve® Plus implant hip resurfacing. Compared with HR patients, THR patients had higher median serum cobalt ion levels at 6 months (3.26 vs 1.12 μg/L, P = .002) 1 year (4.51 vs 1.02, P = .002), and 2 years (3.77 vs 1.22, P (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4647203 Tue, 29 Mar 2011 20:55:13 +0100 4647203 http://www.medworm.com/index.php?rid=4647202&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000022%2Fabstract%3Frss%3Dyes Metal-on-metal total hip replacements (THRs) and hip resurfacings are coming under increasing scrutiny in light of concerns that they fail because of high wear and elevated metal ions. The aim of this study was to investigate the modes of failure in a collection of 433 metal-on-metal THRs and hip resurfacings and to examine the correlations between the reasons for revision and a range of patient and implant variables considered relevant to implant wear. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4647202 Tue, 29 Mar 2011 20:55:13 +0100 4647202 http://www.medworm.com/index.php?rid=4647201&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810001069%2Fabstract%3Frss%3Dyes The purpose of this study was to compare clinical and radiological outcomes of the first 191 fully porous-coated hip resurfacing arthroplasties with 96 hybrid hip resurfacing arthroplasties performed during the same period at a minimum 2-year follow-up to evaluate the initial fixation of uncemented femoral resurfacing components. The results of this study indicate that fully porous-coated femoral resurfacing components can routinely achieve reliable fixation and provide similar initial results as have been achieved with cemented fixation. Long-term results are needed to determine which type of fixation is superior for the femoral hip resurfacing component. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4647201 Tue, 29 Mar 2011 20:55:13 +0100 4647201 http://www.medworm.com/index.php?rid=4647200&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810001057%2Fabstract%3Frss%3Dyes This article determines the incidence and cause of the complications commonly associated with metal-on-metal hip resurfacing implants and the proposed methods to prevent these complications. The literature available in PubMed was reviewed. Complication rates after hip resurfacing are low, and the procedure has shown both safety and efficacy in the hands of surgeons trained in specialized centers. Proper surgical technique can further reduce the incidence of femoral neck fracture, component loosening, and abnormal wear of the prosthesis. A more systematic detection of adverse local tissue reactions is needed to provide accurate assessments of their prevalence. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4647200 Tue, 29 Mar 2011 20:55:13 +0100 4647200 http://www.medworm.com/index.php?rid=4647199&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810001094%2Fabstract%3Frss%3Dyes Conventional radiography is the primary imaging modality to evaluate the condition of hip resurfacing implants and the preferred method of assessing implant stability over time. Radiographs assess the angle of inclination of the femoral and acetabular components, implant stability, and femoral neck narrowing. Ultrasonography detects solid or soft tissue masses adjacent to the implant. Magnetic resonance imaging (MRI) detects osteolysis and complications in the periprosthetic soft tissues such as wear-induced synovitis, periprosthetic collections, neurovascular compression, and quality of the muscle and tendons of the rotator cuff of the hip. For pain after hip resurfacing, early use of optimized MRI is recommended. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4647199 Tue, 29 Mar 2011 20:55:13 +0100 4647199 http://www.medworm.com/index.php?rid=4647198&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000034%2Fabstract%3Frss%3Dyes This study reports the presence and significance of neck narrowing in the first 500 consecutive Conserve® Plus metal-on-metal hip resurfacings in 431 patients. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4647198 Tue, 29 Mar 2011 20:55:13 +0100 4647198 http://www.medworm.com/index.php?rid=4647197&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000071%2Fabstract%3Frss%3Dyes This study sought to investigate the relationship between bearing surface wear rates of metal components and serum metal ion analysis and also to quantify the incidence of excessive increases in serum metal ion concentrations post–hip resurfacing arthroplasty. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4647197 Tue, 29 Mar 2011 20:55:13 +0100 4647197 http://www.medworm.com/index.php?rid=4647196&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810001045%2Fabstract%3Frss%3Dyes The evolution of patient sporting activities after hip resurfacing has not yet been studied. A scoring algorithm to quantify sporting activity was developed to compare type of activity, frequency, duration, and overall activity level in the early postoperative period and at mid- to long-term follow-up. Quantification of sporting activity is a challenging undertaking but should become a useful tool to study the relationship between failure rates and the use of prosthesis. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4647196 Tue, 29 Mar 2011 20:55:13 +0100 4647196 http://www.medworm.com/index.php?rid=4647195&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000058%2Fabstract%3Frss%3Dyes This study highlights the excellent radiographic survivorship profile of the Conserve® Plus socket. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4647195 Tue, 29 Mar 2011 20:55:13 +0100 4647195 http://www.medworm.com/index.php?rid=4647194&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810001100%2Fabstract%3Frss%3Dyes Total hip arthroplasty (THA) results in good outcomes in function and risk for revision in older patients. However, in young, active patients, it results in an increased rate of revision and poorer outcomes. Modern metal-on-metal hip resurfacing arthroplasty (HRA) is described as an appropriate treatment of hip osteoarthritis in young, active patients. The selection of an appropriate prosthesis is critical for this patient demographic. This review compares the functional results of THA and HRA and focuses on range of motion, activity level, groin pain, patient satisfaction, restoration of normal hip anatomy, and gait. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4647194 Tue, 29 Mar 2011 20:55:13 +0100 4647194 http://www.medworm.com/index.php?rid=4647193&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810001082%2Fabstract%3Frss%3Dyes The results of metal-on-metal hip Conserve® Plus resurfacings with up to 14 years of follow-up with and without risk factors of small component size and/or large femoral defects were compared as performed with either first- or second-generation surgical techniques. There was a 99.7% survivorship at ten years for ideal hips (large components and small defects) and a 95.3% survivorship for hips with risk factors optimized technique has measurably improved durability in patients with risk factors at the 8-year mark. The lessons learned can help offset the observed learning curve of resurfacing. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4647193 Tue, 29 Mar 2011 20:55:13 +0100 4647193 http://www.medworm.com/index.php?rid=4647192&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000083%2Fabstract%3Frss%3Dyes Over the past decade, hip resurfacing arthroplasty has made a dramatic comeback. Poor clinical results in the 1970s and 1980s resulted in many orthopedic surgeons abandoning this procedure. However, with improvements in metal-on-metal-bearing technology, new designs were introduced over the last decade to address the shortcomings in the previous generation of devices. While some reports have demonstrated excellent clinical performance of certain contemporary hip resurfacing systems, other reports have documented relatively high failure rates associated with potentially troublesome complications. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4647192 Tue, 29 Mar 2011 20:55:13 +0100 4647192 http://www.medworm.com/index.php?rid=4647191&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000095%2Fabstract%3Frss%3Dyes Few would argue that the most successful orthopedic procedure developed in the 20th century was total hip replacement (THR), and there continues to be improvement in its durability with new designs, bearing materials, and fixation techniques. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4647191 Tue, 29 Mar 2011 20:55:12 +0100 4647191 http://www.medworm.com/index.php?rid=4647190&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000162%2Fabstract%3Frss%3Dyes (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4647190 Tue, 29 Mar 2011 20:55:12 +0100 4647190 http://www.medworm.com/index.php?rid=4647189&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000150%2Fabstract%3Frss%3Dyes (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4647189 Tue, 29 Mar 2011 20:55:12 +0100 4647189 http://www.medworm.com/index.php?rid=4647188&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589811000149%2Fabstract%3Frss%3Dyes (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4647188 Tue, 29 Mar 2011 20:55:12 +0100 4647188 http://www.medworm.com/index.php?rid=4193875&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810001008%2Fabstract%3Frss%3Dyes (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4193875 Wed, 24 Nov 2010 09:02:55 +0100 4193875 http://www.medworm.com/index.php?rid=4193874&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000891%2Fabstract%3Frss%3Dyes The obesity epidemic continues to grow. As the number of obese people increases, it is logical to expect an increasing number of obese patients and increasing costs to care for these patients. Orthopedic surgeons will see many of these patients who need treatment for injuries and chronic conditions. Care of obese patients requires more work and time in providing nonoperative and operative care. No system has been proposed to handle reimbursement disparities, particularly for providers. The model for health care will change and, along with it, should be all parties coming together to address inequalities and inequities in care for obese and morbidly obese patients. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4193874 Wed, 24 Nov 2010 09:02:55 +0100 4193874 http://www.medworm.com/index.php?rid=4193873&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS003058981000088X%2Fabstract%3Frss%3Dyes This article outlines preoperative and postoperative care and describes current techniques and tools used by surgeons in obese patients to facilitate soft tissue dissection, exposure, implant placement, and closure. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4193873 Wed, 24 Nov 2010 09:02:55 +0100 4193873 http://www.medworm.com/index.php?rid=4193872&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000878%2Fabstract%3Frss%3Dyes The purpose of this article is to present the challenges of dealing with the morbidly obese patient suffering from degenerative knee arthrosis. Surgery should only be undertaken when conservative management has failed and comorbidities optimized. Owing to risks related to comorbidities, diligence is necessary before proceeding with surgery to lessen the chance of complications—especially infection. Evaluation, conservative treatments, preoperative optimization, and surgical options are discussed. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4193872 Wed, 24 Nov 2010 09:02:55 +0100 4193872 http://www.medworm.com/index.php?rid=4193870&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000751%2Fabstract%3Frss%3Dyes This article focuses on spine injuries in obese patients. Predisposition to spinal injury, effective evaluation and early management, principles of treatment planning, operative technical pearls, and postoperative management are discussed. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4193870 Wed, 24 Nov 2010 09:02:55 +0100 4193870 http://www.medworm.com/index.php?rid=4193868&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000726%2Fabstract%3Frss%3Dyes A body mass index (BMI) greater than 30 is becoming increasingly common in the United States. Surgery for pelvic and acetabular fractures in this population is particularly problematic because conventional treatment often requires large surgical exposures. The surgery for both these fractures is technically difficult because of the volume of soft tissue and proneness to complications. Wound problems and infections are particularly common after open surgery in obese patients, and these increase linearly with the BMI. In this article, we present a small consecutive series over 14 months on obese patients who underwent percutaneous treatment of their pelvic or acetabular fractures. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4193868 Wed, 24 Nov 2010 09:02:53 +0100 4193868 http://www.medworm.com/index.php?rid=4193864&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000702%2Fabstract%3Frss%3Dyes Upper extremity injuries are more prevalent in obese people than in nonobese people after low-energy falls. Because splinting and casting are inefficient methods of stabilization in the setting of obesity, internal fixation provides stability for mobilization and realignment. Morbid obesity adversely affects positioning, surgical exposures, and complications associated with operative fixation. Avoiding short cuts and complications, morbidly obese patients should be able to return to normal functioning. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4193864 Wed, 24 Nov 2010 09:02:53 +0100 4193864 http://www.medworm.com/index.php?rid=4193862&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS003058981000091X%2Fabstract%3Frss%3Dyes The obesity epidemic is ever increasing, not only in the United States, but throughout the rest of the world. As the population increases in size, it is only reasonable to assume that our patients will be larger. This edition of Orthopedic Clinics of North America is specifically dedicated to the challenges of treating obese and morbidly obese patients. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4193862 Wed, 24 Nov 2010 09:02:52 +0100 4193862 http://www.medworm.com/index.php?rid=4193861&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000994%2Fabstract%3Frss%3Dyes (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4193861 Wed, 24 Nov 2010 09:02:52 +0100 4193861 http://www.medworm.com/index.php?rid=4193860&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000982%2Fabstract%3Frss%3Dyes (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4193860 Wed, 24 Nov 2010 09:02:52 +0100 4193860 http://www.medworm.com/index.php?rid=4193859&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000970%2Fabstract%3Frss%3Dyes (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4193859 Wed, 24 Nov 2010 09:02:52 +0100 4193859 http://www.medworm.com/index.php?rid=4193871&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000738%2Fabstract%3Frss%3Dyes This article describes some of the orthopaedic conditions commonly encountered in overweight/obese children and adolescents, classically infantile and adolescent tibia vara and slipped capital femoral epiphysis. Also discussed are genu valgum, which has been associated with obesity, and other difficulties encountered in providing orthopaedic care to obese children. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4193871 Mon, 11 Oct 2010 00:00:00 +0100 4193871 http://www.medworm.com/index.php?rid=4193869&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS003058981000074X%2Fabstract%3Frss%3Dyes This article summarizes the current literature on open treatment of pelvic and acetabular fractures in the obese patient, reviews the physiologic adaptations of obesity as they relate to pelvic surgery, highlights risk factors for complications, and provides recommendations to reduce the incidence of complications. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4193869 Mon, 11 Oct 2010 00:00:00 +0100 4193869 http://www.medworm.com/index.php?rid=4193866&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000714%2Fabstract%3Frss%3Dyes This article reviews the challenges of obesity as they relate to the 7 steps of lower extremity periarticular fracture care. Specifically, helpful modifications to these 7 steps are provided for the treatment of tibial plateau fractures and tibial plafond fractures. As there is little published evidence with respect to the treatment of these injuries in the obese population, the suggestions that are provided are based on the extrapolation from published evidence of fracture care in other areas in patients with obesity, logic, and personal experience with fracture care in patients with obesity. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4193866 Mon, 11 Oct 2010 00:00:00 +0100 4193866 http://www.medworm.com/index.php?rid=4193865&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000672%2Fabstract%3Frss%3Dyes Given the ongoing epidemic of obesity, femoral fracture management in the population affected by this condition is likely to become more frequent. Fracture treatment in obese patients poses a special challenge given greater difficulty in establishing an accurate diagnosis and confirming associated injuries. Adequate intraoperative positioning and obtaining accurate reduction and stable fixation may require special considerations. Obese patients have a high predisposition for complications such as compartment syndrome, nerve injuries, and pressure ulcers, and are at increased risk for medical complications given the high prevalence of comorbidities. A thorough understanding of the risks associated with obesity and the diagnostic and therapeutic challenges involved with femoral shaft fractur... Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4193865 Mon, 11 Oct 2010 00:00:00 +0100 4193865 http://www.medworm.com/index.php?rid=4193867&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000660%2Fabstract%3Frss%3Dyes Ankle fractures are a common orthopedic injury. Certain ankle injuries have been associated with patient demographics such as obesity and smoking. Obese patients are more prone to severe ankle injuries. Naturally, these injuries affect the lower extremity mobility significantly, which itself is a risk factor for obesity. Although obese patients have increased complications across the board, there are specific techniques that can be used to assure the best possible outcome. The perioperative, surgical, and postoperative considerations as well as the outcomes are discussed in this article. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4193867 Fri, 01 Oct 2010 00:00:00 +0100 4193867 http://www.medworm.com/index.php?rid=4193863&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000684%2Fabstract%3Frss%3Dyes This article discusses the social and physical environment in which orthopedic surgeons evaluate obese patients. Special attention should be paid in both the inpatient and outpatient arenas to the different emotional and physical needs with which obese patients present in contrast to their lean counterparts. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4193863 Fri, 01 Oct 2010 00:00:00 +0100 4193863 http://www.medworm.com/index.php?rid=4007909&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000830%2Fabstract%3Frss%3Dyes (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4007909 Wed, 29 Sep 2010 16:45:07 +0100 4007909 http://www.medworm.com/index.php?rid=4007908&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000611%2Fabstract%3Frss%3Dyes Advances in medical and surgical care over the past 20 years have resulted in children who formerly would have died at birth or infancy now surviving well into adulthood, many with permanent physical disabilities, including those caused by cerebral palsy. Inadequate medical and surgical diagnoses and intervention are prevalent in the adult cerebral palsy population. Decreased physical activity and participation in physical therapy and fitness programs, along with loss of strength, contractures, and pain are common factors in the loss of functional weight bearing, self-care, and daily performance over time. Increased awareness of these problems is needed by adult health care providers who provide care to these individuals and also by pediatric providers who may be able to intervene and prev... Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4007908 Wed, 29 Sep 2010 16:45:07 +0100 4007908 http://www.medworm.com/index.php?rid=4007907&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000568%2Fabstract%3Frss%3Dyes Clinical decision making for the management of foot deformities in children with cerebral palsy is based on the collection and integration of data from 5 sources: the clinical history, physical examination, plain radiographs, observational gait analysis, and quantitative gait analysis (which includes kinematic/kinetic analyses, dynamic electromyography, and dynamic pedobarography). The 3 most common foot segmental malalignments in children with CP are equinus, equinoplanovalgus, and equinocavovarus. The 2 most common associated deformities are ankle valgus and hallux valgus. Foot and ankle deformities caused by dynamic overactivity and imbalance of muscles are best treated with pharmacologic or neurosurgical interventions designed to manage muscle tone and spasticity, or muscle tendon unit... Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4007907 Wed, 29 Sep 2010 16:45:07 +0100 4007907 http://www.medworm.com/index.php?rid=4007906&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS003058981000060X%2Fabstract%3Frss%3Dyes This article discusses the sagittal gait patterns in children with spastic diplegia, with an emphasis on the knee, as well as the concept of the “dose” of surgery that is required to correct different gait pathologies. The authors list the various interventions in the order of their increasing dose. The concept of dose is useful in the consideration of the management of knee dysfunction. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4007906 Wed, 29 Sep 2010 16:45:07 +0100 4007906 http://www.medworm.com/index.php?rid=4007905&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000659%2Fabstract%3Frss%3Dyes Hip abnormalities affect most children with cerebral palsy. Dedicated surveillance programs have been shown to be effective means of identifying hips at risk and preventing pathologic dislocation. Patients who are ambulatory and correlate with Gross Motor Function Classification Score I and II experience deformities that affect mobility and gait, but rarely dislocations. Marginal and nonambulatory patients have an increasing risk of dislocation. Once subluxation has been identified, early surgical intervention is indicated. Long-term postoperative follow-up is needed to monitor for recurrence. Individuals who recur or who do not respond to initial soft tissue releases benefit from bony surgery. Comprehensive reconstruction of the hip has become the predominant treatment approach when aceta... Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4007905 Wed, 29 Sep 2010 16:45:07 +0100 4007905 http://www.medworm.com/index.php?rid=4007904&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000623%2Fabstract%3Frss%3Dyes This article discusses the incidence, causes, natural history, and treatment of patients with scoliosis. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4007904 Wed, 29 Sep 2010 16:45:07 +0100 4007904 http://www.medworm.com/index.php?rid=4007903&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS003058981000057X%2Fabstract%3Frss%3Dyes This article covers the surgical interventions used for the reconstruction of the upper limb in patients with CP. The optimal surgical approach for each deformity type is described. In addition, the various evaluation techniques of the upper extremity, the general principles of an operative treatment plan, and the appropriate postoperative care of these patients is presented. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4007903 Wed, 29 Sep 2010 16:45:06 +0100 4007903 http://www.medworm.com/index.php?rid=4007902&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000556%2Fabstract%3Frss%3Dyes This article reviews hypertonia and provides information on discriminating between spasticity, dystonia, and rigidity. Medication and neurosurgical options for the management of hypertonia are presented and compared. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4007902 Wed, 29 Sep 2010 16:45:06 +0100 4007902 http://www.medworm.com/index.php?rid=4007901&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000635%2Fabstract%3Frss%3Dyes Individuals with cerebral palsy (CP) cannot take a normal activity like walking for granted. CP is the most common pediatric neurologic disorder, with an incidence of 3.6 per 1000 live births. The current trend in the treatment of individuals with CP is to perform a thorough evaluation including a complete patient history from birth to present, a comprehensive physical examination, appropriate radiographs, consultation with other medical specialists, and analysis of gait. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4007901 Wed, 29 Sep 2010 16:45:06 +0100 4007901 http://www.medworm.com/index.php?rid=4007900&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000647%2Fabstract%3Frss%3Dyes This article describes the balanced combination of medical history, detailed physical examination, functional assessment, imaging, observational gait analysis, computerized gait analysis, and assessment of patient and family goals that are necessary to prepare treatment plans and accurately assess outcomes of treatment of children with cerebral palsy. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4007900 Wed, 29 Sep 2010 16:45:06 +0100 4007900 http://www.medworm.com/index.php?rid=4007899&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000593%2Fabstract%3Frss%3Dyes Because of increasing interest in conducting large-scale, multicenter investigations into the epidemiology of cerebral palsy and its prevention and treatment, efforts have been made to establish a standard definition and classification systems for cerebral palsy. In recent years there has also been increased focus on measurement of functional status of patients and new classifications for gross and fine motor function have been developed. The purpose of this article is to update the orthopaedic community on the current classification systems for patients with cerebral palsy. This information will be of value to surgeons in determining patients' suitability for certain treatments and will also assist them in reviewing current literature in cerebral palsy. (Source: Orthopedic Clinics of Nort... Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4007899 Wed, 29 Sep 2010 16:45:06 +0100 4007899 http://www.medworm.com/index.php?rid=4007898&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000581%2Fabstract%3Frss%3Dyes This article provides an overview of CP. The author discusses definitions of CP, its epidemiology, pathologies, and range of possible clinical descriptions, and briefly touches on management and prevention. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4007898 Wed, 29 Sep 2010 16:45:05 +0100 4007898 http://www.medworm.com/index.php?rid=4007897&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000696%2Fabstract%3Frss%3Dyes Cerebral palsy is the most common childhood motor disorder. Orthopedic surgeons have historically been the physicians who provide the most care for these patients and their families, although more of our medical colleagues in neurology, physiatry, developmental pediatrics, and therapies have taken a larger and perhaps central role in their care. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4007897 Wed, 29 Sep 2010 16:45:05 +0100 4007897 http://www.medworm.com/index.php?rid=4007896&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000829%2Fabstract%3Frss%3Dyes (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4007896 Wed, 29 Sep 2010 16:45:05 +0100 4007896 http://www.medworm.com/index.php?rid=4007895&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000817%2Fabstract%3Frss%3Dyes (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4007895 Wed, 29 Sep 2010 16:45:05 +0100 4007895 http://www.medworm.com/index.php?rid=4007894&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000805%2Fabstract%3Frss%3Dyes (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=4007894 Wed, 29 Sep 2010 16:45:04 +0100 4007894 http://www.medworm.com/index.php?rid=3597707&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000398%2Fabstract%3Frss%3Dyes (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3597707 Wed, 26 May 2010 13:55:49 +0100 3597707 http://www.medworm.com/index.php?rid=3597706&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000155%2Fabstract%3Frss%3Dyes As our understanding of the pathoanatomy of glenohumeral instability has improved, surgical techniques for the treatment of anterior instability have progressed. Many stabilization procedures are now successfully performed arthroscopically; open capsular shift, however, continues to play an important role in the management of instability in certain patients, providing an accurate and selective means of capsular plication. When performed with proper surgical technique, shoulder range of motion can be preserved with low recurrence rates and high subjective satisfaction, making the open capsular shift a durable and effective option in the modern management of shoulder instability. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3597706 Wed, 26 May 2010 13:55:49 +0100 3597706 http://www.medworm.com/index.php?rid=3597705&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000283%2Fabstract%3Frss%3Dyes The Hill-Sachs lesion is a well-known entity that threatens recurrent instability, but the treatment options are multiple and the surgical indications remain undefined. The evidence for each operative technique is limited to retrospective reviews and small case series without controls. The decision of which technique to use resides with the surgeon. Older, osteopenic patients, especially those with underlying arthritis and large defects, should be managed with complete humeral resurfacing. Humeralplasty is best used in younger patients with good quality bone in an acute setting with small- to moderate-sized bone defects. Partial resurfacing and remplissage are best used with small to moderate lesions, and both require further study. Allograft humeral reconstruction is an established techn... Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3597705 Wed, 26 May 2010 13:55:48 +0100 3597705 http://www.medworm.com/index.php?rid=3597704&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS003058981000012X%2Fabstract%3Frss%3Dyes Recurrent anterior shoulder instability is commonly associated with glenoid bone defects. When the defect is significant, bony reconstruction is typically necessary. The congruent arc modification of the Latarjet procedure uses the concavity of the undersurface of the coracoid to optimally reconstruct the glenoid. Outcomes are maximized and complications minimized. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3597704 Wed, 26 May 2010 13:55:48 +0100 3597704 http://www.medworm.com/index.php?rid=3597703&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000088%2Fabstract%3Frss%3Dyes This article describes how and why the arthroscopic Latarjet procedure is a valuable tool in the treatment of complex shoulder instability and how the procedure can be introduced into practice. This technique has shown excellent results at short- to mid-term follow-up, with minimal complications. As such, this procedure is recommended to surgeons with good anatomic knowledge, advanced arthroscopic skills, and familiarity with the instrumentation. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3597703 Wed, 26 May 2010 13:55:48 +0100 3597703 http://www.medworm.com/index.php?rid=3597702&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000295%2Fabstract%3Frss%3Dyes The all-arthroscopic technique that the authors propose combines a Bristow-Latarjet procedure with a Bankart repair. This combined procedure provides a triple blocking of the shoulder (the so-called 2B3 procedure): (1) the labral repair recreates the anterior bumper and protects the humeral head from direct contact with the coracoid bone graft (Bumper effect); (2) the transferred coracoid bone block compensates for anterior glenoid bone loss (Bony effect); and (3) the transferred conjoined tendon creates a dynamic sling that reinforces the weak anteroinferior capsule by lowering the inferior part of the subscapularis when the arm is abducted and externally rotated (Belt or sling effect). The procedure combines the theoretic advantages of the Bristow-Latarjet procedure and the arthroscopic ... Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3597702 Wed, 26 May 2010 13:55:48 +0100 3597702 http://www.medworm.com/index.php?rid=3597701&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000131%2Fabstract%3Frss%3Dyes This article reviews the potential pitfalls in anterior shoulder stabilization and discusses appropriate methods of addressing them in revision surgery. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3597701 Wed, 26 May 2010 13:55:48 +0100 3597701 http://www.medworm.com/index.php?rid=3597700&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000106%2Fabstract%3Frss%3Dyes This article focuses on the arthroscopic management of MDI. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3597700 Wed, 26 May 2010 13:55:48 +0100 3597700 http://www.medworm.com/index.php?rid=3597699&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000064%2Fabstract%3Frss%3Dyes This article describes the anatomic-based arthroscopic approach to treatment of RPS, which allows for enhanced identification and repair of intra-articular pathology including posterior capsular laxity, complete or incomplete detachment of the posterior capsulolabral complex, and inferior capsular tears. While postoperative results are generally good to excellent after stabilization for RPS, there is room for improvement. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3597699 Wed, 26 May 2010 13:55:48 +0100 3597699 http://www.medworm.com/index.php?rid=3597698&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000118%2Fabstract%3Frss%3Dyes This article focuses specifically on the pearls and pitfalls that are important to recognize in the preoperative workup, intraoperative evaluation, and arthroscopic surgery to optimize surgical outcomes for anterior instability. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3597698 Wed, 26 May 2010 13:55:48 +0100 3597698 http://www.medworm.com/index.php?rid=3597697&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000143%2Fabstract%3Frss%3Dyes Repetitive throwing or other overhead activity places great stress on the shoulder. As a result, the shoulder is a common site of injury in athletes. Addressing throwing-related injuries requires an understanding of throwing biomechanics and pathology. Nonoperative treatment is directed at restoring strength, flexibility, and neuromuscular control to the entire kinetic chain. Surgery is indicated when nonoperative treatment fails, and is directed at correcting labral, capsular, and rotator cuff pathology. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3597697 Wed, 26 May 2010 13:55:48 +0100 3597697 http://www.medworm.com/index.php?rid=3597696&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000076%2Fabstract%3Frss%3Dyes The capsule, labrum, glenohumeral ligaments, and rotator cuff represent the static and dynamic stabilizers of the glenohumeral joint. Various injuries can occur to one or more of these structures during traumatic shoulder dislocation, predisposing the patient to recurrent instability. Improved understanding of shoulder anatomy and biomechanics, and advancements in arthroscopic technique led to the recognition of various pathologic lesions that may contribute to instability. The ability to identify and address these lesions during arthroscopy will allow the surgeon to more fully tailor operative treatments for each individual patient suffering from shoulder instability. Furthermore, the ability to differentiate pathologic lesions from normal anatomic variants is critical to avoid inadverten... Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3597696 Wed, 26 May 2010 13:55:48 +0100 3597696 http://www.medworm.com/index.php?rid=3597695&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS003058981000009X%2Fabstract%3Frss%3Dyes This article describes clinical evaluation of the glenohumeral joint using pertinent components of the patient history, physical examination, and selective imaging to arrive at the diagnosis of glenohumeral instability in the symptomatic patient. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3597695 Wed, 26 May 2010 13:55:48 +0100 3597695 http://www.medworm.com/index.php?rid=3597694&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000301%2Fabstract%3Frss%3Dyes Treatment for the unstable shoulder has evolved from Hippocrates' “hot poker” treatment to the open repairs popularized by Bankart, Rowe, and Neer to arthroscopic labral and capsular repairs. This special issue of Orthopedic Clinics of North America focuses on the arthroscopic and open management of shoulder instability, and we have enlisted experts from around the world to share their pearls, pitfalls, and insights in managing these challenging problems. Specific emphasis is placed on the proper management of the unstable shoulder in association with bone defects, as this variable has been associated with significantly higher failure rates. Although the open Latarjet and Bristow have just recently enjoyed a renaissance in North America and are highlighted in the excellent contribution... Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3597694 Wed, 26 May 2010 13:55:48 +0100 3597694 http://www.medworm.com/index.php?rid=3597693&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000386%2Fabstract%3Frss%3Dyes (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3597693 Wed, 26 May 2010 13:55:48 +0100 3597693 http://www.medworm.com/index.php?rid=3597692&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000374%2Fabstract%3Frss%3Dyes (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3597692 Wed, 26 May 2010 13:55:48 +0100 3597692 http://www.medworm.com/index.php?rid=3597691&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000362%2Fabstract%3Frss%3Dyes (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3597691 Wed, 26 May 2010 13:55:48 +0100 3597691 http://www.medworm.com/index.php?rid=3474101&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000246%2Fabstract%3Frss%3Dyes (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3474101 Wed, 31 Mar 2010 23:00:00 +0100 3474101 http://www.medworm.com/index.php?rid=3474100&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000052%2Fabstract%3Frss%3Dyes Deep venous thrombosis (DVT) is the end result of a complex interaction of events including the activation of the clotting cascade in conjunction with platelet aggregation. Patients undergoing major lower extremity orthopedic surgery, especially total joint arthroplasty (TJA), are at high risk for developing a postoperative DVT or a subsequent pulmonary embolus. Venous thromboembolic (VTE) prophylaxis, most commonly pharmacologic prophylaxis, has become the standard of care for patients undergoing elective TJA. However, the controversy between the efficacy of VTE prophylaxis and the increased risk for bleeding in the postoperative period continues to exist. This review addresses the controversy underlying VTE prophylaxis by outlining 2 guidelines and demonstrating the pros and cons of diff... Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3474100 Wed, 31 Mar 2010 23:00:00 +0100 3474100 http://www.medworm.com/index.php?rid=3474099&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000039%2Fabstract%3Frss%3Dyes Hip resurfacing arthroplasty has reemerged as a valid reconstruction option for the osteoarthritic hip. Patient selection is critical for excellent surgical outcomes, especially when compared with total hip arthroplasty. However, concerns regarding surgical technique and postsurgical complications persist. The authors review the evidence for surgical technique, outcomes, and complications related to modern metal-on-metal hip resurfacing arthroplasty. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3474099 Wed, 31 Mar 2010 23:00:00 +0100 3474099 http://www.medworm.com/index.php?rid=3474098&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589809001163%2Fabstract%3Frss%3Dyes Tear of the anterior cruciate ligament (ACL) is the most common ligamentous injury of the knee. Reconstructing this ligament is often required to restore functional stability of the knee. Many graft options are available for ACL reconstruction, including different autograft and allograft tissues. Autografts include bone-patellar tendon-bone composites (PT), combined semitendinosus and gracilis hamstring tendons (HT), and quadriceps tendon. Allograft options include the same types of tendons harvested from donors, in addition to Achilles and tibialis tendons. Tissue-engineered anterior cruciate grafts are not yet available for clinical use, but may become a feasible alternative in the future. The purpose of this systematic review is to assess whether one of the popular grafts (PT and HT) is... Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3474098 Wed, 31 Mar 2010 23:00:00 +0100 3474098 http://www.medworm.com/index.php?rid=3474097&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589809001151%2Fabstract%3Frss%3Dyes This article is a review and critique of the methodology used in the SPRINT trial. Numerous aspects of the trial's design served to greatly reduce the potential bias, producing sound and reliable results. Overall, the SPRINT trial should provide recommendations for change in clinical practice and also set a benchmark for the conduct of randomized controlled trials in orthopedic surgery. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3474097 Wed, 31 Mar 2010 23:00:00 +0100 3474097 http://www.medworm.com/index.php?rid=3474096&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589809001138%2Fabstract%3Frss%3Dyes Lower Extremity Assessment Project (LEAP) study set out to answer many of the questions surrounding the decision of whether to amputate or salvage limbs in the setting of severe lower extremity trauma. A National Institutes of Health–funded, multicenter, prospective observational study, the LEAP study represented a milestone in orthopedic trauma research, and perhaps in orthopedics. The LEAP study attempted to define the characteristics of the individuals who sustained these injuries, the characteristics of their environment, the variables of the physical aspects of their injury, the secondary medical and mental conditions that arose from their injury and treatment, their ultimate functional status, and their general health. In the realm of evidence-based medicine, the LEAP studies provi... Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3474096 Wed, 31 Mar 2010 23:00:00 +0100 3474096 http://www.medworm.com/index.php?rid=3474095&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589809001126%2Fabstract%3Frss%3Dyes Clavicle fractures are common, and they comprise close to 3% of all fractures seen in fracture clinics. Midshaft fractures account for approximately 80% of all clavicle fractures and are the focus of this article. In carefully selected cases primary plate fixation of displaced midshaft clavicle fractures improves outcome, results in earlier return to function, and reduces the nonunion and symptomatic malunion rate significantly compared with nonoperative treatment. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3474095 Wed, 31 Mar 2010 23:00:00 +0100 3474095 http://www.medworm.com/index.php?rid=3474094&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000040%2Fabstract%3Frss%3Dyes Lumbar disc herniations are common clinical entities that may cause lumbar-related symptoms. The spectrum of treatment options is geared toward a patient's clinical presentation and ranges from nothing to surgical intervention. Many lumbar disc herniations cause no significant symptoms. In studies of asymptomatic individuals who have never experienced lumbar-related symptoms, 30% have been reported to have major abnormality on magnetic resonance imaging. The mainstay of treatment of patients with symptomatic disc herniations is accepted to be nonoperative (as long as there are no acute or progressive neurologic deficits); this includes medications, physical therapy, and potentially lumbar injection. For patients with symptomatic disc herniations who fail to respond appropriately to conserv... Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3474094 Wed, 31 Mar 2010 23:00:00 +0100 3474094 http://www.medworm.com/index.php?rid=3474093&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589809001114%2Fabstract%3Frss%3Dyes This article provides a synopsis of the literature on human subjects. There is a need for high-quality evidence for interventions for spinal pathology. An evidence-based approach to the management of spinal disorders will require ongoing assessment of clinical outcomes and comparison of effectiveness between alternatives. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3474093 Wed, 31 Mar 2010 23:00:00 +0100 3474093 http://www.medworm.com/index.php?rid=3474092&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589809001175%2Fabstract%3Frss%3Dyes This article explores some of the controversies about CSM and reviews pertinent articles, specifically prospective and randomized clinical trials when possible, to obtain the cleanest and least biased data. The 4 current controversial topics that surround CSM are: (1) natural history of mild CSM; (2) surgical approach: anterior versus posterior; (3) laminoplasty or laminectomy; and (4) cervical arthroplasty for CSM. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3474092 Wed, 31 Mar 2010 23:00:00 +0100 3474092 http://www.medworm.com/index.php?rid=3474091&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589809001102%2Fabstract%3Frss%3Dyes Lumbar spinal stenosis is a common cause of impaired quality of life and diminished functional capacity in the elderly. Due to the advance of noninvasive imaging modalities, spinal stenosis is becoming more frequently identified, and has become the most frequent cause for spinal surgery in patients older than 65 years. Despite the ubiquitous nature of this condition, considerable controversy exists regarding the preferred treatment. Level I evidence that compares the effectiveness of surgical and nonsurgical treatment is lacking. The Spine Patient Outcomes Research Trial, a study that evaluates the common surgical treatments for the lumbar spine, has addressed this deficiency and is discussed in this article. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3474091 Wed, 31 Mar 2010 23:00:00 +0100 3474091 http://www.medworm.com/index.php?rid=3474090&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589809001096%2Fabstract%3Frss%3Dyes This article compares the outcomes following spinal fusion and disk replacement for degenerative conditions of the lumbar and cervical spine. The short-term outcomes of lumbar and cervical total disk replacement are equivalent to that following spinal fusion. Long-term follow-up studies of total disk replacement are necessary to confirm its potential benefit in reducing or preventing adjacent level degeneration. Also discussed is the philosophy of the surgical management of degenerative conditions of the lumbar and cervical spine. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3474090 Wed, 31 Mar 2010 23:00:00 +0100 3474090 http://www.medworm.com/index.php?rid=3474089&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000027%2Fabstract%3Frss%3Dyes For decades, the basic tenets of managing displaced femoral neck fractures have not changed, but the optimal treatment choice continues to be highly debated. The contemporary controversies associated with the treatment principles of displaced femoral neck fractures are distinct between young and old patients and are considered individually in this article about the current evidence. Although fixation constructs all seem to have similar complication rates, there is increasing evidence suggesting that total hip replacement improves patient functional outcomes for healthy, independent, elderly patients compared with hemiarthroplasty and should be considered as the treatment of choice for these patients. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3474089 Wed, 31 Mar 2010 23:00:00 +0100 3474089 http://www.medworm.com/index.php?rid=3474088&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589809001060%2Fabstract%3Frss%3Dyes This article discusses the barriers to implementation of surgical RCTs. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3474088 Wed, 31 Mar 2010 23:00:00 +0100 3474088 http://www.medworm.com/index.php?rid=3474087&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589809001072%2Fabstract%3Frss%3Dyes The promise of evidence-based medicine is to integrate the highest levels of clinical data with patient outcomes. After framing the question and identifying appropriate studies, evaluating their relevance to clinical practice is highly dependent on the instruments and measures selected to demonstrate outcomes. Currently, there are hundreds of outcomes measures available in the orthopedic literature evaluating these treatments, and it is not uncommon for different measures to produce conflicting results. Consequently, the ability to evaluate an outcomes measure is critical in determining the value of a specific treatment intervention. Similarly, selecting the appropriate outcomes measure for research or clinical purposes is an important decision that may have far reaching implications on re... Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3474087 Wed, 31 Mar 2010 23:00:00 +0100 3474087 http://www.medworm.com/index.php?rid=3474086&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589809001084%2Fabstract%3Frss%3Dyes Evidence–based medicine integrates clinical expertise, patients' values and preferences, and the best available evidence from the medical literature. Evidence–based orthopedics is a model to assist surgeons to improve the process of asking questions, obtaining relevant information efficiently, and making informed decisions with patients. With an increasing appreciation for higher levels of evidence, orthopedic surgeons should move away from lower forms of evidence. The adoption of randomized trials and high-quality prospective studies to guide patient care requires 2 prerequisites: (1) greater appreciation for the conduct of randomized trials in orthopedics and (2) improved education and training in evidence-based methodologies in surgery. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3474086 Wed, 31 Mar 2010 23:00:00 +0100 3474086 http://www.medworm.com/index.php?rid=3474085&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000167%2Fabstract%3Frss%3Dyes The principles of evidence-based medicine have been available to us since “The Canon of Medicine” was completed in 1025 by Avicenna. The application of best available evidence to contemporary clinical decision making is not a new one—however, our appreciation of the impact these concepts have on patient care have recently become a subject of great interest. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3474085 Wed, 31 Mar 2010 23:00:00 +0100 3474085 http://www.medworm.com/index.php?rid=3474084&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000234%2Fabstract%3Frss%3Dyes (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3474084 Wed, 31 Mar 2010 23:00:00 +0100 3474084 http://www.medworm.com/index.php?rid=3474083&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000222%2Fabstract%3Frss%3Dyes (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3474083 Wed, 31 Mar 2010 23:00:00 +0100 3474083 http://www.medworm.com/index.php?rid=3474082&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589810000210%2Fabstract%3Frss%3Dyes (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3474082 Wed, 31 Mar 2010 23:00:00 +0100 3474082 http://www.medworm.com/index.php?rid=3006271&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589809001011%2Fabstract%3Frss%3Dyes (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3006271 Thu, 19 Nov 2009 15:03:17 +0100 3006271 http://www.medworm.com/index.php?rid=3006270&cid=s_38705_31_f&fid=38705&url=http%3A%2F%2Fwww.orthopedic.theclinics.com%2Farticle%2FPIIS0030589809000686%2Fabstract%3Frss%3Dyes A thoughtful treatment algorithm is required to optimally treat distal tibia nonunion. A healthy respect for the tenuous soft tissue envelope, compromised vascularity, and challenging mechanical environment is advisable. Achieving osseous union and improved functionality requires an individualized plan of care based on the personality of the nonunion and host. Attention must be focused on providing mechanical stability at the site of nonunion and providing biologic supplementation. (Source: Orthopedic Clinics of North America) Orthopedic Clinics of North America journals http://www.medworm.com/rss/comments.php?id=3006270 Thu, 19 Nov 2009 15:03:17 +0100 3006270