Physical Impairment and Functional Outcome in Patients Having Lower Extremity Fractures After Age 65--Brodie E. McKoy, MD, Langdon A. Hartsock, MD

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The purpose of this study was to evaluate physical impairment and functional outcome in a group of patients who had a fracture of a lower extremity after age 65. The 30 subjects participating were treated between January 1992 and February 1998, for a unilateral fracture of the lower extremity. At the return examination, the patients’ lower extremities were evaluated for range of motion (ROM) and strength. The participants also completed the Short Form 36 (SF-36) questionnaire, and their scores were compared with those of age-matched controls to determine relative disability. There were no statistically significant differences in ROM or muscle strength of the injured versus noninjured extremities, except in the case of knee flexion. The Mental Component Score (MCS) of the SF-36 in our study population was statistically different from that of controls, and there was no statistical difference in the Physical Component Score (PCS). A moderate correlation was found between the PCS and physical impairment.

Complications of the Anterior Retropharyngeal Approach in Cervical Spine Surgery:--Scott D. Hodges, DO S. Craig Humphreys, MD, Teddy W. Brown, Jr., MD, Jason C. Eck, MS, Laurie A. Covington, BS

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The retropharyngeal approach is used to avoid the risks and limitations of transmucosal surgery. The standard Smith-Robinson approach does not allow complete exposure of the C3 body/disk in patients requiring instrumentation of C3 or in patients with a short, thick neck. The anterior retropharyngeal approach provides additional exposure to the entire cervical spine in these patients. Our results in 14 cases show the anterior retropharyngeal approach to the upper and lower cervical spine to be an effective surgical technique in cases of upper cervical spine abnormalities and for multilevel abnormalities in patients with a short, thick neck. Although complications occurred as a result of the procedure, no permanent disorders were encountered. Adequate exposure to the entire cervical spine can be achieved without the high incidence of infection associated with the transoral approach.

Preoperative Administration of Epoetin alfa to Reduce Transfusion Requirements in Elderly Patients Having Primary Total Hip or Knee Reconstruction--Robert A. Lofthouse, FRCS; Marilyn A. Boitano, MD; James R. Davis, FRCS; Riyaz H. Jinnah, MD

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Avoidance of allogeneic blood transfusion is challenging in elderly patients with multiple comorbid conditions, who need major elective orthopaedic surgery. We conducted a study comparing the safety and efficacy of preoperative recombinant human erythropoietin (epoetin alfa) in patients having major elective orthopaedic surgery and in matched historical control patients. Patients aged 70 years or more undergoing primary total knee arthroplasty (TKA) or total hip arthroplasty (THA) were given two or three doses, respectively, of epoetin alfa (40,000 IU). They also received oral iron for 14 or 21 days. Epoetin alfa increased hemoglobin (Hb) and hematocrit (HCT) levels before surgery; 74% of control patients required blood transfusion, compared with 12.5% of patients receiving epoetin alfa. No serious adverse event was attributed to study treatment. These data indicate that epoetin alfa is safe and effective and reduces the need for allogeneic blood transfusion in elderly patients having elective total joint replacement.

Patient Compliance and Satisfaction With Mechanical Devices for Preventing Deep Venous Thrombosis After Joint Replacement--Kathleen A. Robertson, MD; Alexander J. Bertot, MD; Michael W. Wolfe, MD; Robert L. Barrack, MD

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A consecutive series of patients having total joint arthroplasty at a single university hospital were sequentially treated with two mechanical devices for prevention of deep venous thrombosis (DVT). The first 104 patients (group 1) wore thigh-high sequential compression device (SCD). The next 120 patients (group 2) wore a foot pump. Daily documentation of hourly compliance with each respective device was recorded until discharge. A patient satisfaction questionnaire was also obtained. Patient understanding about the devices’ function aided compliance (73% compliance in group 1, and 77% in group 2). The satisfaction questionnaire revealed significantly greater satisfaction in group 2 (73%) versus group 1 (55%). Of a subgroup of 35 patients who had used both devices, 24 preferred the foot pump, 7 the SCD, and 4 had no preference. This study showed a higher degree of compliance and satisfaction for foot pumps as prophylaxis against DVT.

Biomechanics of Minor Automobile Accidents: Treatment Implications for Associated Chronic Spine--J. Monroe Laborde, MD, MS

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Biomedical experimental data indicate that automobile accidents with no vehicle damage are unlikely to cause injury to the occupants. Soft tissue injuries heal in a few weeks. Chronic pain has never been produced by experimental injury and is much less common in countries without financial payments for accident victims. Chronic pain after no-damage collisions is probably caused by psychologic factors. Psychologic treatment should be added to conventional nonoperative treatment when no objective explanation for chronic symptoms is found.

Reinfusion Drains After Primary Total Hip and Total Knee Arthroplasty--Michael A. Mont, MD; Kyle Low, MD; Dawn M. LaPorte, MD Emmanuel Hostin, MD; Lynne C. Jones, PhD; David S. Hungerford, MD

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The purposes of this study were to evaluate the efficacy of intraoperative surgeon-elected reinfusion drain placement and to determine whether drainage at 90 minutes is useful in predicting the need for a reinfusion drain. In the standard drain hip arthroplasty group, 6 of 30 patients (20%) received a reinfusion, similar to the 11 of 41 patients (27%) in the reinfusion drain group. In the total knee arthroplasty group, 38 of 45 patients (84%) in the standard group had reinfusion, similar to the 23 of 27 patients (85%) in the reinfusion drain group. The surgeon could not predict intraoperatively which patients would need a subsequent reinfusion drain. However, in more than 94% of the cases, one could know by 90 minutes postoperatively whether a reinfusion would be necessary. We believe that a drain that can be converted to a reinfusion drain in the recovery room would be the most cost-effective drain system.

Perioperative Enteric Nutritional Supplementation in Pediatric Patients With Neuromuscular Scoliosis--James F. Mooney III, MD

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Perioperative nutritional status has been shown to be important in minimizing complications after extensive spinal procedures. Traditionally, total parenteral nutrition has been used to supplement oral nutrition intake. Little information exists regarding the risks and benefits of enteric supplementation in pediatric patients. To assess use and safety of enteric nutritional supplementation after extensive pediatric spine surgery, a retrospective review was done of 21 consecutive pediatric cerebral palsy patients receiving enteric nutritional supplementation via nasal or gastric feeding tubes after, and/or between stages of, anterior and posterior spinal fusions. Enteric supplementation was maintained for an average of 9.1 days, and the lowest albumin and total protein levels were seen the third postoperative day. Enteric nutritional supplementation was found to be a safe alternative to total parenteral nutrition in pediatric cerebral palsy patients after spinal stabilization procedures. In addition, enteric feedings may be less costly than central hyperalimentation and do not carry the inherent risk of central venous access.

Complications in Total Knee Arthroplasty With and Without Surgical Drainage--R. Scott Corpe, MD; James W. Gallentine, MD; Timothy R. Young, DO; David E. Steflik, EdD; Joseph Rectinwald, MD; Shashidhar Kusuma, MD

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The standard practice in total joint arthroplasty has included the use of postsurgical drains to minimize perioperative wound complications, particularly infection. This practice is not without cost and potential morbidity. Our recent cemented and cementless total knee arthroplasties (TKAs) have been done without the use of postoperative surgical drains and without any appreciable increase in wound complications. To confirm this, we retrospectively reviewed 227 consecutive TKAs, specifically evaluating perioperative wound complications. No statistical increase in perioperative complications in TKAs without drains was found. A lower percentage of complications was seen in the cementless population when compared with cemented or drained knees. We suggest that surgical drainage is not required in TKA, even when cementless fixation is used.

Isolated Acute Hip Adductor Brevis Strain--David E. Attarian, MD

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Acute muscle strain occurs as a result of an eccentric contraction that exceeds the biomechanical strength of the musculotendinous junction of a single muscle within a synergistic group. To date, only the (hip) adductor longus was shown to sustain this type of injury. In this case report, I describe the first published example of an magnetic resonance imaging (MRI)-documented acute hip adductor brevis strain.

Intraosseous Ganglia of Glenoid--Mordechai Kligman, MD Moshe Roffman, MD

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A rare case of intraosseous ganglia of the glenoid in a 35-year-old woman is presented. The patient had painful right shoulder and no limit of motion. Radiographs and computed tomographic scans showed a large lytic lesion involving the entire glenoid bone. The patient was treated by curettage and autocorticocancellous bone graft. Six months after the operation, the patient has an excellent clinical outcome and radiologic sign of integration of the bone graft. Few cases of intraosseous ganglia of the glenoid have been reported, but none with the entire glenoid involvement.

Incidental Finding of Chondroid Lipoma at Total Hip Arthroplasty--Con Vasili, MD Mordechai Kligman, MD George Kirsh, MB, BS

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Chondroid lipoma is a rare, benign, lipomatous soft tissue tumor that manifests as a painless lump. We report the incidental finding of such a tumor at total hip replacement and briefly review the literature regarding the histopathologic features of this recently described neoplasm.

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