Journal of Bone and Joint Surgery
1535-1386
0021-9355
Mỹ
Cơ quản chủ quản: Lippincott Williams and Wilkins Ltd. , LIPPINCOTT WILLIAMS & WILKINS
Phân tích ảnh hưởng
Thông tin về tạp chí
Lĩnh vực:
SurgerySports ScienceMedicine (miscellaneous)Orthopedics and Sports Medicine
The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, JBJS publishes evidence-based research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do, from the science of the content published to the customer service we provide. JBJS is an independent, non-profit journal. JBJS.org is the version of record of The Journal of Bone & Joint Surgery. JBJS is published twice a month on the first and third Wednesday of each month, each time adding to a comprehensive PDF archive dating back to 1889. Additional features online include: article commenting, social sharing links, instructional videos, podcasts, and continuing medical education activities. Contributions from anywhere in the world are welcome and considered on their merits. The manuscript must be written in English and should be submitted as outlined in the Instructions for Authors. Manuscripts are subject to blinded peer review by experts and a final decision by the editor. Papers are judged by the quality and relevance of the work. Our aim is to publish the best material available from anywhere in the world.
Preventing the Development of Chronic Pain After Orthopaedic Surgery with Preventive Multimodal Analgesic Techniques
Tập 89 Số 6 - Trang 1343-1358 - 2007
Postoperative CT Is Superior for Acetabular Fracture Reduction Assessment and Reliably Predicts Hip Survivorship
Background:
Postoperative pelvic radiographs are routinely used to assess acetabular fracture reduction. We compared radiographs and computed tomography (CT) with regard to their ability to detect residual fracture displacement. We also determined the association between the quality of reduction as assessed on CT and hip survivorship and identified risk factors for conversion to total hip arthroplasty (THA).
Methods:
Patients were included in the study who had undergone acetabular fracture fixation between 1992 and 2012, who were followed for ≥2 years (or until early THA), and for whom radiographs and a pelvic CT scan were available. Residual displacement was measured on postoperative radiographs and CT and graded according to Matta’s criteria (0 to 1 mm indicating anatomic reduction; 2 to 3 mm, imperfect reduction; and >3 mm, poor reduction) by observers who were blinded to patient outcome. Kaplan-Meier survivorship curves were plotted and log-rank tests were used to assess statistical differences in survivorship curves between adequate (anatomic or imperfect) and inadequate reductions on CT. Cox proportional hazard regression analysis was used to identify risk factors for conversion to THA. Two hundred and eleven patients were included. At mean of 9.0 years (standard deviation [SD], 5.6; median, 7.9; range, 0.5 to 23.3 years) postoperatively, 161 patients (76%) had retained their native hip.
Results:
Compared with radiographs, CT showed worse reduction in 124 hips (59%), the same reduction in 79 (37%), and better reduction in 8 (4%). Of the 99 patients graded as having adequate reduction on CT, 10% underwent conversion to THA in comparison with 36% of those with inadequate reduction, and there was a significant difference between the survivorship curves (p < 0.001). Mean hip survivorship was shorter in patients ≥50 years of age (p < 0.001) and in those with an inadequate reduction on CT (p < 0.001). Independent risk factors for conversion to THA were age (hazard ratio [HR] = 4.46, 95% confidence interval [CI] = 2.07 to 9.62; p < 0.001), inadequate reduction (HR = 3.57, 95% CI = 1.71 to 7.45; p = 0.001), and posterior wall involvement (HR = 1.81, 95% CI = 1.00 to 3.26; p = 0.049). Sex, fracture type (elementary versus associated), and year of surgery did not influence hip survivorship.
Conclusions:
CT is superior to radiographs for detecting residual displacement after acetabular fracture fixation. Hip survivorship is greater in patients with adequate (anatomic or imperfect) reduction on CT. Along with older age and posterior wall involvement, an inadequate reduction on CT is a risk factor for conversion to THA.
Level of Evidence:
Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
Tập 99 Số 20 - Trang 1745-1752 - 2017
The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip.
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Ewingʼs sarcoma. A clinicopathological and statistical analysis of patients surviving five years or longer
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A skip lesion in association with Ewing sarcoma. Report of a case.
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