A retrospective analysis was conducted on injury statistics compiled over 12 seasons, from 1982 t... more A retrospective analysis was conducted on injury statistics compiled over 12 seasons, from 1982 to 1993 (2.55 million skier-days), at a Wyoming ski resort. The population at risk was determined by ticket sales per year. A total of 9749 skiing injuries was indexed by anatomic region and severity according to diagnosis on initial evaluation. Injury rates were then analyzed as a function of time. The injury rate remained constant at 3.7 injuries per 1000 skier-days during the 12 seasons. The rate of lower extremity to upper extremity injury decreased from 4:1 to 2:1 during the study period (P < 0.03). The ankle injury rate also decreased with time (P < 0.04). Ulnar collateral ligament sprains make up 7% of all injuries. Knee sprains in general account for 30% of all injuries. The incidence of anterior cruciate ligament tears increased as a function of time (P < 0.04) and accounted for 16% of all skiing injuries during the study period. The medial collateral ligament sprain was the most common injury, making up 18% of skiing injuries. Forty-seven snowboard injuries from the 1992 to 1993 season are also presented. Our injury statistics mirror those currently reported in North America, except our data reflect a higher incidence of knee sprains.
Journal of Bone and Joint Surgery, American Volume, Apr 1, 2004
Background: Although both corticosteroid and hyaluronic acid injections are widely used to pallia... more Background: Although both corticosteroid and hyaluronic acid injections are widely used to palliate the symptoms of knee osteoarthritis, little research involving a comparison of the two interventions has been done. We tested the hypothesis that there are no significant differences between Hylan G-F 20 (Synvisc) and the corticosteroid betamethasone sodium phosphate-betamethasone acetate (Celestone Soluspan) in terms of pain relief or improvement in function, as determined by validated scoring instruments. Methods: One hundred patients with knee osteoarthritis were randomized to receive intra-articular injection of either Hylan G-F 20 or the corticosteroid, and they were followed for six months. The patients treated with Hylan G-F 20 received one course of three weekly injections. The patients treated with the corticosteroid received one injection at the time of enrollment in the study, and they could request one more injection any time during the study. An independent, blinded evaluator assessed the patients with the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), a modification of the Knee Society rating system, and the visual analog pain scale. Results: Both the group treated with the corticosteroid and the group treated with Hylan G-F 20 demonstrated improvements from baseline WOMAC scores (a median decrease from 55 to 40 points and from 54 to 44 points, respectively; p < 0.01 for both). The scores according to the Knee Society system did not significantly improve for the patients who received the corticosteroid (median, 58 to 70 points; p = 0.06) or for those who received Hylan G-F 20 (median, 58 to 68 points; p = 0.15). The scores on the visual analog scale improved for patients receiving Hylan G-F 20 (median, 70 to 52 mm; p < 0.01) but not for the patients who received the corticosteroid (median, 64 to 52 mm; p = 0.28). However, no significant differences between the two treatment groups were found with respect to the WOMAC, Knee Society system, or visual analog scale results. Women demonstrated a significant improvement in only one of the six possible outcome-treatment combinations (the WOMAC scale), whereas men demonstrated significant improvements in five of the six outcomes (all measures except the Knee Society rating system). Conclusions: No differences were detected between patients treated with intra-articular injections of Hylan G-F 20 and those treated with the corticosteroid with respect to pain relief or function at six months of follow-up. Women demonstrated significantly less response to treatment than men did for both treatments on all three outcome scales. Such significant gender-related differences warrant further investigation. Level of Evidence: Therapeutic study, Level I-1b (randomized controlled trial [no significant difference but narrow confidence intervals]). See Instructions to Authors for a complete description of levels of evidence.
The Journal of Bone and Joint Surgery-American Volume, 2003
To The Editor: We read with great interest "Increased Frequency of Acute Local Reaction to I... more To The Editor: We read with great interest "Increased Frequency of Acute Local Reaction to Intra-Articular Hylan GF-20 (Synvisc) in Patients Receiving More Than One Course of Treatment" (2002; 84:1619-23), by Leopold et al. The authors compared the frequency of adverse events in a group of osteoarthritis patients who had received multiple courses of Synvisc with that in another group who had received a single course. Although an important issue was examined by the authors with regard to the treatment of osteoarthritis with Synvisc, we believe that weaknesses in the study design (some of which are mentioned in the paper) raise questions regarding the validity of their conclusions. Data on the baseline characteristics and the local adverse events in the group of nineteen patients who had received more than one course of Synvisc were collected retrospectively by means of a chart review. In contrast, data on the forty-two patients who had received only one course were obtained prospectively within the structure of a separate clinical trial. This clinical trial involved more than one treatment group; however, only the patients treated with Synvisc were included in the analysis discussed in the paper. Although the same investigators administered Synvisc to the patients in the prospective cohort, it is unclear if other physicians injected Synvisc and/or evaluated the patients in the retrospective cohort. Even if the same physicians were involved in the administration of Synvisc and the …
Six goats had 2 Schanz pins inserted in each tibia. Twenty-four pins were inoculated with saline ... more Six goats had 2 Schanz pins inserted in each tibia. Twenty-four pins were inoculated with saline or Staphylococcus aureus. Three investigators, blinded to the inoculum, evaluated 23 pins at 14 days. Clinical pin tract infections developed in all inoculated pins and in 5/12 uninoculated pins, Quantitative cultures demonstrated that infections were produced in 10/11 inoculated and in 0/12 uninoculated pins. Prediction of culture status by clinical criterion (P<.01, Fisher Exact Test) had 100% sensitivity and a 58% specificity. The prediction of infection in inoculated sites by culture criterion (P<.001, Fisher Exact Test) had a 91% sensitivity and 100% specificity. A reproducible long bone pin tract infection model was developed that produced clinically and microbiologically evident pin tract infections.
An outbreak of dermatitis occurred among county jail inmates who removed dead fish from the Sacra... more An outbreak of dermatitis occurred among county jail inmates who removed dead fish from the Sacramento River in California after a spill of metam sodium. The spilled chemical decomposes to methylisothiocyanate (MITC), a known skin irritant. A retrospective cohort study was conducted among the inmates and their crew leaders. Among 42 jail group members, 27 had dermatitis involving the feet and ankles; dermatitis was associated with lower extremity water 'contact (RR = 3.4,95% CI 1.0-I 1.8); the attack rate increased with length of time spent in the water. For comparison, other state and federal employees who worked in the river at the same time were also interviewed. None reported dermatitis. Over three-quarters (24/31) of these other clean-up workers whose feet became wet changed to dry clothing immediately; none of the jail group changed immediately. The river concentration of MITC measured 20-40 ppb at the time of exposure. We speculate that prolonged wetness, occlusive boots, friction, and heat contributed to chemical irritation at this low concentration; the experience of the other cleanup workers suggests that this outbreak could have been prevented.
An 18-year-old male presented to his family physician approximately 45 minutes after sustaining a... more An 18-year-old male presented to his family physician approximately 45 minutes after sustaining an injury to his right shoulder. He was tackled by another player while playing football. He noted a "pop" at his right sternoclavicular joint (SCJ), and resultant difficulty moving the right arm secondary to pain and a reproducible popping sensation of the clavicle. He denied numbness or tingling, shortness of breath, neck pain, jaw pain, or facial swelling, but noted mild difficulty swallowing. The patient's past medical history was unremarkable. On physical examination, there was asymmetric swelling at the right SCJ. His skin was intact. Range of motion and strength was limited by pain. Tenderness to palpation was present at the right SCJ, and shoulder motion produced a palpable clavicular "clunk." The neurovascular exam of the right upper extremity was unremarkable. Radiographs revealed an asymmetry of the SC joints (Fig. 1). The patient's arm was placed in a sling, and an emergent CT scan was then obtained (Figs. 2 and 3).
Background: Tears of the posterior cruciate ligament (PCL) in pediatric patients, especially avul... more Background: Tears of the posterior cruciate ligament (PCL) in pediatric patients, especially avulsions from its tibial insertion, are not frequently encountered by physicians. However, with an increasing incidence of ligamentous injuries to the knee in skeletally immature patients, orthopaedic surgeons will more frequently need to decide how best to manage a PCL injury in children with open physes. Methods: A 10-year-old boy sustained an avulsion of the PCL from its tibial insertion site after a bicycle motocross racing accident. He required a PCL reconstruction after failed conservative treatment and an unsuccessful attempt at primary repair. This successful physeal sparing reconstruction was accomplished using a modified method of femoral tunnel placement in combination with the tibial inlay technique. Results: A magnetic resonance imaging was acquired 2 years postoperatively when physical examination demonstrated both legs of equal length, no varus or valgus deformity, and a normal posterior drawer examination. Four years after the reconstruction, he continues to bicycle motocross race while experiencing no further symptoms and complete restoration to his prior quality of life. Conclusions: The use of the tibial inlay technique together with the modified femoral tunnel location prevented transphyseal drilling while attaining a favorable anatomic placement of the graft while avoiding the ''killer'' turn associated with the transtibial approach. Level of Evidence: Level IV (Therapeutic Study).
We attempted to determine the potential cost savings of prearthroscopic knee MR imaging examinati... more We attempted to determine the potential cost savings of prearthroscopic knee MR imaging examinations. SUBJECTS AND METHODS. This prospective study involved 50 consecutive patients. The patients met the surgical-indications-for-monitoring-appropriateness criteria for knee arthroscopy and underwent MR imaging of the knee before arthroscopy. For all patients, we compared MR imaging and arthroscopic findings. On the basis of a cost of $1000 for each MR imaging examination and $4000 for each diagnostic arthroscopy, we decided that costeffective MR imaging would require 25% true negativity. RESULTS.
In the young athlete, anterior shoulder dislocations are common injuries that usually result in r... more In the young athlete, anterior shoulder dislocations are common injuries that usually result in recurrent instability, and often require surgical treatment. Nonoperative treatment remains the initial recommended course for most conditions. Operative treatment has advanced to more anatomical repairs, both open and arthroscopic. The purpose of this paper is to review the evaluation and treatment of anterior shoulder instability, to include acute dislocations, acute subluxations and recurrent instability.
Journal of Bone and Joint Surgery, American Volume, Apr 1, 2004
Although both corticosteroid and hyaluronic acid injections are widely used to palliate the sympt... more Although both corticosteroid and hyaluronic acid injections are widely used to palliate the symptoms of knee osteoarthritis, little research involving a comparison of the two interventions has been done. We tested the hypothesis that there are no significant differences between Hylan G-F 20 (Synvisc) and the corticosteroid betamethasone sodium phosphate-betamethasone acetate (Celestone Soluspan) in terms of pain relief or improvement in function, as determined by validated scoring instruments. One hundred patients with knee osteoarthritis were randomized to receive intra-articular injection of either Hylan G-F 20 or the corticosteroid, and they were followed for six months. The patients treated with Hylan G-F 20 received one course of three weekly injections. The patients treated with the corticosteroid received one injection at the time of enrollment in the study, and they could request one more injection any time during the study. An independent, blinded evaluator assessed the patients with the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), a modification of the Knee Society rating system, and the visual analog pain scale. Both the group treated with the corticosteroid and the group treated with Hylan G-F 20 demonstrated improvements from baseline WOMAC scores (a median decrease from 55 to 40 points and from 54 to 44 points, respectively; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01 for both). The scores according to the Knee Society system did not significantly improve for the patients who received the corticosteroid (median, 58 to 70 points; p = 0.06) or for those who received Hylan G-F 20 (median, 58 to 68 points; p = 0.15). The scores on the visual analog scale improved for patients receiving Hylan G-F 20 (median, 70 to 52 mm; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01) but not for the patients who received the corticosteroid (median, 64 to 52 mm; p = 0.28). However, no significant differences between the two treatment groups were found with respect to the WOMAC, Knee Society system, or visual analog scale results. Women demonstrated a significant improvement in only one of the six possible outcome-treatment combinations (the WOMAC scale), whereas men demonstrated significant improvements in five of the six outcomes (all measures except the Knee Society rating system). No differences were detected between patients treated with intra-articular injections of Hylan G-F 20 and those treated with the corticosteroid with respect to pain relief or function at six months of follow-up. Women demonstrated significantly less response to treatment than men did for both treatments on all three outcome scales. Such significant gender-related differences warrant further investigation.
An unusual case of a close-range, low-velocity gunshot wound to the knee is presented. Arthroscop... more An unusual case of a close-range, low-velocity gunshot wound to the knee is presented. Arthroscopic debridement was accomplished using standard anterior portals as well as the existing entry and exit wounds. All bullet fragments were successfully removed from the joint by arthroscopy and tractoscopy. A minimally displaced marginal, lateral tibial plateau fracture was observed and treated with restricted weight bearing and active motion. The patient recovered uneventfully and maintained full knee range of motion and a normal gait.
We conducted a study to characterize compression forces and pullout strengths of 4 commercially a... more We conducted a study to characterize compression forces and pullout strengths of 4 commercially available bioabsorbable nails and screws in a synthetic bone model. A piezoelectric sensor was used to measure peak compression forces, and a material testing machine was used to measure maximum pullout strengths. The strongest compression force was found for SmartScrew (12.7 N), then SmartNail (12.3 N), LactoNail (8.5 N), and ReUnite Screw (5.1 N). Mean compression force was significantly (P<.05) different between LactoNail and SmartScrew, ReUnite Screw and SmartNail, and ReUnite Screw and SmartScrew. The most pullout strength was found for SmartScrew (530 N), then ReUnite Screw (414 N), SmartNail (336 N), and LactoNail (189 N). These values were all statistically significantly (P<.05) different from each other. In this model, SmartScrew had the overall strongest compression force and most pullout strength.
A retrospective analysis was conducted on injury statistics compiled over 12 seasons, from 1982 t... more A retrospective analysis was conducted on injury statistics compiled over 12 seasons, from 1982 to 1993 (2.55 million skier-days), at a Wyoming ski resort. The population at risk was determined by ticket sales per year. A total of 9749 skiing injuries was indexed by anatomic region and severity according to diagnosis on initial evaluation. Injury rates were then analyzed as a function of time. The injury rate remained constant at 3.7 injuries per 1000 skier-days during the 12 seasons. The rate of lower extremity to upper extremity injury decreased from 4:1 to 2:1 during the study period (P < 0.03). The ankle injury rate also decreased with time (P < 0.04). Ulnar collateral ligament sprains make up 7% of all injuries. Knee sprains in general account for 30% of all injuries. The incidence of anterior cruciate ligament tears increased as a function of time (P < 0.04) and accounted for 16% of all skiing injuries during the study period. The medial collateral ligament sprain was the most common injury, making up 18% of skiing injuries. Forty-seven snowboard injuries from the 1992 to 1993 season are also presented. Our injury statistics mirror those currently reported in North America, except our data reflect a higher incidence of knee sprains.
Journal of Bone and Joint Surgery, American Volume, Apr 1, 2004
Background: Although both corticosteroid and hyaluronic acid injections are widely used to pallia... more Background: Although both corticosteroid and hyaluronic acid injections are widely used to palliate the symptoms of knee osteoarthritis, little research involving a comparison of the two interventions has been done. We tested the hypothesis that there are no significant differences between Hylan G-F 20 (Synvisc) and the corticosteroid betamethasone sodium phosphate-betamethasone acetate (Celestone Soluspan) in terms of pain relief or improvement in function, as determined by validated scoring instruments. Methods: One hundred patients with knee osteoarthritis were randomized to receive intra-articular injection of either Hylan G-F 20 or the corticosteroid, and they were followed for six months. The patients treated with Hylan G-F 20 received one course of three weekly injections. The patients treated with the corticosteroid received one injection at the time of enrollment in the study, and they could request one more injection any time during the study. An independent, blinded evaluator assessed the patients with the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), a modification of the Knee Society rating system, and the visual analog pain scale. Results: Both the group treated with the corticosteroid and the group treated with Hylan G-F 20 demonstrated improvements from baseline WOMAC scores (a median decrease from 55 to 40 points and from 54 to 44 points, respectively; p < 0.01 for both). The scores according to the Knee Society system did not significantly improve for the patients who received the corticosteroid (median, 58 to 70 points; p = 0.06) or for those who received Hylan G-F 20 (median, 58 to 68 points; p = 0.15). The scores on the visual analog scale improved for patients receiving Hylan G-F 20 (median, 70 to 52 mm; p < 0.01) but not for the patients who received the corticosteroid (median, 64 to 52 mm; p = 0.28). However, no significant differences between the two treatment groups were found with respect to the WOMAC, Knee Society system, or visual analog scale results. Women demonstrated a significant improvement in only one of the six possible outcome-treatment combinations (the WOMAC scale), whereas men demonstrated significant improvements in five of the six outcomes (all measures except the Knee Society rating system). Conclusions: No differences were detected between patients treated with intra-articular injections of Hylan G-F 20 and those treated with the corticosteroid with respect to pain relief or function at six months of follow-up. Women demonstrated significantly less response to treatment than men did for both treatments on all three outcome scales. Such significant gender-related differences warrant further investigation. Level of Evidence: Therapeutic study, Level I-1b (randomized controlled trial [no significant difference but narrow confidence intervals]). See Instructions to Authors for a complete description of levels of evidence.
The Journal of Bone and Joint Surgery-American Volume, 2003
To The Editor: We read with great interest "Increased Frequency of Acute Local Reaction to I... more To The Editor: We read with great interest "Increased Frequency of Acute Local Reaction to Intra-Articular Hylan GF-20 (Synvisc) in Patients Receiving More Than One Course of Treatment" (2002; 84:1619-23), by Leopold et al. The authors compared the frequency of adverse events in a group of osteoarthritis patients who had received multiple courses of Synvisc with that in another group who had received a single course. Although an important issue was examined by the authors with regard to the treatment of osteoarthritis with Synvisc, we believe that weaknesses in the study design (some of which are mentioned in the paper) raise questions regarding the validity of their conclusions. Data on the baseline characteristics and the local adverse events in the group of nineteen patients who had received more than one course of Synvisc were collected retrospectively by means of a chart review. In contrast, data on the forty-two patients who had received only one course were obtained prospectively within the structure of a separate clinical trial. This clinical trial involved more than one treatment group; however, only the patients treated with Synvisc were included in the analysis discussed in the paper. Although the same investigators administered Synvisc to the patients in the prospective cohort, it is unclear if other physicians injected Synvisc and/or evaluated the patients in the retrospective cohort. Even if the same physicians were involved in the administration of Synvisc and the …
Six goats had 2 Schanz pins inserted in each tibia. Twenty-four pins were inoculated with saline ... more Six goats had 2 Schanz pins inserted in each tibia. Twenty-four pins were inoculated with saline or Staphylococcus aureus. Three investigators, blinded to the inoculum, evaluated 23 pins at 14 days. Clinical pin tract infections developed in all inoculated pins and in 5/12 uninoculated pins, Quantitative cultures demonstrated that infections were produced in 10/11 inoculated and in 0/12 uninoculated pins. Prediction of culture status by clinical criterion (P<.01, Fisher Exact Test) had 100% sensitivity and a 58% specificity. The prediction of infection in inoculated sites by culture criterion (P<.001, Fisher Exact Test) had a 91% sensitivity and 100% specificity. A reproducible long bone pin tract infection model was developed that produced clinically and microbiologically evident pin tract infections.
An outbreak of dermatitis occurred among county jail inmates who removed dead fish from the Sacra... more An outbreak of dermatitis occurred among county jail inmates who removed dead fish from the Sacramento River in California after a spill of metam sodium. The spilled chemical decomposes to methylisothiocyanate (MITC), a known skin irritant. A retrospective cohort study was conducted among the inmates and their crew leaders. Among 42 jail group members, 27 had dermatitis involving the feet and ankles; dermatitis was associated with lower extremity water 'contact (RR = 3.4,95% CI 1.0-I 1.8); the attack rate increased with length of time spent in the water. For comparison, other state and federal employees who worked in the river at the same time were also interviewed. None reported dermatitis. Over three-quarters (24/31) of these other clean-up workers whose feet became wet changed to dry clothing immediately; none of the jail group changed immediately. The river concentration of MITC measured 20-40 ppb at the time of exposure. We speculate that prolonged wetness, occlusive boots, friction, and heat contributed to chemical irritation at this low concentration; the experience of the other cleanup workers suggests that this outbreak could have been prevented.
An 18-year-old male presented to his family physician approximately 45 minutes after sustaining a... more An 18-year-old male presented to his family physician approximately 45 minutes after sustaining an injury to his right shoulder. He was tackled by another player while playing football. He noted a "pop" at his right sternoclavicular joint (SCJ), and resultant difficulty moving the right arm secondary to pain and a reproducible popping sensation of the clavicle. He denied numbness or tingling, shortness of breath, neck pain, jaw pain, or facial swelling, but noted mild difficulty swallowing. The patient's past medical history was unremarkable. On physical examination, there was asymmetric swelling at the right SCJ. His skin was intact. Range of motion and strength was limited by pain. Tenderness to palpation was present at the right SCJ, and shoulder motion produced a palpable clavicular "clunk." The neurovascular exam of the right upper extremity was unremarkable. Radiographs revealed an asymmetry of the SC joints (Fig. 1). The patient's arm was placed in a sling, and an emergent CT scan was then obtained (Figs. 2 and 3).
Background: Tears of the posterior cruciate ligament (PCL) in pediatric patients, especially avul... more Background: Tears of the posterior cruciate ligament (PCL) in pediatric patients, especially avulsions from its tibial insertion, are not frequently encountered by physicians. However, with an increasing incidence of ligamentous injuries to the knee in skeletally immature patients, orthopaedic surgeons will more frequently need to decide how best to manage a PCL injury in children with open physes. Methods: A 10-year-old boy sustained an avulsion of the PCL from its tibial insertion site after a bicycle motocross racing accident. He required a PCL reconstruction after failed conservative treatment and an unsuccessful attempt at primary repair. This successful physeal sparing reconstruction was accomplished using a modified method of femoral tunnel placement in combination with the tibial inlay technique. Results: A magnetic resonance imaging was acquired 2 years postoperatively when physical examination demonstrated both legs of equal length, no varus or valgus deformity, and a normal posterior drawer examination. Four years after the reconstruction, he continues to bicycle motocross race while experiencing no further symptoms and complete restoration to his prior quality of life. Conclusions: The use of the tibial inlay technique together with the modified femoral tunnel location prevented transphyseal drilling while attaining a favorable anatomic placement of the graft while avoiding the ''killer'' turn associated with the transtibial approach. Level of Evidence: Level IV (Therapeutic Study).
We attempted to determine the potential cost savings of prearthroscopic knee MR imaging examinati... more We attempted to determine the potential cost savings of prearthroscopic knee MR imaging examinations. SUBJECTS AND METHODS. This prospective study involved 50 consecutive patients. The patients met the surgical-indications-for-monitoring-appropriateness criteria for knee arthroscopy and underwent MR imaging of the knee before arthroscopy. For all patients, we compared MR imaging and arthroscopic findings. On the basis of a cost of $1000 for each MR imaging examination and $4000 for each diagnostic arthroscopy, we decided that costeffective MR imaging would require 25% true negativity. RESULTS.
In the young athlete, anterior shoulder dislocations are common injuries that usually result in r... more In the young athlete, anterior shoulder dislocations are common injuries that usually result in recurrent instability, and often require surgical treatment. Nonoperative treatment remains the initial recommended course for most conditions. Operative treatment has advanced to more anatomical repairs, both open and arthroscopic. The purpose of this paper is to review the evaluation and treatment of anterior shoulder instability, to include acute dislocations, acute subluxations and recurrent instability.
Journal of Bone and Joint Surgery, American Volume, Apr 1, 2004
Although both corticosteroid and hyaluronic acid injections are widely used to palliate the sympt... more Although both corticosteroid and hyaluronic acid injections are widely used to palliate the symptoms of knee osteoarthritis, little research involving a comparison of the two interventions has been done. We tested the hypothesis that there are no significant differences between Hylan G-F 20 (Synvisc) and the corticosteroid betamethasone sodium phosphate-betamethasone acetate (Celestone Soluspan) in terms of pain relief or improvement in function, as determined by validated scoring instruments. One hundred patients with knee osteoarthritis were randomized to receive intra-articular injection of either Hylan G-F 20 or the corticosteroid, and they were followed for six months. The patients treated with Hylan G-F 20 received one course of three weekly injections. The patients treated with the corticosteroid received one injection at the time of enrollment in the study, and they could request one more injection any time during the study. An independent, blinded evaluator assessed the patients with the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), a modification of the Knee Society rating system, and the visual analog pain scale. Both the group treated with the corticosteroid and the group treated with Hylan G-F 20 demonstrated improvements from baseline WOMAC scores (a median decrease from 55 to 40 points and from 54 to 44 points, respectively; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01 for both). The scores according to the Knee Society system did not significantly improve for the patients who received the corticosteroid (median, 58 to 70 points; p = 0.06) or for those who received Hylan G-F 20 (median, 58 to 68 points; p = 0.15). The scores on the visual analog scale improved for patients receiving Hylan G-F 20 (median, 70 to 52 mm; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01) but not for the patients who received the corticosteroid (median, 64 to 52 mm; p = 0.28). However, no significant differences between the two treatment groups were found with respect to the WOMAC, Knee Society system, or visual analog scale results. Women demonstrated a significant improvement in only one of the six possible outcome-treatment combinations (the WOMAC scale), whereas men demonstrated significant improvements in five of the six outcomes (all measures except the Knee Society rating system). No differences were detected between patients treated with intra-articular injections of Hylan G-F 20 and those treated with the corticosteroid with respect to pain relief or function at six months of follow-up. Women demonstrated significantly less response to treatment than men did for both treatments on all three outcome scales. Such significant gender-related differences warrant further investigation.
An unusual case of a close-range, low-velocity gunshot wound to the knee is presented. Arthroscop... more An unusual case of a close-range, low-velocity gunshot wound to the knee is presented. Arthroscopic debridement was accomplished using standard anterior portals as well as the existing entry and exit wounds. All bullet fragments were successfully removed from the joint by arthroscopy and tractoscopy. A minimally displaced marginal, lateral tibial plateau fracture was observed and treated with restricted weight bearing and active motion. The patient recovered uneventfully and maintained full knee range of motion and a normal gait.
We conducted a study to characterize compression forces and pullout strengths of 4 commercially a... more We conducted a study to characterize compression forces and pullout strengths of 4 commercially available bioabsorbable nails and screws in a synthetic bone model. A piezoelectric sensor was used to measure peak compression forces, and a material testing machine was used to measure maximum pullout strengths. The strongest compression force was found for SmartScrew (12.7 N), then SmartNail (12.3 N), LactoNail (8.5 N), and ReUnite Screw (5.1 N). Mean compression force was significantly (P<.05) different between LactoNail and SmartScrew, ReUnite Screw and SmartNail, and ReUnite Screw and SmartScrew. The most pullout strength was found for SmartScrew (530 N), then ReUnite Screw (414 N), SmartNail (336 N), and LactoNail (189 N). These values were all statistically significantly (P<.05) different from each other. In this model, SmartScrew had the overall strongest compression force and most pullout strength.
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Papers by Winston Warme